Functional and histopathologic changes in renal transplant patients with new-onset diabetes and dyslipidemia.

BACKGROUND: The principal risk factors for cardiovascular mortality posttransplantation are hyperglycemia, hypertriglyceridemia, obesity, and smoking. METHODS: Among 115 patients, we assessed the risk factors for new-onset diabetes (NODM) and dyslipidemia (NODL), and their effects on the function and histopathologic changes in the allografts at 1 year posttransplantation. RESULTS: When evaluating the risk factors and the initial recipient data, we observed a significant difference in age when comparing normal vs NODM patients (P=.004), normal versus NODL patients (P=.002), and normal versus NODL + NODM patients (P=.0001). The difference in body mass index (BMI) was significant when comparing normal with NODM + NODL patients (P=.003). In regard to immunosuppressive therapy, NODM was significantly more frequent among/prescribed tacrolimus (tac; P=.005), whereas subjects who received cyclosporine (CsA) showed a significantly higher incidence of NODL (P=.001). The triglyceride levels were 3.02 ± 1.51 mmol/L among those on CsA versus 2.15 ± 1.57 mmol/L for (P=.004). The difference also proved to be significant for total cholesterol level: 5.43 ± 1.23 mmol/L versus 4.42 ± 1.31 mmol/L respectively (P=.001). In regard to allograft function a significant difference was noted at 1 year after transplantation between the NODM + NODL and the normal group in serum creatinine level (P=.02) as well as the estimated glomerular filtration rate (P=.004). Among diabetic patients, the serum creatinine level measured at posttransplant year 5 was significantly higher than that in 1 year (212.43 vs 147.00 µmol/L; P=.0003). When assessing morphologic changes in the kidney, we observed significantly more frequent interstitial fibrosis/tubular atrophy in all 3 groups compared with normal function patients. CONCLUSION: Our clinical study suggested that at 1 year after transplantation allograft function is already impaired in the presence of both medical conditions (NODM and NODL). However, in regard to morphology, a single condition (NODM or NODL) was sufficient to produce histologic changes in the kidney.

Diagnostic developments for quasicontinuous operation of the Wendelstein 7-X stellarator.

The stellarator Wendelstein 7-X will allow for quasicontinuous operation with the duration only being limited to two 30 min discharges per day, at a continuous heating power of 10 MW electron cyclotron resonance heating (ECRH) at 140 GHz, by the capacity of the cooling water reservoir. This will result in high thermal loads on all plasma facing components of 50-100 kW/m(2) from radiation alone and of up to about 500 kW/m(2) on components additionally exposed to convective loads. In high density scenarios toroidally varying ECRH stray radiation levels of 50-200 kW/m(2) need to be coped with, requiring careful material selection and different shielding and hardening techniques. Furthermore, a gradual buildup of coatings on plasma facing optical components, which without any measures being taken, would lead to high transmission losses already within a few days of long pulse operation (equivalent to about 1 year of operation in pulsed devices like JET or ASDEX-upgrade) and therefore needs to be prevented as much as possible. In addition in situ cleaning as well as absolute calibration techniques need to be developed for all plasma facing optical systems. Here we report about some of our efforts to find, for various types of diagnostics, ways to cope with these adverse effects. Moreover, we give a few examples for individual diagnostic specific issues with respect to quasicontinuous operation, such as the development of a special integrator for the magnetic diagnostics as well as special interferometer types which can cope with unavoidable vibrations and slow path length changes due to, e.g., thermal expansion of the plasma vessel.

Clinical and genetic findings in Hungarian patients with X-linked juvenile retinoschisis.

