Panel reactive HLA antibodies,soluble CD30 levels,and acute rejection six months following renal transplant

Domingues EMFL, Matuck T, Graciano ML, Souza E, Rioja S, Falci MC, Monteiro de Carvalho DB, Porto LC. Panel reactive HLA antibodies, soluble CD30 levels, and acute rejection six months following renal transplant.
Clin Transplant 2010: 24: 821–829. © 2009 John Wiley & Sons A/S. Abstract: Background: Specific anti‐human leukocyte antigen antibodies (HLA) in the post‐transplant period may be present with acute rejection episodes (ARE), and high soluble CD30 (sCD30) serum levels may be a risk factor for ARE and graft loss. Methods: HLA cross‐matching, panel reactive antibodies (PRA), and sCD30 levels were determined prior to transplantation in 72 patients. Soluble CD30 levels and PRA were re‐assessed at day 7, 14, 21, and 28, and monthly up to the sixth. Results: Twenty‐four subjects had a positive PRA and 17 experienced ARE. Nine of 17 ARE subjects demonstrated positive PRA and 16 had HLA mismatches. Positive PRA was more frequent in ARE subjects (p = 0.03). Eight subjects with ARE had donor‐specific antibodies (DSA) in serum samples pre‐transplantation, two subjects developed DSA. Three subjects without ARE had positive PRA only in post‐transplantation samples. Soluble CD30 levels were higher in pre‐transplant samples and ARE subjects than non‐ARE subjects (p = 0.03). Post‐transplant sCD30 levels were elevated in subjects who experienced rejection and were significantly higher at seven d (p = 0.0004) and six months (p = 0.03). Conclusions: Higher sCD30 levels following transplant were associated with ARE. Elevated sCD30 levels may represent a risk factor for acute rejection.     

Focal adhesion kinase is a blood–testis barrier regulator

In mammalian testes, such as rats, the mechanism(s) that regulate blood–testis barrier (BTB) restructuring at stages VIII–IX of the seminiferous epithelial cycle of spermatogenesis to facilitate the transit of preleptotene/leptotene spermatocytes is not known. This is due to the lack of information on the regulatory proteins at the BTB. Herein, focal adhesion kinase (FAK), a nonreceptor protein tyrosine kinase, is shown to structurally interact with occludin and ZO-1 to form a functional protein complex at the BTB. Its expression at the BTB in the seminiferous epithelium is stage specific, being lowest at stage VIII–IX tubules, analogous to the expression pattern of occludin. Using primary Sertoli cells cultured in vitro with an established tight junction (TJ) permeability barrier that mimics the BTB in vivo, the knockdown of FAK by RNAi led to a transient disruption of the TJ barrier. This was accompanied by a loss of association between occludin and ZO-1, likely the result of reduced occludin phosphorylation at Tyr and Ser residues, but not Thr, which in turn led to a redistribution of occludin at the Sertoli–Sertoli cell interface, moving from cell membrane into cell cytosol, thereby disrupting the BTB. These findings suggest that a similar mechanism is in place in the testis in vivo to regulate BTB restructuring to facilitate the transit of primary spermatocytes. Furthermore, FAK was shown to be a molecular target of cadmium because its knockdown would desensitize Sertoli cells to cadmium-induced TJ barrier disruption. In summary, FAK is a unique regulator of BTB dynamics in the testis.     

Visual impairment in severe and profound sensorineural deafness

The frequency of reversible and irreversible visual impairment was determined in children with severe and profound sensorineural deafness, as subnormal vision can adversely affect their educational and social development. Eighty three of 87 such children attending an audiology service were examined to assess the incidence and severity of visual impairment. Each child underwent a detailed ophthalmic assessment. The criteria for visual impairment were visual acuity < 6/9 Snellen or equivalent and/or abnormal binocular vision. Forty five had a normal ophthalmic examination (54.2%). Twenty nine had visual impairment (34.9%) and nine had ophthalmological abnormalities that did not interfere with vision (10.9%). A higher proportion of children with risk factors for visual pathology demonstrated visual impairment than those in whom there were no risk factors. None the less, 44% of visual impairment was among patients without risk factors. The results underline the need to examine all children with severe and profound sensorineural deafness soon after diagnosis and indicate that children with multiple handicaps have a greater likelihood of visual impairment (11 of 14 cases).     

Alkaloids,amides and antispasmodic activity of Zanthoxylum hyemale

Two quinoline alkaloids, (-)-R-geilbalansine (1) and hyemaline (2), as well as aromatic amide, N-[2-(3,4-dimethoxyphenyl)-2-methoxyethyl)-2-methoxyethyl]benzamide (O-methylbalsamide) (3), were isolated as new natural products from the stem barks of Zanthoxylum hyemale, together with seven known compounds. Their structures were determined on the basis of spectroscopic data (IR, (1)H- and (13)C-NMR, MS). In addition, the antispasmodic activity of the crude extract of Z. hyemale and three other more abundant isolated compounds (4, 5 and 10) were studied in two different antispasmodic test models on isolated rat ileum and only the crude ethanolic extract presented antispasmodic activity.     

Equity and geographic distribution of financial resources in health systems

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.     

Spinal subdural haematoma mimicking tethered cord after posterior fossa open surgery

We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. Control MRI 48 h after surgery showed a spinal subdural haematoma without clinical signs of paresis or bladder dysfunction. Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that "silent" (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery.     

Primary lumbar epidural Ewing's sarcoma: case report

We report a case of a 15-years old female with an acute paraparesis secondary of an epidural mass and histopathological diagnosis was consistent with an Ewing's sarcoma without bone compromise. An exaustive literature review showed only 17 cases of primary lumbar epidural extraosseus Ewing's sarcoma.     

Eye-hand preference dissociation in obsessive-compulsive disorder and dyslexia

Dyslexia may be a development disturbance in which there are alterations in visual-spatial and visual-motor processing, while obsessive-compulsive disorder (OCD) is a psychiatric disease in which there are alterations in memory, executive function, and visual-spatial processing. Our hypothesis is that these disturbances may be, at least partially, the result of a crossed eye and hand preference. In the present study 16 controls, 20 OCD (DSM-IV criteria) and 13 dyslexic adults (Brazilian Dyslexia Association criteria) were included. All had a neurological examination, the Yale-Brown scale for obsessive-compulsive symptoms application and the Zazzó evaluation for laterality, abridged by Granjon. Results showed a right hand preference for 100% of controls, 84.6% of dyslexics, and 75% of OCD patients and a right eye preference for 73.3% of controls, 69.2% of dyslexics, and 35% of OCD patients. The left eye preference was significantly higher in OCD when compared with the two other groups (p = 0.01) and the left hand preference of OCD patients (25%) was also significant when compared to Brazilian population (4%) or British population (4.5%). It is possible that this crossed preference may be partially the reason for visual-spatial and constructive disturbances observed in OCD.