Goodpasture's disease presenting with acute renal failure

A 15-year-old boy was admitted for vomiting, diarrhea, fatigue, crampy abdominal pain and oliguria. A renal failure was diagnosed (creatinine 2523 μmol/, urea 53,1 mmol/l) with severe aregenerative anemia (80 g/l), metabolic acidosis, hyperkalemia, elevated inflammatory markers and normal platelet count. A nephrotic proteinuria was noticed (350 g/mol). Patient's creatinine was normal 4 months before. The diagnosis of rapidly progressive glomerulonephritis was suspected. C3 and C4 were normal, ANA and ANCA were negative; anti-glomerular basement membrane antibody (anti-GBM) was positive (1/320) which lead to the diagnosis of Goodpasture's disease. Chest X-ray showed bilateral hilar infiltration and CT-scan revealed multiple alveolar haemorrhages, confirmed by broncho-alveolar lavage. Renal ultrasound showed swollen and hyperechogenous kidneys with loss of corticomedullary differentiation. Renal biopsy revealed a global extracapillary necrotising glomerulonephritis, with IgG lining the membrane at immunofluorescence. The patient was treated with continuous venovenous hemodia- filtration, plasmapheresis and immunosuppressive therapy (cyclophosphamid and corticoids) which lead to normalisation of anti-GBM level and favourable respiratory evolution with no sequelae. The renal evolution was unfavourable and the patient developed end stage renal disease and was treated with haemodialysis. Goodpasture's disease is an autoimmune process in which anti-GBM are produced against collagen IV present in the kidneys and pulmonary alveolae, resulting in acute or rapidly progressive glomerulonephritis and altering the pulmonary alveolae. It is a rare disease concerning mostly infants and young adults. Clinical presentation consists in an acute renal failure with proteinuria. Pulmonary symptoms (60-70% of the total cases) are dyspnea, cough, and haemoptysis. Diagnosis is made with the dosage of immunological anti-GBM and with renal biopsy. Factors of poor prognosis are initial oliguria, alteration of >50% of the glomerulus, very high creatinine or need of dialysis. Anti-GBM dosage is used for follow up. Patients are treated with immunosuppressive therapy for 6 to 9 months and plasmapheresis. Few recurrences are seen. Goodpasture's disease should be evoqued whenever a young patient is seen with glomerulonephritis, especially if pulmonary abnormalities are present. The disease requires an aggressive treatment in order to prevent respiratory and kidney failure.

Estoque de C e Abundância Natural de 13C em Razão da Conversão de Áreas de Floresta e Pastagem em Bioma Mata Atlântica

RESUMO Conversões da cobertura vegetal decorrentes do manejo podem alterar o estoque de carbono e a abundância natural de 13C. Objetivou-se avaliar o estoque de C e a abundância natural de 13C em áreas de sucessão de floresta (F) e pastagem (P), com diferentes tempos de uso, na Floresta Atlântica no Estado de Santa Catarina. Sete sucessões de uso entre F e P foram definidas por fotografias aéreas tomadas em 1957, 1978 e 2008, entrevistas com moradores e escolha de áreas com florestas em estádio médio de regeneração. As sucessões foram identificadas como FFP, FPF, FFP, FPP, PFF, PPF, PPP, em que a primeira letra se refere ao uso observado em 1957; a segunda, em 1978; e a terceira, em 2008. Foram coletadas amostras de solo nas camadas de 0,00-0,10; 0,10-0,20; 0,20-0,30; 0,30-0,40; 0,40-0,50; 0,50-0,60; 0,60-0,80 e 0,80-1,00 m. Quantificaram-se os teores de carbono orgânico total (COT), abundância de C (δ13C), densidade do solo (Ds) e estoque de carbono (ECOT). A conversão de F em P proporcionou aumento da Ds e reduções nos teores de COT e no ECOT do solo. O maior valor de ECOT ocorreu nas áreas atualmente ocupadas por florestas, mesmo tendo sido utilizadas como pasto anteriormente. Áreas de floresta secundária tenderam, em relação aos teores de COT, a um novo equilíbrio, dado que foram verificados teores de COT superiores aos quantificados em áreas de floresta primária. As áreas de floresta e pastagem, com diferentes idades de uso e nas diferentes profundidades de solo avaliadas, evidenciaram respostas na δ13C, resultando em diferentes assinaturas isotópicas, confirmando a mudança de uso de plantas C3 para C4. Em pastagens com 50 anos de uso, na camada de 0,00-0,10 m, 66 % do COT do solo ainda é derivado da floresta original. A análise de componentes principais (ACP) indicou que o COT foi o atributo que melhor discriminou as alterações em razão do uso da terra, nas diferentes camadas de solo.

