Suspected autochthonous Thelazia callipaeda infection in a dog in northern Germany.

A 12-year old Elo dog was presented with recurring symptoms of conjunctivitis in November 2019. A single whitish nematode was found upon inspection of the eye and identified as a Thelazia callipaeda male. The morphological identification of the eye worm was supported by analysis of a partial cytochrome c oxidase I (cox1) gene sequence. The dog lived in Lower Saxony, northwestern Germany, and had not visited regions known to be endemic for T. callipaeda. This suggests that a local transmission cycle of this zoonotic nematode may exist in Germany.

First report of a Hypoderma diana infestation in alpaca (Vicugna pacos) in Germany.

A Hypoderma larva was removed from a painful swelling in the lumbar region of a 17-month-old male alpaca kept on a farm in the Brandenburg district, eastern Germany. Morphological analysis and sequencing of the 18S rRNA gene demonstrated it was a second instar larvae of Hypoderma diana. The main host of H. diana is the roe deer (Capreolus capreolus). This is the first description of hypodermosis caused by H. diana in a camelid species.

Insecticide resistance in stable flies (Stomoxys calcitrans) on dairy farms in Germany.

Stable flies (Stomoxys calcitrans Linnaeus, 1758) can have a considerable negative impact on animal well-being, health, and productivity. Since insecticides constitute the mainstay for their control, this study aimed at assessing the occurrence of insecticide resistance in S. calcitrans on dairy farms in Brandenburg, Germany. First, the susceptibility of stable flies from 40 dairy farms to a deltamethrin-impregnated fabric was evaluated using the FlyBox® field test method. Then, S. calcitrans strains from 10 farms were reared in the laboratory, and the offspring was tested against the adulticides deltamethrin and azamethiphos and the larvicides cyromazine and pyriproxyfen. The FlyBox® method indicated 100% resistance in stable flies against deltamethrin. Later, to the offspring of those 10 established laboratory strains previously caught on suspected dairy farms, these field findings could be confirmed with mortalities well below 90% 24 h following topical application of the calculated LD95 of deltamethrin and azamethiphos. The ten strains could therefore be classified as resistant to the tested insecticides. In contrast, exposure to the insect growth regulators cyromazine and pyriproxyfen at their recommended concentrations demonstrated 100% efficacy. Both larvicides inhibited the moulting process of the stable fly larval stages completely, showing that the stable fly strains tested were susceptible to them. The intensive use of insecticides in recent decades has probably promoted the development of insecticide resistance. Systematic surveys in different livestock production systems and vigilance are therefore deemed necessary for estimating the risk of insecticide resistance development on a nationwide scale.

Aurix Gel Is an Effective Intervention for Chronic Diabetic Foot Ulcers: A Pragmatic Randomized Controlled Trial.

BACKGROUND: Autologous platelet-rich plasma products can significantly vary with respect to platelet concentration, the presence of additional cellularity, and the use of additives. Therefore, the utility of each formulation for treating chronic wounds needs to be established. OBJECTIVE: To establish the efficacy of up to 12 weeks of treatment with Aurix hematogel for healing diabetic foot ulcers against usual and customary care including any wound modality in 129 patients using a Medicare Coverage with Evidence Development paradigm. METHODS: This pragmatic randomized controlled trial was conducted in 28 real-world outpatient wound care sites using an inclusive design that included participants with various health risks, comorbidities (eg, peripheral arterial disease, smoking), and any wound severity (Wagner 1-4). RESULTS: Kaplan-Meier analysis showed a significant (log-rank P = .0476) time-to-heal advantage, with 48.5% of wounds healing with Aurix hematogel compared with 30.2% with usual and customary care. A higher percentage of healing was observed for Aurix across all wound severities (Wagner grade 1-4). Subgroup analysis revealed a significant healing advantage for Aurix when treating wounds accompanied by peripheral arterial disease and a demonstrated advantage for smokers. CONCLUSIONS: This first Coverage with Evidence Development study in wound care demonstrates the effectiveness of Aurix for treating diabetic foot ulcers in Medicare beneficiaries.

