Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case–Control Study

Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case–control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09–90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08–10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04–339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63–456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.     

Bile duct exclusion from selective vascular inflow occlusion in rat liver: role of ischemic preconditioning and N-acetylcysteine on hepatic reperfusion injury

AIM: To study the effects of N-acetylcysteine and ischemic preconditioning on the portal triad clamping compared to arterial and portal clamping alone. METHODS: Eighty EPM 1-Wistar rats were randomized into two groups, depending on inclusion (Group 1) or not (Group 2) of the bile duct in the hepatic vascular pedicle occlusion. Each group was divided into four subgroups as follows. IR 1: 20 minutes after celiotomy, the pedicle containing vascular elements and bile duct to the left lateral and median liver lobes was occluded for 40 minutes, followed by 30 minutes of reperfusion. IPC 1: after 10 minutes of ischemia and 10 minutes of reperfusion, the ischemic preconditioning period, the rats were submitted to the same procedure described for IR 1 Group. NAC 1: the rats received N-acetylcysteine (150 mg/kg) 15 minutes before 40 minutes of ischemia and 5 minutes before 30 minutes of reperfusion. SHAM 1: The hepatic pedicle for the lateral and median liver lobes was dissected after 20 minutes, the bile duct alone was clamped for 40 minutes, and released for an additional 30 minutes. In the IR 2, IPC 2, and NAC 2 groups, ischemia was achieved with an exclusive vascular occlusion. SHAM 2: dissection and observation for 90 minutes. The blood was sampled for liver enzyme levels. Statistical analysis was done (P 相似文献   

海风藤的原植物——腺鳞蒟与山药的比较研究

本文对模式产地的山药Piper haneei Maxim, var, hancei Maxim,和腺鳞蒟P. kancei Maxim var. squamiglanduferum Fan var. nov.进行了原植物形态特征和花序轴、花序梗、茎、叶的显微特征以及化学成分的TLC及UV比较。挥发油的GC—MS研究共鉴定出38个成分,其中28个是胡椒属植物中首次报道的成分。结果证明了在福建长期以来被认为是山药的腺鳞蒟与模式产地的山药有较大差别,尤其是腺鳞蒟叶上表面有腺鳞,是迄今为止第1个发现具有腺鳞的胡椒属植物。据此把腺鳞蒟作为新变种从山药中分出。腺鳞药是福建南部海风藤主要来源之一。     

Retinal toxicity of intravitreal triamcinolone acetonide at high doses in the rabbit

In order to study acute retinal toxicity of intravitreal triamcinolone acetonide (TA) at high doses in an animal model, thirty New Zealand albino rabbits were injected with intravitreal TA. The animals were divided in five groups: Group 1 received an intravitreal injection of 0.1 mL balanced salt solution; Group 2, 0.1 mL of the solvent (0.99 mg of benzyl alcohol); Group 3, received 4 mg/0.1 mL TA; Group 4, 20mg/0.1 mL TA; and Group 5, 30 mg/0.1 mL TA. A standard light and dark adapted electroretinogram (ERG) was obtained prior and 28 days after the injection. The animals were sacrificed 28 days after the injection and the eyes were enucleated and examined by electron (EM) and light microscopy (LM) using hematoxylin-eosin, Nissl fluorescent, and immunohistochemistry (glial fibrillary acidic protein). No statistically significant differences in ERG before and 28 days after the injection were found. LM and EM did not show retinal damage in any animal. One eye developed bacterial endophthalmitis 14 days after the injection. Intravitreal TA up to 30 mg does not seem to have acute toxic effects on the function (ERG) or the structure (LM, EM) of the retina of albino rabbits.     

Intravitreal bevacizumab for adult-onset vitelliform dystrophy: a case report

PURPOSE: Adult-onset foveomacular vitelliform dystrophy (AFVD) is often misdiagnosed as occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The authors report the anatomic and functional outcome of intravitreal bevacizumab in a case of AFVD associated with a suspected occult CNV. METHODS: Prospective, interventional, single case report. One female patient with decreased visual acuity (VA) and metamorphopsia secondary to AFVD received one single intravitreal injection of bevacizumab 1.25 mg. RESULTS: The patient reported unchanged VA and decreased metamorphopsia 6 weeks after the injection. Fluorescein angiography (FA) and optical coherence tomography (OCT) showed progressive decrease of subretinal fluid until complete disappearance. VA, OCT, and FA remained unchanged during 10 months follow-up. CONCLUSIONS: Intravitreal bevacizumab showed a morphologic improvement and stable VA in a patient with AFVD. Further case series are required to confirm this observation.     

