Growth Differentiation Factor 15 Is Related to Anemia and Iron Metabolism in Heart Allograft Recipients and Patients With Chronic Heart Failure

Background

Growth differentiation factor (GDF) 15 was recently identified as a hepcidin-suppression factor that is expressed at high levels in patients with ineffective erythropoiesis. Hepcidin is a small defensin-like peptide whose production by hepatocytes is modulated in response to anemia, hypoxia, or inflammation. The aim of this study was to assess GDF15 levels and its correlation with iron parameters in 134 stable heart transplant recipients compared with 157 patients with chronic heart failure (CHF).

Methods

Complete blood count, urea, creatinine, lipids, fasting glucose, and iron status were studied with the use of standard laboratory methods. We assessed GDF15, hepcidin, and soluble transferrin receptor (sTfR) with commercially available assays.

Results

Mean levels of GDF15 and hepcidin were significantly higher in heart allograft recipients compared with patients with chronic heart failure (P < .001). GDF15 was significantly higher in patients with anemia compared with nonanemic counterparts in both groups. In univariate analysis in heart transplant recipients, GDF15 was related to kidney function, age, time after transplantation, hepcidin, sTfR, hemoglobin, transferrin saturation, ejection fraction (EF), and New York Heart Association functional class. GDF15 was not related to serum iron or ferritin in both groups. In multivariate analysis, sTfR, creatinine, and age were found to be predictors of GDF15. In univariate analysis in CHF patients, GDF15 was related to creatinine, erythrocyte count, hemoglobin, hepcidin, and total iron binding capacity and tended to correlate with EF. In multivariate analysis, hepcidin, creatinine, and EF were found to be predictors of GDF15 in CHF.

Conclusions

GDF15, by affecting iron status, might be involved in the pathogenesis of anemia in patients with cardiovascular pathology.     

Cytomegaloviral Infection in Solid Organ Transplant Recipients: Preliminary Report of One Transplant Center Experience

Background

Despite advances in immunosuppressive therapy and post-transplantation care, antiviral prevention, and therapy, cytomegalovirus (CMV) infection remains the most common viral infection after solid organ transplantation (SOT).

Methods

This study included 2,375 patients under the care of our transplant center during the 1-year period from June 2012 to June 2013. There were 351 patients (14.78%) suspected and tested for CMV infection with the use of viral DNA amplification test.

Results

Symptoms that triggered diagnostics were graft dysfunction in 24 (55.8%), diarrhea in 18 (41.9%), fever in 15 (34.9%), leukopenia in 14 (32.6%), abdominal pain in 13 (30.2%), nausea in 7 (16.3%), cough in 6 (14%), and shivers in 2 (4.7%). Positive test results were obtained in 43 patients (12.3% of patients tested and 1.8% of the entire cohort). The group consisted of 17 women (39.5%) and 26 men (60.5%), 26 kidney (60.5%) and 17 liver (39.5%) transplant recipients, aged 49.3 years (SD 14.9). The initial viral load was median 8,093 (range: 4,232–219,180) copies/mL. The mean ganciclovir (GCV) treatment duration was 19.05 (SD 8.1) days. GCV doses ranged from 100 to 1,000 mg/d, mean 370.6 (SD 254.2) mg/d. Clinical resistance to treatment was diagnosed in 5 patients (11.6%). We found a positive correlation of GCV treatment duration with natural logarithm of initial CMV viremia (r = 0.56; P = .0002) and of time in months to CMV infection with mean cyclosporine level (r = −0.74; P = .04) and GCV dose (r = −0.34; P = .03). The duration of GCV therapy was positively influenced by CMV load and tacrolimus administration and negatively by patient's age and male sex.

Conclusions

Appearance of any symptoms occurring after transplantation, even nonspecific, should lead to diagnostics for CMV infection. The duration of treatment depends on the severity of the infection expressed by CMV viremia. Clinical resistance to GCV is not frequent, but it is an important transplantologic problem.     