DECOMPOSIÇÃO DE LODO DE ESGOTO E COMPOSTO DE LODO DE ESGOTO EM NITOSSOLO HÁPLICO

RESUMO O uso agrícola de lodo de esgoto e derivados no Estado de São Paulo é regulamentado por norma federal e por norma paulista, que recomendam que esses materiais quando incorporados a solos agrícolas devem apresentar no mínimo 30 % de degradação do carbono total. Para observar as frações de degradação de um lodo de esgoto e de um composto, produzido a partir do mesmo lodo juntamente com poda de árvore urbana triturada, realizaram-se dois ensaios de biodegradação de C. As doses dos resíduos foram adicionadas em frascos contendo 500 g de solo coletado na profundidade de 0,00-0,20 m de um Nitossolo Háplico Álico textura argilosa. No ensaio I, as doses de lodo (L) e composto (C) utilizadas consideraram percentuais da necessidade em N para a cultura da cana-de-açúcar, e expressas em Mg ha-1 de resíduo (base úmida): L1 21,2 (100 %); L2 42,4 (200 %); C1 69,4 (50 %); C2 138,9 (100 %); e C3 277,8 (200 %). O ensaio II foi realizado apenas com o lodo de esgoto, utilizando-se doses 5, 10, 15 e 20 vezes maiores que aquelas recomendadas no ensaio I: L3 120; L4 240; L5 360; e L6 480, simulando sucessivas aplicações do resíduo no solo. O C-CO2liberado foi quantificado por meio da medida de condutividade elétrica. O lodo de esgoto no ensaio I apresentou menores frações de degradação quando comparado ao composto orgânico, mas a taxa de decomposição do composto foi menor, provavelmente pela presença de substâncias recalcitrantes resultantes do processo de humificação. A fração de degradação dos resíduos no solo atingiu valor próximo a 30 % apenas para a dose de lodo de esgoto 20 vezes superior à dose exigida pela cultura, e assim não poderiam ser utilizados em solos agrícolas argilosos. Observou-se a necessidade de revisão desse valor adotado pela legislação paulista de uso de resíduos orgânicos em solos.

Chemical composition of the small coastal lagoons of the Mediterranean Spanish littoral

About sixty small water bodies (coastal lagoons, marshes, salt pans, channels, springs, etc.) of the Spanish Mediterranean coast were sampled seasonally for one year (1979-1980), in order to study different aspects of their chemical composition. The concentrations of major ions (alkalinity, Cl-, Ca2+, Mg2+, Na+, and K+), nutrients (N.NO-3, N.NO2-, TRP and Si), oxygen and pH were determined for this purpose. The salt concentrations measured range between 0.4 and 361.3 g l-1. The samples have been divided into four classes of salinity (in g l-1): Cl, S < 5; C2, 5 40. Within these classes, the pattern of ionic dominance recorded is remarkably constant and similar to that found in most coastal lagoons (Cl- > So42- > Alk., for the anions, and Na+ > Mg2+ > Ca2+ > K+, for the cations), although other models occur especially in the first class. The dominance of Na+ and Cl-, as well as the molar ratios Mg2+/Ca2+ and Cl- / SO42- ,clearly increase from class Cl to class C4. The hyperhaline waters include different subtypes of the major brine type"c",, of EUGSTER & HARDIE (1978), the Na+ - (Mg2+) - Cl- - (SO42-) being the most frequent. Nutrient concentrations fall within a wide range (N.NO3 from 0.1 to 1100 mg-at 1-1; PRT from 0.01 to 23.56 mg-at l-1 and Si from 1.0 to 502.0 mg-at l-1). The oxygen values are very variable too, ranging between 0 and 14.4 ml l-1. Four different patterns of nutrient distribution have been distinguished based on the mean concentrations of N.NO3-, and TRP (mean values in mg-at l-1): A, N.NO3- < 10, TRP > l ; B, N.NO3- > 100, TRP < 1; C, 10 < N.NO3- < 100, TRP < 1; C, D, N.NO3- < 10, TRP < 1. As a rule, lagoons of low salinity (C1 and C2 classes) display the nutrient pattern C, and lagoons of high salinity (C3 and C4) show the nutrient pattern D. Model A only appears in waters of very low salinity, whereas model B does not seem to be related to salinity.