Diode laser-induced mitosis in the rabbit retinal pigment epithelium.

BACKGROUND AND OBJECTIVE: The induction of retinal pigment epithelium (RPE) proliferation without damaging the inner layers of the retina might be helpful in patients with RPE atrophic changes and degeneration. This study aimed to induce mitosis in the RPE of the rabbit after subthreshold photocoagulation with the diode laser. MATERIALS AND METHODS: Twenty-five male Dutch rabbits received retinal photocoagulation using an 810-nm diode laser with different power settings and exposure times. The eyes were processed for light microscopy, electron transmission microscopy, and immunohistochemistry. RESULTS: Neither morphological alterations nor mitotic activity was found after 5-mJ energies. Retinal layers were not affected and RPE hyperplasia appeared in the treated areas associated with mitotic activity when 10 mJ was used. Mitosis induction and retinal damage appeared with 20, 50, and 100 mJ and were associated with ophthalmoscopic damage. CONCLUSIONS: The use of subthreshold 810-nm diode laser treatment may induce mitosis in the RPE without causing damage to the neighboring layers.     

Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units.

Background Little information exists about the role of anemia in patients with acute coronary syndromes (ACS) admitted to Intensive Cardiac Care Units (ICCU).Th...     

Right atrial pheochromocytoma

Pheochromocytoma is a catecholamine-producing tumor and a rare cause of hypertension. Most cases are intra-adrenal and intrapericardial pheochromocytomas are extremely uncommon. We report the case of a 46-year-old woman with a 1-year history of hypertension, in which a right atrial pheochromocytoma was detected after a hypertensive crisis. 131I-metaiodobenzylguanidine scintigraphy and magnetic resonance imaging established the diagnosis. The tumor was successfully resected using cardiopulmonary bypass and the right atrium was reconstructed using bovine pericardium.     

Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists

OBJECTIVE: To investigate the impact of official recommendations regarding the management of latent tuberculosis (TB) infection on the rate of active TB in patients receiving treatment with tumor necrosis factor (TNF) antagonists. METHODS: Data on active TB rates and on screening and treatment of latent TB infection were extracted from the BIOBADASER (Spanish Society of Rheumatology Database on Biologic Products), a registry of patients with rheumatic conditions treated with TNF antagonists. The rates of active TB among the BIOBADASER patients were compared with those in the background Spanish population, and BIOBADASER patients with rheumatoid arthritis (RA) were compared with a cohort of RA patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) study who were not treated with TNF antagonists and were followed up for 5 years. RESULTS: Active TB developed in 34 patients, of whom 32 started taking TNF antagonists prior to the official recommendations on latent TB infection (pre-OR) and 2 began treatment after the recommendations were issued (post-OR). All cases of TB occurred during treatment with infliximab, and 28 of these patients had RA. Pre-OR, the active TB rate in BIOBADASER patients was 20.9-fold higher than in the background Spanish population, while RA patients in the BIOBADASER had rates 22.6- and 6.2-fold higher than the background and EMECAR populations, respectively. Post-OR, 324 patients with a tuberculin skin test result > or =5 mm and/or chest radiograph findings suggestive of past TB were treated for 9 months with isoniazid (INH). Post-OR, active TB rates among the BIOBADASER patients decreased by 78% (incidence risk ratio [IRR] 0.22, 95% confidence interval [95% CI] 0.03-0.88; P = 0.008), while among RA patients in the BIOBADASER, the rate dropped by 83% and reached the EMECAR rate (IRR 1.0, 95% CI 0.02-8.2). There were no INH treatment-related hospitalizations or deaths. CONCLUSION: Strategies to treat latent TB infection that are tailored to the at-risk population can effectively and safely lessen the likelihood of active TB in patients treated with TNF antagonists.