Surveillance Registry of Sirolimus Use in Recipients of Kidney Allografts From Expanded Criteria Donors.

BACKGROUND: The use of expanded criteria donor (ECD) kidneys has increased the overall availability of renal transplants. This study assessed the use of sirolimus in patients receiving Argentina-ECD kidneys. METHODS: This observational, open-label, 1-arm, prospective, longitudinal pilot study was conducted at 8 transplant centers in Argentina. Adults receiving kidney transplants (without pancreas) from ECDs were eligible if they were converted to sirolimus 1 to 36 months' posttransplantation, with sirolimus becoming base therapy within 1 month after conversion. Patients were followed up for 1 year. Outcomes included reasons for conversion, acute rejection, patient and graft survival, graft status, and safety. RESULTS: The intention-to-treat population included 52 patients (mean age, 48.7 years). Calcineurin inhibitor nephropathy (40%) and chronic allograft nephropathy (25%) were the most frequent reasons for conversion. Two acute rejections occurred during follow-up, but no patients experienced graft loss. One patient died during follow-up, and 3 patients died within 1 month of the last sirolimus dose. Levels of serum creatinine and creatinine clearance remained stable from baseline to week 52/53. Mean proteinuria measured in a subset of patients was 0.2 ± 0.2 g/24 hours before conversion and increased to 0.6 ± 1.2 g/24 hours at week 24/25 and 0.5 ± 0.6 g/24 hours at week 52/53. Adverse events were consistent with those in previous conversion trials; the most common were infections and infestations (54%). CONCLUSIONS: This pilot study illustrates the potential benefits of sirolimus in recipients of ECD kidneys in Argentina. Larger, randomized controlled trials are needed to confirm these findings and to clarify the long-term benefits of sirolimus in this patient population.

Chlamydia trachomatis YtgA is an iron-binding periplasmic protein induced by iron restriction.

Chlamydia trachomatis is a Gram-negative obligate intracellular bacterium that is the causative agent of common sexually transmitted diseases and the leading cause of preventable blindness worldwide. It has been observed that YtgA (CT067) is very immunogenic in patients with chlamydial genital infections. Homology analyses suggested that YtgA is a soluble periplasmic protein and a component of an ATP-binding cassette (ABC) transport system for metals such as iron. Since little is known about iron transport in C. trachomatis, biochemical assays were used to determine the potential role of YtgA in iron acquisition. (59)Fe binding and competition studies revealed that YtgA preferentially binds iron over nickel, zinc or manganese. Western blot and densitometry techniques showed that YtgA concentrations specifically increased 3-5-fold in C. trachomatis, when cultured under iron-starvation conditions rather than under general stress conditions, such as exposure to penicillin. Finally, immuno-transmission electron microscopy provided evidence that YtgA is more concentrated in C. trachomatis during iron restriction, supporting a possible role for YtgA as a component of an ABC transporter.

Postural trials: expertise in rhythmic gymnastics increases control in lateral directions.

The first aim of this paper was to investigate if expertise in rhythmic gymnastics influences postural performance even in an easy non-specific task such as bipedal posture. Rhythmic gymnastics is a unique female sport which encompasses aspects of both artistic gymnastics and ballet and includes the use of a small apparatus (rope, hoop, ball, clubs and ribbon). Most previous studies have shown that expertise achieved by artistic gymnasts and dancers improves postural steadiness only in the situations for which those athletes are trained. Literature has not yet compared rhythmic gymnasts to other athletes in terms of their postural strategies. Hence, the study presented herein tested a group of high level rhythmic gymnasts and a group of female university students, trained in other sports, in the bipedal posture under eyes open and closed conditions. A force platform was used to record body sway. (1) Distance from the centre of sway, (2) lateral and (3) antero-posterior displacements were analyzed in time and frequency domains. Comparing the two groups, it was found that rhythmic gymnasts had better strategies than students in simple postural tasks, especially in lateral directions and in the period from 0.05 to 2 s. The most interesting finding in this study is that rhythmic gymnastics training seems to have a direct effect on the ability to maintain bipedal posture, which may confirm the "transfer" hypothesis of rhythmic gymnastics expertise to bipedal postural sway, especially in medio-lateral displacements. This finding has never been reported in previous studies on artistic gymnasts and ballet dancers. Furthermore, the present study confirmed the visual dependence of all the athletes, irrespective of their disciplines, in their postural trials.