Evaluation of a semi-automated in vitro feeding system for Dermacentor reticulatus and Ixodes ricinus adults.

The long feeding duration of ixodid ticks and need for regular blood changes turns the artificial feeding of ticks into a tedious process. To reduce the number of blood changes, a semi-automated system (SAS) for the artificial feeding of hard ticks was developed and evaluated. It consisted of a glass feeding reservoir that can accommodate six tick feeding chambers. A peristaltic pump was used to pump blood through the feeding reservoir, which was changed once daily. Groups of Dermacentor reticulatus and Ixodes ricinus adults were fed simultaneously in both the SAS and a conventional in vitro feeding system. In the conventional system, feeding chambers were hung inside a glass beaker filled with blood that was replaced twice daily. Dermacentor reticulatus adults fed in the SAS obtained significantly higher engorgement weights. Although engorgement rates between both systems were comparable, significantly more SAS-fed females laid fertile egg batches. The egg batch weight of SAS-fed females was also significantly higher. In contrast, the engorgement rate and fecundity of SAS-fed I. ricinus were significantly reduced in comparison to ticks fed in the conventional system. This reduction was likely to be caused by fungal infestation, which could spread between feeding chambers in the SAS. Although the SAS reduced the workload compared to the conventional feeding system and showed promising results for the in vitro feeding of D. reticulatus adults, measures to prevent fungal infestations in the SAS should be considered in future studies.

Resistance to trypanocidal drugs in cattle populations of Zambezia Province, Mozambique.

African animal trypanosomosis is a debilitating tsetse-transmitted parasitic disease of sub-Saharan Africa. Therapeutic and prophylactic drugs were introduced more than 50 years ago, and drug resistance is increasingly reported. In a cross-sectional study, 467 cattle were microscopically screened for trypanosomes. Samples were collected in May-July 2014 from five villages (Botao, Mungama, Zalala-Electrosul, Zalala-Madal, and Namitangurine) in Nicoadala district, Zambezia province. To evaluate treatment efficacy, trypanosome-positive animals in each village were randomly assigned to two groups, one treated with 0.5 mg/kg b.w. isometamidium (Inomidium®), the second with 3.5 mg/kg b.w. diminazene (Inomazene®). Cattle were microscopically monitored at days 0, 14, and 28 post-treatment. At day 28, trypanocides were swapped to investigate single or multiple resistance. Microscopically negative samples from the monitoring days were tested using 18S-PCR-RFLP. 22.9% (107/467) was found positive on day 0. On day 14, nine animals in Botao and seven in Mungama were positive. On day 28, in Botao, four animals from the diminazene group and four from the isometamidium group were positive. In Mungama, four animals from the diminazene group were positive on day 28. On day 42, six animals (9%) in Botao and two (9.5%) in Mungama remained positive after drug swap. No relapses occurred in Namitangurine. The 18S-PCR-RFLP consistently detected more positive than microscopy: indeed, positives reached 12, 13, and 8 in Botao and 9, 7, and 4 in Mungama, at days 14, 28, and 42, respectively. Single- and multi-drug resistance in Nicoadala district, Zambezia province, is thus here confirmed. This should be considered when choosing control options.

Baiting studies on oral vaccination of the greater kudu (Tragelaphus strepsiceros) against rabies.

Rabies in the greater kudu (Tragelaphus strepsiceros), one of the largest African antelopes, is a phenomenon unique to Namibia. Since the mid-1970s, the country has been plagued by two epizootics that claimed thousands of casualties among the indigenous kudu population. Reasons as to why kudus appear to be exceptionally susceptible to the disease still remain speculative at best. Because the Namibian economy relies heavily on trophy hunting, game meat hunting, and ecotourism, the current severe spread of rabies among kudus calls for effective measures to protect these antelopes. Oral vaccination of kudus may offer a possibility provided efficacious oral rabies vaccines are available. In this screening study, we explored options for attractive baits that facilitate optimal vaccine uptake by the target species and a bait distribution system that maximizes bait availability to the target species meanwhile minimizing bait depletion by non-target species. The results show that gelatin-based baits mixed with local (pods of the camel thorn tree) but also imported (apple-flavored corn meal) attractants are highly attractive for kudus providing a basis for future oral rabies vaccine baits.

