Monocyte Chemoattractant Protein-1 (MCP-1/CCL2) Levels and Its Association with Renal Allograft Rejection

Background: CCL2 is a chemoattractant for monocytes/macrophages, T cells, and natural killer cells. It is shown to be involved in the immunological responses against renal allograft. This study was conducted to access the role of urinary CCL2 expression in predicting the rejection episodes in renal transplant patients.

Method: A total of 409 urine samples included in this study. The samples were consisted of (a) biopsy-proven graft rejection (n = 165); (b) non-rejection (n = 93); (c) non-biopsy stable-graft (n = 42), and (d) healthy renal donors (n = 109). The samples were quantified for the CCL2 using the MCP-1/CCL2 ELISA kit. The data were analyzed using the Statistical Package for Social Sciences (SPSS^®) and MedCalc^® statistical software.

Results: Results showed that the CCL2 levels were significantly increased in rejection group when compared with the non-rejection, stable-graft, and control, P < 0.05. The receiver operating curve’s characteristics illustrated that the urinary CCL2 level is a good predictor for graft rejection, with an area under the curve of 0.81 ± 0.03 with optimum sensitivity and specificity of 87% and 62%, respectively, at a cut-off value of 198 pg/mL. Kaplan–Meier curve also showed better cumulative rejection-free graft survival time in group with less than 198 pg/mL of CCL2 as compared to those with expression levels of more than 198 pg/mL (30 weeks vs. 3 weeks; log-rank test, P < 0.001).

Conclusion: In our study, noninvasive investigation of CCL2 levels in urine has showed potential to predict rejection episodes. It is suggested that the CCL2, with others markers, may help in early detection and monitoring of graft rejection episodes.     

Controlled degradation of low-fouling poly(oligo(ethylene glycol)methyl ether methacrylate) hydrogels

Degradable low-fouling hydrogels are ideal vehicles for drug and cell delivery. For each application, hydrogel degradation rate must be re-optimized for maximum therapeutic benefit. We developed a method to rapidly and predictably tune degradation rates of low-fouling poly(oligo(ethylene glycol)methyl ether methacrylate) (P(EG)_xMA) hydrogels by modifying two interdependent variables: (1) base-catalysed crosslink degradation kinetics, dependent on crosslinker electronics (electron withdrawing groups (EWGs)); and, (2) polymer hydration, dependent on the molecular weight (M_W) of poly(ethylene glycol) (PEG) pendant groups. By controlling PEG M_W and EWG strength, P(EG)_xMA hydrogels were tuned to degrade over 6 to 52 d. A 6-member P(EG)_xMA copolymer library yielded slow and fast degrading low-fouling hydrogels suitable for short- and long-term delivery applications. The degradation mechanism was also applied to RGD-functionalized poly(carboxybetaine methacrylamide) (PCBMAA) hydrogels to achieve slow (∼50 d) and fast (∼13 d) degrading low-fouling, bioactive hydrogels.

To tune degradation rates of low-fouling hydrogels, a 6-member P(EG)_xMA copolymer library with different electronics and hydration levels was developed.     

Correction: prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children

ABSTRACT: Since the publication of our article [1], we have noticed some errors in the final published version, for which the corresponding author accepts full responsibility. Page references are to the final PDF version. Page 3: Results, second paragraph Lines 1-2: "BMI... 20.7 (5.02) kg/m2..." should read "BMI... 16.0 (3.0) kg/m2..." Lines 6-8: "According to the IOTF cut-offs, overweight and obesity prevalence was 33% (95% CI 31.1-35.3) and 24% (95% CI 22.4-26.2) respectively" should read "According to the IOTF cut-offs, overweight and obesity prevalence was 8.3% (95% CI 7.1-9.6) and 4.7% (95% CI 3.8-5.7) respectively" Page 4: Table 1 The values for mean and standard deviation (SD) for BMI (kg/m2) are revised. Page 4: Table 2 The values for mean BMI (SD) and overweight and obesity prevalence according to the IOTF cut-offs are revised. Page 5: Figure 2 The values for grade- and gender- specific mean BMI are revised. Page 6: Second paragraph Lines 1-8: "Prevalence of overweight by the IOTF cut-offs was twice the prevalence by the WHO 2007 reference (33% versus 17%) and prevalence of obesity by the IOTF cutoffs was three times higher than that calculated by the WHO 2007 reference (24% versus 7.5%). Using IOTF cut-offs for overweight and obesity in Pakistani schoolaged children would result in higher estimates than the WHO 2007 reference." should read "Prevalence of overweight by the IOTF cut-offs was half the prevalence by the WHO 2007 reference (8% versus 17%) and prevalence of obesity by the IOTF cutoffs was two-third of that calculated by the WHO 2007 reference (5% versus 7.5%). Using IOTF cut-offs for overweight and obesity in Pakistani schoolaged children would result in lower estimates than the WHO 2007 reference. A relatively lower overweight and obesity prevalence with use of the IOTF cut-offs as compared to the WHO reference had been reported elsewhere [2-3]." In present study, the estimates for overweight included obese children.     