Computed tomography of the cervical spine: comparison of image quality between a standard-dose and a low-dose protocol using filtered back-projection and iterative reconstruction.

OBJECTIVE: To compare image quality of a standard-dose (SD) and a low-dose (LD) cervical spine CT protocol using filtered back-projection (FBP) and iterative reconstruction (IR). MATERIALS AND METHODS: Forty patients investigated by cervical spine CT were prospectively randomised into two groups: SD (120 kVp, 275 mAs) and LD (120 kVp, 150 mAs), both applying automatic tube current modulation. Data were reconstructed using both FBP and sinogram-affirmed IR. Image noise, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were measured. Two radiologists independently and blindly assessed the following anatomical structures at C3-C4 and C6-C7 levels, using a four-point scale: intervertebral disc, content of neural foramina and dural sac, ligaments, soft tissues and vertebrae. They subsequently rated overall image quality using a ten-point scale. RESULTS: For both protocols and at each disc level, IR significantly decreased image noise and increased SNR and CNR, compared with FBP. SNR and CNR were statistically equivalent in LD-IR and SD-FBP protocols. Regardless of the dose and disc level, the qualitative scores with IR compared with FBP, and with LD-IR compared with SD-FBP, were significantly higher or not statistically different for intervertebral discs, neural foramina and ligaments, while significantly lower or not statistically different for soft tissues and vertebrae. The overall image quality scores were significantly higher with IR compared with FBP, and with LD-IR compared with SD-FBP. CONCLUSION: LD-IR cervical spine CT provides better image quality for intervertebral discs, neural foramina and ligaments, and worse image quality for soft tissues and vertebrae, compared with SD-FBP, while reducing radiation dose by approximately 40 %.

Padrões de distribuição espacial de comunidades campestres sob plantio de eucalipto

O trabalho objetivou descrever padrões de distribuição espacial da composição florística e de tipos funcionais (C3, C4) de espécies, relacionar estes padrões a condições de luz e gerar hipóteses sobre a dinâmica da vegetação campestre em resposta ao desenvolvimento de uma floresta de eucalipto plantada há dois anos. O levantamento foi realizado em 66 parcelas de 0,25 m² nas entrelinhas do plantio de eucalipto, em quatro transecções atravessando a bordadura da floresta. Foram encontradas 164 espécies, as quais tiveram sua abundância-cobertura estimada em cada parcela e foram classificadas quanto à rota fotossintética. Em uma das transecções foi avaliado o nível de radiação solar incidente nas parcelas, tendo sido encontrada associação significativa entre padrão de sombreamento e composição de espécies (P = 0,001) e composição de tipos funcionais (P = 0,007). Os resultados permitem postular a hipótese de que a diminuição da radiação incidente no estrato inferior, durante o desenvolvimento inicial do eucalipto, determina redução da cobertura com espécies C4 e aumento com espécies C3, mais tolerantes ao sombreamento.

HIV rebounds from latently infected cells, rather than from continuing low-level replication.

Rapid rebound of plasma viremia in patients after interruption of long-term combination antiretroviral therapy (cART) suggests persistence of low-level replicating cells or rapid reactivation of latently infected cells. To further characterize rebounding virus, we performed extensive longitudinal clonal evolutionary studies of HIV env C2-V3-C3 regions and exploited the temporal relationships of rebounding plasma viruses with regard to pretreatment sequences in 20 chronically HIV-1-infected patients having undergone multiple 2-week structured treatment interruptions (STI). Rebounding virus during the short STI was homogeneous, suggesting mono- or oligoclonal origin during reactivation. No evidence for a temporal structure of rebounding virus in regard to pretreatment sequences was found. Furthermore, expansion of distinct lineages at different STI cycles emerged. Together, these findings imply stochastic reactivation of different clones from long-lived latently infected cells rather than expansion of viral populations replicating at low levels. After treatment was stopped, diversity increased steadily, but pretreatment diversity was, on average, achieved only >2.5 years after the start of STI when marked divergence from preexisting quasispecies also emerged. In summary, our results argue against persistence of ongoing low-level replication in patients on suppressive cART. Furthermore, a prolonged delay in restoration of pretreatment viral diversity after treatment interruption demonstrates a surprisingly sustained evolutionary bottleneck induced by punctuated antiretroviral therapy.