Bottleneck Accumulation of Hybrid Magnetoelastic Bosons.

An ensemble of magnons, quanta of spin waves, can be prepared as a Bose gas of weakly interacting quasiparticles. Furthermore, the thermalization of the overpopulated magnon gas through magnon-magnon scattering processes, which conserve the number of particles, can lead to the formation of a Bose-Einstein condensate at the bottom of a spin-wave spectrum. However, magnon-phonon scattering can significantly modify this scenario and new quasiparticles are formed-magnetoelastic bosons. Our observations of a parametrically populated magnon gas in a single-crystal film of yttrium iron garnet by means of wave-vector-resolved Brillouin light scattering spectroscopy evidence a novel condensation phenomenon: A spontaneous accumulation of hybrid magnetoelastic bosonic quasiparticles at the intersection of the lowest magnon mode and a transversal acoustic wave.

The impact of insecticide-treated material to reduce flies among pork outlets in Kampala, Uganda.

Synanthropic flies have adapted to the mass of decaying organic matter near human settlements. As such, they feed and breed on food, faeces and other organic material and are known vectors for various diseases. Many of these diseases are associated with food, and foodborne diseases are of growing concern in developing countries where human population and food consumption increase. This pilot study aims at investigating the impact of a novel application of insecticide-treated material (ZeroFly®) to reduce flies among pork outlets in Kampala, Uganda. A cross-sectional survey randomly selected 60 of 179 pork outlets in Kampala. A controlled longitudinal trial followed in which 23 out of the 60 pork outlets were recruited for an intervention with insecticide-treated material. The pork outlets were randomly allocated to a group of 18 netted pork outlets (intervention) and five non-netted pork outlets (control). Monitoring took place over 15 weeks including 2 weeks as the baseline survey. The units were monitored for fly abundance using non-attractant sticky traps, which were placed within the pork outlet once per week for 48 consecutive hours. Medians of fly numbers before and after the intervention indicated a decrease of fly numbers of 48% (p = 0.002). Fly bioassays showed that the insecticidal activity of the netting remained active over the entire intervention period and led to a total paralysis of flies within at least 6 h after exposure. Insecticide-treated material provides a practical and sustainable solution in controlling flies and is therefore recommended as a complementary strategy for an integrated vector control and hygiene management.

Toxocara vitulorum infection in German beef cattle.

Toxocara vitulorum is an ascarid that is frequently found in sub-tropical regions but little is known about infections in more temperate climates. In this study, we report the occurrence of this parasite in a beef cattle herd in eastern Germany. In June 2016, large (14-20 cm) cream-colored worms identified as adult T. vitulorum were observed in the feces of 2- to 3-month-old calves. Eggs of this parasite were subsequently detected in pooled fecal samples collected on all three farm sites. The morphological identification was supported by analysis of partial cytochrome c oxidase I and internal transcribed spacer 1 gene sequences. Clinical signs of toxocariasis, such as diarrhea and loss of body weight were not apparent.

Prevalence and risk factors for gastrointestinal parasites in small-scale pig enterprises in Central and Eastern Uganda.