PURPOSE: To determine clinical phenotypes, examine the age dependency of X-linked juvenile retinoschisis (XLRS), and identify mutations in the retinoschisis1 gene (RS1) in 13 Hungarian (Caucasian) families with this disease. METHODS: This study included 72 members in 13 families. Complete ophthalmological examinations, including optical coherence tomography (OCT) and full-field and multifocal electroretinography (ERG), were performed on 20 affected males, 13 female carriers, and 27 healthy controls. The patients were divided into two age groups (Group I <25 years and Group II >25 years), retrospectively, to assess the possible effects of age. Correlations among genotype, age, best corrected visual acuity (BCVA), OCT, and ERG results were analyzed. A modified classification scheme was done to identify the different phenotypes of the disease. In each of the 72 family members and 100 age-matched male controls, all exons and introns of RS1 were amplified by polymerase chain reaction (PCR) and directly sequenced. RESULTS: Foveal retinoschisis was detected in 25 eyes (62.5%) of patients by funduscopy, and in 29 eyes (72.5%) by OCT, while macular lamellar schisis was recognizable only by OCT in 30 eyes (75%) of patients. Foveal thickness (FT) and total macular volume were significantly increased in younger (Group I) patients only. For patients younger than 26 years, large inner nuclear central cysts were observable by OCT, while after 26 years, foveas were atrophic. White flecks and dots, which were like that seen in fundus albipunctatus, were detected in both eyes of one patient. In both patient groups, characteristically decreased b-waves of standard combined ERG were recorded without any significant difference between the patient groups. The BCVA and ERG parameters of all patients and the OCT of younger patients were significantly worse (p<0.05) than those of age-matched controls. A significant difference between the two age groups was found in case FT, total macular volume, and amplitudes of rod b-wave only. Moderate negative correlation (r=-0.54, p<0.001) was detected between age and FT, while only low negative correlation (r=-0.33, p<0.05) was detected between age and standard combined b-wave amplitudes of full-field ERG. BCVA LogMAR did not show any obvious correlation with age (r=-0.14, p=0.39) or with the type of mutation. Nine different mutations were identified in 25 male patients and 31 female carriers of 13 families: six known and one novel missense mutation (c.575C>T, p.Pro192Leu), one insertion mutation (c.579dupC, p.Ile194Hisfs29ext43), and one frameshift, causing splice site mutation (c.78+1G>C) were detected. These mutations were absent in the 100 age-matched male control samples. CONCLUSIONS: Foveal cystic schisis was found more often by OCT than by funduscopy (+10%), while flat macular lamellar schisis was recognizable only by OCT. Advancing age inversely influenced the size of cavities (FT), and standard combined b-wave amplitudes of full-field ERG, while BCVA, response density, and implicit times of multifocal electroretinography did not show any obvious correlation with age. The atrophic stage of the disease was observable after 26 years of age. The lesions that appeared to be indicative of fundus albipunctatus were proven to be palisades between the splitted retinal layers. Our modified classification scheme was helpful in assessing the prevalence of disease types. In these Hungarian patients, one novel and eight known mutations were detected. The distribution of mutations in RS1 was different to that reported in the literature, because the greatest number of different mutations was in exon 6 instead of exon 4. Two mutation hot spots were found: between c.418-422 in exon 5 and between c.574-579 in exon 6. Genotype-phenotype correlation was not demonstrable.

Apoptosis in various organs of preterm infants: histopathologic study of lung, kidney, liver, and brain of ventilated infants.

Apoptosis, the well-characterized form of active programmed cell death, is a physiologic phenomenon in embryonal and fetal life in developing organs. Severe hypoxia, which occurs in most preterm infants, also leads to cell death, which may be necrotic or apoptotic. The aim of our study was to examine the incidence of apoptosis in various organs (such as lung, kidney, and brain) of preterm infants who suffered from clinically proven respiratory distress causing infantile respiratory distress syndrome (IRDS), cardiac failure, and periventricular leukomalacia (PVL). Twenty-four autopsy cases were studied histologically to detect the apoptotic ratio, which was performed on the basis of hematoxylin and eosin staining and validated by terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL) reaction. Elevated apoptotic ratio was found in stages II, III, and IV of bronchopulmonary dysplasia (BPD) among alveolar and bronchiolar cells. The apoptotic activity was very low in stage I of BPD. High apoptotic ratio was detected in hypoxic injuries of the central nervous system (CNS) of preterm infants. Features of apoptosis were present in proximal and excreting tubules of the kidney. Significant elevation of apoptotic activity may play a role in the development of BPD, ischemic brain lesions, and renal failure.

Experiencing control in caregiving.

PURPOSE: To describe the experience of control as perceived by family caregivers who care for relatives with dementia to determine how caregivers manage care at home. The ability to manage care effectively at home is important because of the rise in the number of family caregivers. DESIGN: Descriptive using secondary analysis of qualitative data. The sample was 21 family caregivers of relatives with dementia, 4 men and 17 women, from one medium-sized city in Canada. METHODS: Grounded-theory methods were used for the secondary analysis of data completed in 1997 from a previous 1995 study of caregivers. RESULTS: The experience of control was related to how caregivers managed or coped with their caregiving situations. The dimensions of control were characterized as either "maintaining control" or as "lacking control" with each dimension relating to caregivers' beliefs about caregiving. CONCLUSIONS: Results of this study can help nurses intervene more effectively with family caregivers by recognizing how caregivers manage and whether they need assistance to continue to provide care. The proposed model is a starting point for further research on control and coping; it also provides direction for practice.

Secondary analysis of qualitative data.

Secondary analysis of qualitative data is a valid mode of clinical inquiry. However, there is limited information available on its use in nursing. This article describes the use of secondary analysis for a study of family caregivers of relatives with dementia. The advantages, limitations, and application of secondary analysis are outlined; data management, analysis, and rigor are also discussed. The article concludes that this method is cost-effective, decreases respondent burden, and is a useful research method for students. However, the secondary analyst must be aware of the limitations of using secondary analysis of qualitative data.

The Arabidopsis downy mildew resistance gene RPP5 shares similarity to the toll and interleukin-1 receptors with N and L6.