Selective resonance suppression 1H-[13C] NMR spectroscopy with asymmetric adiabatic RF pulses.

Despite obvious improvements in spectral resolution at high magnetic field, the detection of 13C labeling by 1H-[13C] NMR spectroscopy remains hampered by spectral overlap, such as in the spectral region of 1H resonances bound to C3 of glutamate (Glu) and glutamine (Gln), and C6 of N-acetylaspartate (NAA). The aim of this study was to develop, implement, and apply a novel 1H-[13C] NMR spectroscopic editing scheme, dubbed "selective Resonance suppression by Adiabatic Carbon Editing and Decoupling single-voxel STimulated Echo Acquisition Mode" (RACED-STEAM). The sequence is based on the application of two asymmetric narrow-transition-band adiabatic RF inversion pulses at the resonance frequency of the 13C coupled to the protons that need to be suppressed during the mixing time (TM) period, alternating the inversion band downfield and upfield from the 13C resonance on odd and even scans, respectively, thus suppressing the detection of 1H resonances bound to 13C within the transition band of the inversion pulse. The results demonstrate the efficient suppression of 1H resonances bound to C3 of Glu and Gln, and C4 of Glu, which allows the 1H resonances bound to C6 of NAA and C4 of Gln to be revealed. The measured time course of the resolved labeling into NAA C6 with the new scheme was consistent with the slow turnover of NAA.

Evolutionary insights on C4 photosynthetic subtypes in grasses from genomics and phylogenetics

In plants, an oligogene family encodes NADP-malic enzymes (NADP-me), which are responsible for various functions and exhibit different kinetics and expression patterns. In particular, a chloroplast isoform of NADP-me plays a key role in one of the three biochemical subtypes of C4 photosynthesis, an adaptation to warm environments that evolved several times independently during angiosperm diversification. By combining genomic and phylogenetic approaches, this study aimed at identifying the molecular mechanisms linked to the recurrent evolutions of C4-specific NADP-me in grasses (Poaceae). Genes encoding NADP-me (nadpme) were retrieved from genomes of model grasses and isolated from a large sample of C3 and C4 grasses. Genomic and phylogenetic analyses showed that 1) the grass nadpme gene family is composed of four main lineages, one of which is expressed in plastids (nadpme-IV), 2) C4-specific NADP-me evolved at least five times independently from nadpme-IV, and 3) some codons driven by positive selection underwent parallel changes during the multiple C4 origins. The C4 NADP-me being expressed in chloroplasts probably constrained its recurrent evolutions from the only plastid nadpme lineage and this common starting point limited the number of evolutionary paths toward a C4 optimized enzyme, resulting in genetic convergence. In light of the history of nadpme genes, an evolutionary scenario of the C4 phenotype using NADP-me is discussed.

Direct evidence for the existence of dairying farms in prehistoric Central Europe (4th millennium BC)

The molecular and isotopic chemistry of organic residues from archaeological potsherds was used to obtain further insight into the dietary trends and economies at the Constance lake-shore Neolithic settlements. The archaeological organic residues from the Early Late Neolithic (3922-3902 BC) site Hornstaad-Hornle IA/Germany are, at present, the oldest archaeological samples analysed at the Institute of Mineralogy and Geochemistry of the University of Lausanne. The approach includes 13C/12C and 15N/14N ratios of the bulk organic residues, fatty acids distribution and 13C/12C ratios of individual fatty acids. The results are compared with those obtained from the over 500 years younger Neolithic (3384-3370 BC) settlement of Arbon Bleiche 3/Switzerland and with samples of modern vegetable oils and fat of animals that have been fed exclusively on C3 forage grasses. The overall fatty acid composition (C9 to C24 range, maximizing at C14 and C16), the bulk 13C/12C and 15N/14N ratios (delta13C, delta15N) and the 13C/12C ratios of palmitic (C16:0), stearic (C18:0) and oleic acids (C18:1) of the organic residues indicate that most of the studied samples (25 from 47 samples and 5 from 41 in the delta13C18:0 vs. delta13C16:0 and delta13C18:0 vs. delta13C18:1 diagrams, respectively) from Hornstaad-Hornle IA and Arbon Bleiche 3 sherds contain fat residues of pre-industrial ruminant milk, and young suckling calf/lamb adipose. These data provide direct proof of milk and meat (mainly from young suckling calves) consumption and farming practices for a sustainable dairying in Neolithic villages in central Europe around 4000 BC.dagger