Isolation and characterization of fifteen microsatellite loci for the giant clam Hippopus hippopus (family Tridacnidae)

Fifteen polymorphic microsatellite markers were developed for Hippopus hippopus in order to assess the effectiveness of population replenishment within marine protected areas in New Caledonia. Number of alleles varied from 2 to 11 per locus, observed and expected heterozygosities ranged from 0.300 to 0.866 and 0.495 to 0.858 respectively. Significant deviations from HWE were detected in two loci. Cross-amplifications were tested in four other species of Tridacnidae.     

Correction of thoracic kyphosis and lumbar lordosis in the treatment of idiopathic scoliosis treatment with Cotrel-Dubousset instrumentation

Background. The treatment of thoracic kyphosis and lumbar lordosis with the C-D method remains controversial. Material and methods. The lateral radiographs of 70 patients with King I, II, III, IV idiopathic scoliosis, treated with C-D instrumentation, were retrospectively analyzed. The average age was 14 +/- 1.8 years. Thoracic kyphosis between T2 and T12 and lumbar lordosis between L1 and L5 were measured. Results. Normalization of thoracic kyphosis occurred in 15 of the 22 hypokyphosis patients. The largest kyphosis correction (average +12 +/- 8 degrees ) was in the preoperative hypokyphosis group. A deep hyperkyphosis (average 64 degrees ) was found preoperatively in patients with postoperative hyperkyphosis. Kyphosis correction in the instrumented region was often reverse to the uninstrumented region correction. Lumbar lordosis remained normal in 29 (63%) and hypolordosis occurred in 14 (31%) of the 45 patients with normal preoperative lordosis. When instrumentation below L1 was performed, a greater decrease in lumbar lordosis was observed. Conclusions. The C-D method enables good kyphosis and lordosis correction in scoliotic patients, but problems may occur in greater deformities. Longer lumbar instrumentation may result in decreased lumbar lordosis.     

Late-Onset Subcutaneous Scalp Calcifications in a Patient with Pseudo-Pseudohypoparathyroidism

Ectopic calcifications and even bone formation have been linked to GNAS gene mutations. A 51-year-old Caucasian female had been diagnosed of pseudo-pseudohypoparathyroidism (PPHP) in 1989. She has always had normal serum parathyroid hormone, calcium, and phosphorus levels. A non-contrast computed tomography of the head was done in 2013 and it showed finely speckled subcutaneous calcifications in the high convexity of the head. Cutaneous exploration did not show any abnormality. We herein report an unusual case of late-onset scalp calcifications in a patient with PPHP.     

Effects of laser irradiation (670-nm InGaP and 830-nm GaAlAs) on burn of second-degree in rats

This study investigated the effects of 670-nm indium gallium phosphide (InGaP) and 830-nm gallium aluminum arsenide (GaAlAs) laser therapy on second-degree burns induced on the back of Wistar rats. Sixty-three male Wistar rats were anesthetized, and second-degree burns were made on their back. The animals were then divided randomly into three groups: control (C), animals treated with 670-nm InGaP laser (LIn), and animals treated with 830-nm GaAlAs laser (LGa). The wound areas were removed after 2, 6, 10, 14, and 18 days of treatment and submitted to structural and morphometric analysis. The following parameters were studied: total number of granulocytes and fibroblasts, number of newly formed blood vessels, and percentage of birefringent collagen fibers in the repair area. Morphometric analysis showed that different lasers 670-nm InGaP and 830-nm GaAlAs reduced the number of granulocytes and an increase of newly formed vessels in radiated lesions. The 670-nm InGaP laser therapy was more effective in increasing the number of fibroblasts. The different treatments modified the expression of VEGF and TGF-β1, when compared with lesions not irradiated. The different types of light sources showed similar effects, improved the healing of second-degree burns and can help for treating this type of injury. Despite the large number of studies with LLTI application in second-degree burns, there is still divergence about the best irradiation parameters to be used. Further studies are needed for developing a protocol effective in treating this type of injury.     

Both the middle and distal sections of the urethra may be regarded as optimal targets for ‘outside-in’ transobturator tape placement

Purpose

To investigate whether the position of the tape under the urethra may influence ‘outside-in’ transobturator sling (TOT) outcome.

Methods

The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment.

Results

Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40–70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results.

Conclusions

The highest failure rate for ‘outside-in’ TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.