Effects of the number of sperm and site of uterine semen deposition on conception rate and the number of embryos in weaned sows receiving a single fixed-time insemination.

Reducing the number of sperm needed to produce a litter with artificial insemination (AI) allows greater use of higher genetic merit boars. Induced ovulation with single fixed-time artificial insemination (SFTAI), combined with intrauterine (IUI) or deep uterine insemination (DUI), could improve fertility with low numbers of sperm. The objectives of the study were to determine the fertility effects of sperm numbers and the site of insemination. At weaning (0 h), sows (n = 534) were assigned by parity and estrus induction method (equine chorionic gonadotropin [eCG] or Control) to receive 1,200 × 106 sperm by IUI; 600, 300, or 150 × 106 sperm by IUI or DUI; or 75 × 106 sperm by DUI. At 80 h postweaning, sows received OvuGel and 26 h later a SFTAI using pooled semen. Sows were exposed to boars once daily and ultrasound was performed to determine follicle size and time of ovulation. Following SFTAI, sows were slaughtered 27 d after AI to determine pregnancy and litter traits. Data were analyzed using different models to test for effects of estrus induction, interaction of three levels of sperm (600 to 150) with two levels for site (IUI vs. DUI), and the overall effects of AI method (eight treatments). There was no effect (P > 0.05) of estrus induction on estrus (93%) within 5 d of weaning or on follicle size (6.1 mm) at OvuGel, but wean-to-estrus interval (3.8 vs. 4.0 d) was slightly reduced (P < 0.01) as was AI-to-ovulation interval (15.9 vs. 17.0 h, P = 0.04) for eCG and Control, respectively. There was no effect (P > 0.05) of estrus induction on pregnancy rate (78.6%), number of corpora lutea (CL; 21.7), or number of viable embryos (12.2). There was no effect of number of sperm or site of insemination and no interaction (P > 0.05) on pregnancy rate (range: 80.9% to 70.5%), but AI occurring after ovulation reduced the pregnancy rate (P < 0.02). The total number of embryos (range: 16.5 to 10.3) was not affected by estrus induction, number of sperm, or site of insemination (P > 0.05), but was influenced by AI treatment (P < 0.01). Treatments with a higher number of sperm (1,200 and 600) had more embryos compared with those with a lower number of sperm (300 to 75). The numbers of embryos also increased with the number of CL (P < 0.0001). These results suggest that the lower number of sperm affects litter size more than the pregnancy status. Acceptable fertility can be achieved with low numbers of sperm when using a SFTAI and uterine deposition, but AI-to-ovulation interval and ovulation rate influence final fecundity.

Anti-Hla donor-specific antibody monitoring in pancreas transplantation: Role of protocol biopsies.

In kidney transplantation, de novo donor-specific antibodies (DSA) correlate with poor graft survival, and Consensus Guidelines recommend a protocol biopsy. In pancreas transplantation, DSA are also associated with poor graft outcomes; however, there are no recommendations on protocol biopsies. We started an antibody screening protocol on pancreas transplant patients at 0, 3, 6, 12 months, and yearly. Patients with DSA or high MFI non-DSA were considered for protocol biopsies of both organs. Results: 143 pancreas recipients were screened. 84 patients had negative antibodies throughout the study, 11 patients were found to have antibodies at graft dysfunction, and 48 patients had positive antibodies at screening without acute organ dysfunction (study group). Among the 30 non-DSA patients, 9 had protocol simultaneous pancreas and kidney biopsies performed with negative results in all of them. In contrast, among the 18 DSA patients, 15 had these biopsies performed, and 47% presented with subclinical rejection of the kidney, the pancreas, or both. In addition, some of the DSA patients without a protocol biopsy presented with rejection during the first 15 months of follow-up. Conclusion: We conclude that protocol biopsies of both grafts may play a role in the follow-up of pancreas transplant patients with de novo DSA appearance.

Graft dysfunction in simultaneous pancreas kidney transplantation (SPK): Results of concurrent kidney and pancreas allograft biopsies.

Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Because both organs are from the same donor, the kidney has been treated traditionally as the "sentinel" organ to biopsy, presumably representing the status of both allografts. Truly concurrent biopsy studies, however, are needed to confirm this hypothesis. We examined 101 concurrent biopsies from 70 patients with dysfunction in either or both organs. Results showed concurrent rejection in 23 of 57 (40%) of cases with rejection; 19 of 57 (33.5%) and 15 of 57 (26.5%) showed kidney or pancreas only rejection, respectively. The degree and type of rejection differed in the majority (13 of 23, 56.5%) of cases with concurrent rejection, with the pancreas more often showing higher rejection grade. Taking into account pancreas dysfunction, a positive kidney biopsy should correctly predict pancreas rejection in 86% of the instances. However, the lack of complete concordance between the 2 organs, the discrepancies in grade and type of rejection, and the tendency for higher rejection grades in concurrent or pancreas only rejections, all support the rationale for pancreas biopsies. The latter provide additional data on the overall status of the organ, as well as information on nonrejection-related pathologies.

Acute pulmonary involvement by paracoccidiodomycosis disease immediately after kidney transplantation: Case report and literature review.