Plant disease resistance genes operate at the earliest steps of pathogen perception. The Arabidopsis RPP5 gene specifying resistance to the downy mildew pathogen Peronospora parasitica was positionally cloned. It encodes a protein that possesses a putative nucleotide binding site and leucine-rich repeats, and its product exhibits striking structural similarity to the plant resistance gene products N and L6. Like N and L6, the RPP5 N-terminal domain resembles the cytoplasmic domains of the Drosophila Toll and mammalian interleukin-1 transmembrane receptors. In contrast to N and L6, which produce predicted truncated products by alternative splicing, RPP5 appears to express only a single transcript corresponding to the full-length protein. However, a truncated form structurally similar to those of N and L6 is encoded by one or more other members of the RPP5 gene family that are tightly clustered on chromosome 4. The organization of repeated units within the leucine-rich repeats encoded by the wild-type RPP5 gene and an RPP5 mutant allele provides molecular evidence for the heightened capacity of this domain to evolve novel configurations and potentially new disease resistance specificities.

Simple inheritance of key traits distinguishing maize and teosinte.

The segregation of key traits distinguishing maize and teosinte was analyzed in three F2 and three backcross populations derived from crosses of the modern maize inbred T232 with Zea mays ssp. parviglumis. These traits were (i) paired vs. single female spikelets; (ii) two-ranked vs. many-ranked ears; (iii) non-indurated vs. indurated glumes; (iv) inclination of the kernels toward the rachis, and (v) distichous vs. polystichous central staminate spike. All traits showed a simple mode of inheritance except for paired female spikes, which appeared to be controlled by two genes. The loci controlling these major changes were mapped with RFLP markers to four chromosomal regions. These results support the suggestion that maize became differentiated from teosinte with as few as five major gene changes.

[Botulism in infancy]. / Csecsemökori botulizmus.

According to international references the publication ascertains the etiologic role of neurotoxin producing Clostridial spp., other than C. botulinum in Infant botulism. Authors report on the first Hungarian case of Infant botulism. The organism isolated -- C. barati -- is responsible only for a small proportion of published cases. Authors point out the conjunction of Infantile botulism and crib death.

Integration of CAPS markers into the RFLP map generated using recombinant inbred lines of Arabidopsis thaliana.

Konieczny and Ausubel have described a technique whereby Arabidopsis thaliana loci can be rapidly mapped to one of the ten chromosome arms using a small number of F2 progeny from crosses between the ecotypes Landsberg erecta and Columbia. The technique involves the use of 18 co-dominant, cleaved amplified polymorphic sequence (CAPS) markers which are evenly distributed throughout the Arabidopsis genome. We have mapped these 18 markers using recombinant inbred (RI) lines generated in our laboratory. These data enable a better integration of loci mapped relative to the CAPS markers into the restriction fragment length polymorphism (RFLP) map generated using Arabidopsis RI lines.

Ultrastructural changes in the nerve elements in Crohn's disease.

Electron microscopic investigations were carried out to study the nerve elements in the wall of the small intestine in Crohn's disease, comparing it with the control. In the ileum of Crohn's disease only a few synapses were found. The number of nerve terminals were decreased, as well as that of the vesicle population in the remaining nerve terminals. Some of the nerve processes were observed in degeneration. The number of the lysosomes in the nerve cell bodies increased. Inflammatory cells as lymphocytes, plasma cells, mast cells were noted in the tola submucosa and in the mucous membrane, their number was also increased. It is suggested that the immunological effector cells and their products could be responsible for changing the neuronal elements.

[Aneurysm of the internal carotid artery with fatal epistaxis]. / Anevrism al arterei carotide interne, cu epistaxis letal.

The paper reports on a case of aneurysm of the internal carotid artery that broke out by the sphenoidal sinus and manifested itself by a violent, lethal nasal hemorrhage. The necropsy established the cause of the hemorrhage. The elements of diagnosis and therapeutical behaviour required by these extremely severe cases are discussed.

Radical nephrectomy through total median laparotomy.

Twenty-two carcinoma patients aged less than 65 years were subjected to radical nephrectomy through total median laparotomy. This type of approach provides excellent access to both essential operation phases: vessel management and lymphadenectomy. Postoperative abdominal complications and hernia have not been encountered.

The echographic examination of urological homogeneous masses based on 15 years of experience.

Based on his 15 years' experience, the author described the ultrasound diagnostics of urological homogeneous masses. He stresses that, of the diagnostic examinations, always the less inconvenient intervention imposing the least strain on the patients should be selected. The reliability of ultrasonic diagnosis is verified by the authors' own results.

A tetrahedral representation of poly-codon sequences and a possible origin of codon degeneracy.

A novel and interesting representation of codon space is introduced in which the 64 codons are grouped and re-arranged as vertices in a tetrahedral lattice. Amino acids are then assigned to the lattice in a suggestive way which, when combined with earlier work, leads to an interesting speculation on the origin and development of the genetic code.