In Eastern Africa, small-scale pig keeping has emerged as a popular activity to generate additional household income. Infections of pigs with gastrointestinal helminths can limit production output, increase production costs, and pose zoonotic risks. A cross-sectional, community-based study in three districts in Eastern and Central Uganda examined the prevalence of gastrointestinal helminthes and associated risk factors in 932 randomly sampled pigs. Using the combined sedimentation-flotation method, 61.4 % (58.2-64.5 %, 95 % confidence interval [CI]) tested positive for one or more gastrointestinal helminths, namely, strongyles (57.1 %, 95 % CI), Metastrongylus spp. (7.6 %, 95 % CI), Ascaris suum (5.9 %, 95 % CI), Strongyloides ransomi (4.2 %, 95 % CI), and Trichuris suis (3.4 %, 95 % CI). Coccidia oocysts were found in 40.7 % of all pigs sampled (37.5-44.0 %, 95 % CI). Significant differences across the three districts were observed for the presence of A. suum (p < 0.001), Metastrongylus spp. (p = 0.001), S. ransomi (p = 0.002), and coccidia oocysts (p = 0.05). All animals tested negative for Fasciola spp. and Balantidium coli. Thirty-five variables were included in univariable analyses with helminth infection as the outcome of interest. A causal model was generated to identify relationships among the potential predictors, and consequently, seven variables with p ≤ 0.15 were included in a multivariable analysis for helminth infection. The final regression models showed that routine management factors had a greater impact on the prevalence of infection than regular, preventive medical treatment or the level of confinement. Factors that negatively correlated with gastrointestinal infection were the routine removal of manure and litter from pig pens (p ≤ 0.05, odds ratio [OR] = 0.667) and the routine use of disinfectants (p ≤ 0.05, OR = 0.548).

Sequence diversity between class I MHC loci of African native and introduced Bos taurus cattle in Theileria parva endemic regions: in silico peptide binding prediction identifies distinct functional clusters.

There is strong evidence that the immunity induced by live vaccination for control of the protozoan parasite Theileria parva is mediated by class I MHC-restricted CD8(+) T cells directed against the schizont stage of the parasite that infects bovine lymphocytes. The functional competency of class I MHC genes is dependent on the presence of codons specifying certain critical amino acid residues that line the peptide binding groove. Compared with European Bos taurus in which class I MHC allelic polymorphisms have been examined extensively, published data on class I MHC transcripts in African taurines in T. parva endemic areas is very limited. We utilized the multiplexing capabilities of 454 pyrosequencing to make an initial assessment of class I MHC allelic diversity in a population of Ankole cattle. We also typed a population of exotic Holstein cattle from an African ranch for class I MHC and investigated the extent, if any, that their peptide-binding motifs overlapped with those of Ankole cattle. We report the identification of 18 novel allelic sequences in Ankole cattle and provide evidence of positive selection for sequence diversity, including in residues that predominantly interact with peptides. In silico functional analysis resulted in peptide binding specificities that were largely distinct between the two breeds. We also demonstrate that CD8(+) T cells derived from Ankole cattle that are seropositive for T. parva do not recognize vaccine candidate antigens originally identified in Holstein and Boran (Bos indicus) cattle breeds.

Efficacy of selected anthelmintic drugs against cyathostomins in horses in the federal state of Brandenburg, Germany.

Cyathostomins are currently the most common internal parasites of horses. With the intensive use of anthelmintic drugs over the past decades, resistance of cyathostomins to anthelmintics is becoming a growing problem in many countries. The aim of this study was to assess the current situation on horse farms in the German federal state of Brandenburg. A pre-selected population of horses from 24 premises that had shown a prevalence of cyathostomins higher than the average in a previous study was examined for anthelmintic efficacy. Faecal egg count reduction tests (FECRTs) were performed for ivermectin (IVM) and pyrantel (PYR). For IVM, the egg reappearance period (ERP) was also examined, as a shortened ERP can be indicative of developing resistance. The efficacy of IVM on cyathostomins was high: 99.1 % of 224 horses had a zero egg count 14 days after treatment. No shortening of the ERP was detected. For the data of the FECRT for PYR, three different methods of calculation were employed: (a) the method as recommended by the World Association for the Advancement of Veterinary Parasitology (WAAVP), (b) a bootstrapping method and (c) a Markov chain Monte Carlo method. Two methods of interpretation for these data were used: Resistance was declared (a) when FECR was <90 % and the lower 95 % confidence interval (LCL) <80 % and (b) when additionally the upper 95 % confidence level (UCL) was <95 %. When applying the first interpretation, resistance against PYR was found on four yards, while, when considering the UCL, all three methods for calculation only detected resistance on one single yard. Twelve species of cyathostomins were detected in larval cultures derived from strongyle egg positive faecal samples collected 14 days after treatment with PYR by reverse line blot hybridization (RLB). In order to generate comparable data, it is suggested to establish international standards for the calculation of FECRT data.