Paracoccidioides brasiliensis is the cause of paracoccidioidomycosis, one of the most important systemic mycoses in Latin America. Human disease has been observed in a limited geographic and ecological niche, and it is attributed to exposure to the fungus in soil. Most primary infections are subclinical, as the infection is contained by the host mainly through cell-mediated immune response. However, as the fungus has the ability to survive in a dormant state for long periods, an impairment of the immune response may lead to reactivation and clinical disease. Surprisingly, paracoccidioidomycosis has rarely been reported in transplanted patients. The aim of this communication is to report a case occurring in a kidney recipient in an acute clinical form immediately after transplantation, and to review the available information on previously reported cases.

α-Lipoic Acid Protects Against Ischemia-Reperfusion Injury in Simultaneous Kidney-Pancreas Transplantation.

BACKGROUND: Multiple factors have been implicated in the process of ischemia-reperfusion injury (IRI) in organ transplantation. Among these factors, oxidative damage seems to initiate the injury. α-lipoic acid (ALA) is a potent antioxidant that is used in patients with diabetic polyneuropathy. The aim of the present study was to determine the effect of ALA in patients undergoing simultaneous kidney-pancreas transplant by evaluating the functional recovery of the graft and biochemical markers of IRI. METHODS: Twenty-six patients were included in the following groups: (i) untreated control; (ii) donor and recipient (DR) ALA-treated, in which ALA was administered both to the deceased donor and to the recipients; and (iii) recipient ALA-treated group. The expression of inflammatory genes, as observed in biopsies taken at the end of surgery, as well as the serum cytokines, secretory leukocyte protease inhibitor, regenerating islet-derived protein 3ß/pancreatitis-associated protein, amylase, lipase, glucose, and creatinine levels were quantified as markers of organ function. RESULTS: The DR group showed high levels of TGFß and low levels of C3 and TNFα in the kidneys, whereas high levels of C3 and heme oxygenase were identified in pancreas biopsies. Decreases in serum IL-8, IL-6, secretory leukocyte protease inhibitor, and regenerating islet-derived protein 3 ß/pancreatitis-associated protein were observed after surgery in the DR group. Serum lipase and amylase were lower in the DR group than in the control and recipient groups. Early kidney dysfunction and clinical pancreatitis were higher in the control group than in either treatment group. CONCLUSIONS: These results show that ALA preconditioning is capable of reducing inflammatory markers while decreasing early kidney dysfunction and clinical posttransplant pancreatitis.

Understanding the acceptance factors of an Hospital Information System: evidence from a French University Hospital.

The goal of this study was to examine the perceived usefulness, the perceived ease of use and the perceived behavioral control of a Hospital Information System (HIS) for the care staff. We administrated a questionnaire composed of open-end and closed questions, based on the main concepts of Technology Acceptance Model. As results, the perceived usefulness, ease of use and behavioral control (self-efficacy and organizational support) are correlated with medical occupations. As an example, we found that a half of the medical secretaries consider the HIS is ease of use, at the opposite to the anesthesiologists, surgeons and physicians. Medical secretaries reported also the highest rate of PBC and a high rate of PU. Pharmacists reported the highest rate of PU but a low rate of PBC, which is similar to the rate of the surgeons and physicians. Content analysis of open questions highlights factors influencing these constructs: ergonomics, errors in the documenting process, insufficient compatibility with the medical department or the occupational group. Consequently, we suggest that the gap between the perceptions of the different occupational groups may be explained by the use of different modules and by interdependency of the care stare staff.

Uso de la inmunoglobulina intravenosa (IVIg) como terapia de rescate de rechazos refractarios en pacientes trasplantados renales / Use of intravenous immunoglobulin as rescue therapy of refractory Graft rejection in renal transplanted patients

La inmunoglobulina intravenosa (IVIg) ha sido utilizada en el pasado en pacientes con enfermedades autoinmunes, y también ha sido recientemente usada en pacientes sensibilizados que se encuentran en lista de espera para transpalnte renal, con el fin de reducir sus niveles de anticuerpos reactivos contra panel (PRA). Basados en estos reportes, se ha postulado también que la IVIg podría ser utilizada como un agente de rescate ene el tratamiento de rechazos refractarios en el transplante renal. Este trabajo reporta a cuatro pacientes, quienes se encontraban cursando su primer transplante renal. Tres de ellos habían sido trasplantados con donante vivo, dos relacionados y uno no relaiconado (esposo), y el cuarto había recibido un riñón cadavérico. El diagnóstico de rechazo, fue efectuado por biopsia renal y punción aspirativa renal. Inicialmente a todos los pacientes se les suministró esteroides y luego terapia antilinfocitaria, tres de ellos con anticuerpos monoclonales (OKT3), y el rescate con globulina antilinfocitaria (GAL). Luego del fracaso de la terapia antilinfocitaria, IVIg fue administrada a dosis de 500 mg/Kg/d durante siete días consecutivos. todos los rechazos fueron exitosamente revertidos. el mecanismo de acción de la IVIg puede estar relacionada con los anticuerpos antiidiotípicos. IVIg aparece como una alternativa útil para el rescate de receptores de transplantes renales con rechazos refractarios.

Autotransfusión en pacientes oncológicos quirúrgicos / Autotranfusion in oncologic surgical patients

Se analiza la aplicación de autotransfusión a 45 pacientes intervenidos quirúrgicamente por patología neoplásica. Se realizan consideraciones sobre las modalidades de autotransfusión, los resultados obtenidos y las ventajas del método que mejora la relación costo beneficio y constituye un factor importante de seguridad en el quirófano, lo que hace recomendable su utilización. El promedio de sangre extraída fue de 1500cc; no hubo complicaciones inherentes al método. Si la cantidad extraída fue mayor a 500cc se indicó seroterapia