Technology in Treatment: Are Adolescents and Counselors Interested in Online Relapse Prevention?

Background  

Approximately 75% of adolescents who receive substance abuse treatment relapse within 1 year; therefore, it is important to have effective, easily accessible aftercare resources to support them while they are in recovery.     

Partial life-cycle and acute toxicity of perfluoroalkyl acids to freshwater mussels

Freshwater mussels are among the most sensitive aquatic organisms to many contaminants and have complex life-cycles that include several distinct life stages with unique contaminant exposure pathways. Standard acute (24-96 h) and chronic (28 d) toxicity tests with free larva (glochidia) and juvenile mussels are effective at generating data on contaminant effects at two discrete life stages but do not incorporate effects on brooded glochidia. We developed a novel partial life-cycle assay that incorporates exposures to brooding adult female mussels and used this method in combination with acute toxicity tests to assess adverse effects of perfluoroctanesulfonic acid (PFOS) and perfluoroctanoic acid (PFOA) on freshwater mussels. Fatmucket (Lampsilis siliquoidea) were exposed to PFOS at two life stages: brooding glochidia (in marsupia) for 36 d and free glochidia in water for 24 h. In standard acute tests with glochidia (24-48 h exposures) and juveniles (48-96 h exposures) of fatmucket and black sandshell (Ligumia recta), glochidia were 8 to 25 times more sensitive than juveniles. Perfluoroctanesulfonic acid significantly reduced the duration of glochidia viability and reduced probability of metamorphosis at concentrations 3,000 times lower than the most sensitive acute endpoint (24-h EC50). The partial life-cycle test is adaptable to a variety of endpoints and research objectives and is useful for identifying adverse effects at contaminant concentrations below those required for an acute lethal response.     

Body piercing: a rare cause of mitral valve endocarditis

Body piercing has become a way of life for many individuals. It represents freedom, as well as rebellion, and can provide shock value to the public. Often, it is used as a rite of passage from adolescence into adulthood, and can also provide a boost in self-esteem. However, body piercing may lead to non-infectious complications such as prolonged bleeding and keloid formation, while infectious complications include the transmission of blood-borne infections (e.g. human immunodeficiency virus, hepatitis B, C and D), as well as bacteremia through the site of piercing. Infective endocarditis in individuals with congenital heart defects has been identified after body piercing. Here, the first documented case is reported of mitral valve endocarditis in a previously fit and healthy young female following navel piercing.     

A prospective international cooperative information technology platform built using open-source tools for improving the access to and safety of bone marrow transplantation in low- and middle-income countries

Jagriti Innovations developed a collaboration tool in partnership with the Cure2Children Foundation that has been used by health professionals in Italy, Pakistan, and India for the collaborative management of patients undergoing bone marrow transplantation (BMT) for thalassemia major since August 2008. This online open-access database covers data recording, analyzing, and reporting besides enabling knowledge exchange, telemedicine, capacity building, and quality assurance. As of February 2014, over 2400 patients have been registered and 112 BMTs have been performed with outcomes comparable to international standards, but at a fraction of the cost. This approach avoids medical emigration and contributes to local healthcare strengthening and competitiveness. This paper presents the experience and clinical outcomes associated with the use of this platform built using open-source tools and focusing on a locally pertinent tertiary care procedure—BMT.     

A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department

Background  

To assess clinical utility of computed tomography angiography (CTA) in the diagnosis of chest pain patients presenting to emergency departments (EDs), we conducted a meta-analysis of CTA in patients with suspected acute coronary syndromes (ACSs).     

Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing

Purpose

To determine the most common errors of epinephrine administration during severe allergic-like contrast reaction management using high-fidelity simulation surrogates.

Materials and methods

IRB approval and informed consent were obtained for this HIPAA-compliant bi-institutional prospective study of 40 radiology residents, fellows, and faculty who were asked to manage a structured high-fidelity severe allergic-like contrast reaction scenario (i.e., mild hives progressing to mild bronchospasm, then bronchospasm unresponsive to bronchodilators, and finally anaphylactic shock) on an interactive manikin. Intravenous (IV) and intramuscular epinephrine ampules were available to all participants, and the manikin had a functioning intravenous catheter for all scenarios. Video recordings of their performance were reviewed by experts in contrast reaction management, and errors in epinephrine administration were recorded and characterized.

Results

No participant (0/40) failed to give indicated epinephrine, but more than half (58% [23/40]) committed an error while doing so. The most common mistake was to administer epinephrine as the first-line treatment for mild bronchospasm (33% [13/40]). Other common errors were to administer IV epinephrine without a subsequent IV saline flush or concomitant IV fluids (25% [10/40]), administer an overdose of epinephrine (8% [3/40]), and administer epinephrine 1:1000 intravenously (8% [3/40]).

Conclusion

Epinephrine administration errors are common. Many radiologists fail to administer albuterol as the first-line treatment for mild bronchospasm and fail to flush the IV catheter when administering IV epinephrine. High-fidelity contrast reaction scenarios can be used to identify areas for training improvement.