High levels of mannose-binding lectin are associated with lower pulse wave velocity in uraemic patients.

BACKGROUND: Uraemia is associated with a highly increased risk of cardiovascular disease. Mannose-binding lectin (MBL) has been shown to be involved in cardiovascular pathophysiology and a protective effect of MBL is suggested. The purpose of the present study was to evaluate a potential impact of MBL on vascular parameters in uraemic patients. METHODS: A cohort of 98 patients with end stage renal disease (ESRD) awaiting kidney transplantation had pulse wave velocity (PWV) and augmentation index (AIX) examined by tonometry and endothelial dependent flow-mediated (FMD) and endothelial independent nitroglycerin-induced (NID) dilatory capacities of the brachial artery measured by ultrasound. An oral glucose tolerance test (OGTT) was performed and serum levels of MBL were measured using Luminex xMAP bead array technology. RESULTS: The cohort was divided in two groups according to MBL-concentration below or above the median concentration. These groups were comparable regarding age, BMI, and duration of ESRD. PWV was significantly lower in the group with high MBL levels compared to the group with low MBL levels and trends toward better AIX and higher insulin sensitivity (ISI) was also seen in the group with high MBL levels. No difference was seen in FMD and NID. CONCLUSIONS: High levels of MBL are associated with lower PWV and the use of antihypertensive drugs in a cohort of patients with ESRD awaiting kidney transplantation suggesting a beneficial role of high levels of MBL on arterial stiffness in uraemia.

Field trials assessing deltamethrin (Butox®) treatments of sheep against Culicoides species.

Culicoides (Diptera: Ceratopogonidae) biting midges may transmit various diseases of economic importance, including bluetongue virus (BTV) and Schmallenberg (SV) virus, which affect ruminants. During the outbreak of BTV in central and northern Europe in 2006, and in the absence of BTV vaccines, many national veterinary services recommended the treatment of susceptible livestock with pyrethroids as a first-line defense against biting midges, although these insecticides were officially not registered and authorized for use against Culicoides midges. The efficacy of Butox® pour on (7.5 mg deltamethrin/mL) against biting midges was therefore evaluated in a double-blinded GCP field trial performed in Brandenburg, Germany. Forty female Merino sheep with an average body weight of 38 kg (±7 kg) were used for the study. Twenty randomly selected sheep were treated with 10 mL Butox® pour on. The remaining 20 sheep were left untreated and served as a control group. Midge collections took place in two separate drop traps covering two crush pens with three confined treated/untreated sheep standing inside, on weekdays at 1, 7, 14, 21, 28, and 35 days post treatment. A total of 19,057 midges were collected during this period. Midges were identified as belonging to the subgenus Avaritia, Fox (84.6%) and subgenus Culicoides, Latreille (15.4%). A total of 12,031 midges were collected inside the drop trap containing untreated sheep, in comparison to 7,026 midges collected from the vicinity of the treated sheep. Significantly, more midges had fed on control compared to treated sheep with 757 and 103 engorged midges, respectively. The results indicate that treatment of sheep with Butox® pour on provided a significant decrease in Culicoides feeding rates under field conditions for at least 35 days.

Analysis of Glossina palpalis gambiensis and Glossina tachinoides from two distant locations in Burkina Faso using MALDI TOF MS.

Riverine tsetse (Glossina) as Glossina palpalis gambiensis Vanderplank 1949 and Glossina tachinoides Westwood 1850 are the main vectors for African animal trypanosomoses in Burkina Faso. Vector control has been proven efficient in disease containment, but its success is endangered by the reinvasion of tsetse from neighbouring areas. Thus, identifying relic populations can enhance the success rate of vector control efforts. This is currently carried out through microsatellite analysis which is time-consuming and costly. Recently, matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry-based analysis has become a routine method in microbial species identification. Owing to the rapidness and cost-effectiveness, this approach has been extended towards species identification of higher organisms such as tsetse. Following the recent experiences in distinguishing two genotypes of Prototheca spp., it is of interest to explore the validity of mass spectrometry for tsetse population differentiation. As a preliminary test, we submitted male and female G. palpalis gambiensis and G. tachinoides from Sideradougou and Folonzo, Burkina Faso (distance 60 km) to matrix-assisted laser desorption/ionisation analysis. The wing samples were utilized for protein extraction and mass spectra in a broad mass to charge ratio (2,000-20,000 kDa) were obtained. Specific peaks appeared to represent species, sex and location. Then, a peak list was extracted, containing the peaks in mass-to-charge ratio by revealing their intensities as well. These lists were used to compute a spectral dendrogram and a principle component analysis which displayed the differences among the samples from the two different regions. The results indicate that this technique can be extended with additional tsetse species, ideally with supporting genomic data, to later assist in designing rational vector control strategies.

Isolation and propagation of an Egyptian Theileria annulata infected cell line and evaluation of its use as a vaccine to protect cattle against field challenge.

Tropical theileriosis is an important protozoan tick-borne disease in cattle. Vaccination using attenuated schizont-infected cell lines is one of the methods used for controlling the disease. This study describes the production of attenuated schizont-infected cell lines from Egypt and an evaluation of its use as a vaccine to protect calves against clinical disease upon field challenge. Two groups of exotic and crossbred male calves were divided into vaccinated and control groups. The vaccinated groups were inoculated with 4 ml (1 × 106 cells/ml) of the attenuated cell line. Three weeks after vaccination, calves of both groups were transported to the New Valley Governorate (Egyptian oasis) where they were kept under field conditions and exposed to the natural Theileria annulata challenge. All animals in the control group showed severe clinical signs and died despite treatment with buparvaquone, which was administered after two days of persistent fever due to a severe drop in packed cell volume (PCV). Animals in the vaccinated group became seropositive without developing severe clinical signs other than transient fever. Post-mortem examinations revealed enlarged and fragile lymph nodes, spleen, and liver with necrosis and hemorrhages. These findings indicate that the Egyptian attenuated cell line was successful in protecting both exotic and crossbred animals against tropical theileriosis under field conditions.

Protocol for a randomised controlled trial comparing warfarin with no oral anticoagulation in patients with atrial fibrillation on chronic dialysis: the Danish Warfarin-Dialysis (DANWARD) trial.

INTRODUCTION: Atrial fibrillation is highly prevalent in patients on chronic dialysis. It is unclear whether anticoagulant therapy for stroke prevention is beneficial in these patients. Vitamin K-antagonists (VKA) remain the predominant anticoagulant choice. Importantly, anticoagulation remains inconsistently used and a possible benefit remains untested in randomised clinical trials comparing oral anticoagulation with no treatment in patients on chronic dialysis. The Danish Warfarin-Dialysis (DANWARD) trial aims to investigate the safety and efficacy of VKAs in patients with atrial fibrillation on chronic dialysis. The hypothesis is that VKA treatment compared with no treatment is associated with stroke risk reduction and overall benefit. METHODS AND ANALYSIS: The DANWARD trial is an investigator-initiated trial at 13 Danish dialysis centres. In an open-label randomised clinical trial study design, a total of 718 patients with atrial fibrillation on chronic dialysis will be randomised in a 1:1 ratio to receive either standard dose VKA targeting an international normalised ratio of 2.0-3.0 or no oral anticoagulation. Principal analyses will compare the risk of a primary efficacy endpoint, stroke or transient ischaemic attack and a primary safety endpoint, major bleeding, in patients allocated to VKA treatment and no treatment, respectively. The first patient was randomised in October 2019. Patients will be followed until 1 year after the inclusion of the last patient. ETHICS AND DISSEMINATION: The study protocol was approved by the Regional Research Ethics Committee (journal number H-18050839) and the Danish Medicines Agency (case number 2018101877). The trial is conducted in accordance with the Helsinki declaration and standards of Good Clinical Practice. Study results will be disseminated to participating sites, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBERS: NCT03862859, EUDRA-CT 2018-000484-86 and CTIS ID 2022-502500-75-00.

Micro-fragmented adipose tissue cellular composition varies by processing device and analytical method.

Autologous adipose-derived biologics are of clinical interest based on accessibility of adipose tissue, a rich source of progenitor and immunomodulatory cells. Micro-fragmented adipose tissue (MFAT) preserves the cellular niche within intact extracellular matrix, potentially offering benefit over enzymatically-liberated stromal vascular fraction (SVF), however lack of standardized analyses complicate direct comparison of these products. In this study, MFAT from LipoGems® and AutoPose™ Restore systems, which utilize different washing and resizing methods, was analyzed for cellular content using different techniques. Flow cytometry was performed on SVF, with or without culture, and on the adherent cell population that naturally migrated from undigested MFAT. Cytokine release during culture was also assessed. SVF contained more diverse progenitor populations, while MFAT outgrowth contained lower cell concentrations of predominantly mesenchymal stromal cells (MSC). MSCs were significantly higher in MFAT from the AutoPose System for all analyses, with increased cytokine secretion characterized by high levels of anti-inflammatory and low to non-detectable inflammatory cytokines. These results demonstrate that cellularity depends on MFAT processing methods, and different techniques can be employed to evaluate graft cellularity. Comparisons of cell concentrations determined via these methods could be used to better interpret inter-study variability.

Kidney transplantation improves arterial function measured by pulse wave analysis and endothelium-independent dilatation in uraemic patients despite deterioration of glucose metabolism.

BACKGROUND: The aim of this study is to investigate the effect of kidney transplantation on arterial function in relation to changes in glucose metabolism. METHODS: Included were 40 kidney recipients (Tx group, age 38 ± 13 years) and 40 patients without known diabetes remaining on the waiting list for kidney transplantation (uraemic control group, age 47 ± 11 years). Arterial function was estimated by the pulse wave velocity (PWV) of the carotid-femoral pulse wave, aortic augmentation index (AIX), flow-mediated (FMD) and nitroglycerin-induced vasodilatation (NID) of the brachial artery performed before transplantation and after 12 months. PWV recorded sequentially at the carotid and femoral artery is an estimate of arterial stiffness; AIX is an integrated index of vascular and ventricular function. FMD and NID are the dilatory capacities of the brachial artery after increased flow (endothelium dependent) and after nitroglycerin administration (endothelium independent). The insulin resistance was estimated by the insulin sensitivity index (ISI). RESULTS: AIX was reduced from 27% (17-33) to 14% (7-25) (P = 0.01) after 1 year in the Tx group and remained stable in uraemic controls (P = 0.001, between groups), and NID increased from 11% (7-16) to 18% (12-23) (P = 0.0005). At baseline, carotid-femoral PWV was similar in the Tx group, uraemic controls and healthy controls and it did not change significantly after transplantation. ISI deteriorated in the Tx group from 7.2 ± 4.0 to 5.0 ± 3.0 (P = 0.005) and remained stable in uraemic controls (7.9 ± 5.1 vs 8.5 ± 4.9, NS). Mean arterial blood pressure decreased from 105 ± 13 to 96 ± 11 mmHg (P = 0.005) in the Tx group despite a 20% lower use of antihypertensive agents. CONCLUSIONS: Arterial function measured by AIX and NID was improved 1 year after kidney transplantation. This was associated with a decline in blood pressure and seen inspite of an increase in insulin resistance.