Bioinformatic and biochemical evidence for the identification of the type III secretion system needle protein of Chlamydia trachomatis.

Chlamydia spp. express a functional type III secretion system (T3SS) necessary for pathogenesis and intracellular growth. However, certain essential components of the secretion apparatus have diverged to such a degree as to preclude their identification by standard homology searches of primary protein sequences. One example is the needle subunit protein. Electron micrographs indicate that chlamydiae possess needle filaments, and yet database searches fail to identify a SctF homologue. We used a bioinformatics approach to identify a likely needle subunit protein for Chlamydia. Experimental evidence indicates that this protein, designated CdsF, has properties consistent with it being the major needle subunit protein. CdsF is concentrated in the outer membrane of elementary bodies and is surface exposed as a component of an extracellular needle-like projection. During infection CdsF is detectable by indirect immunofluorescence in the inclusion membrane with a punctuate distribution adjacent to membrane-associated reticulate bodies. Biochemical cross-linking studies revealed that, like other SctF proteins, CdsF is able to polymerize into multisubunit complexes. Furthermore, we identified two chaperones for CdsF, termed CdsE and CdsG, which have many characteristics of the Pseudomonas spp. needle chaperones PscE and PscG, respectively. In aggregate, our data are consistent with CdsF representing at least one component of the extended Chlamydia T3SS injectisome. The identification of this secretion system component is essential for studies involving ectopic reconstitution of the Chlamydia T3SS. Moreover, we anticipate that CdsF could serve as an efficacious target for anti-Chlamydia neutralizing antibodies.

Spirochete periplasmic flagella and motility.

Spirochetes have a unique structure, and as a result their motility is different from that of other bacteria. They also have a special attribute: spirochetes can swim in a highly viscous, gel-like medium, such as that found in connective tissue, that inhibits the motility of most other bacteria. In spirochetes, the organelles for motility, the periplasmic flagella, reside inside the cell within the periplasmic space. A given periplasmic flagellum is attached only at one end of the cell, and depending on the species, may or may not overlap in the center of the cell with those attached at the other end. The number of periplasmic flagella varies from species to species. These structures have been shown to be directly involved in spirochete motility, and they function by rotating within the periplasmic space. The mechanics of motility also vary among the spirochetes. In Leptospira, a motility model developed several years ago has been extensively tested, and the evidence supporting this model is convincing. Borrelia burgdorferi swims differently, and a model of its motility has been recently put forward. This model is based on analyzing the motion of swimming cells, high voltage electron microscopy of fixed cells, and mutant analysis. To better understand spirochete motility on a more molecular level, the proteins and genes involved in motility are being analyzed. Spirochete periplasmic flagellar filaments are among the most complex of bacterial flagella. They are composed of the FlaA sheath proteins, and in many species, multiple FlaB core proteins. Allelic exchange mutagenesis of the genes which encode these proteins is beginning to yield important information with respect to periplasmic flagellar structure and function. Although we are at an early stage with respect to analyzing the function, organization, and regulation of many of the genes involved in spirochete motility, unique aspects have already become evident. Future studies on spirochete motility should be exciting, as only recently have complete genome sequences and tools for allelic exchange mutagenesis become available.

[A prognostic multifactorial study of sepsis in an internal medicine service]. / Estudio multifactorial pronóstico de la sepsis en un Servicio de Medicina Interna.

All cases of sepsis attended at the Service of Internal Medicine from 1985 to 1989, both inclusive, were retrospectively analyzed by the statistical study of several clinical, epidemiological, bacteriological and laboratory factors. The parameters acting as prognosis factors were analyzed using Cox's method of logistic regression, in order to obtain more reliable information on the multifactorial spectrum determining "death due to sepsis". The unifactorial analysis (UFA) suggested that the following factors were associated to an statistically significant increase in the mortality due to sepsis: age above 70; male sex; presence of shock upon hospitalization; nosocomial etiology; high levels of urea, creatinine and LDH; proteinuria; family of the causal germ (gram-positive coccus) and underlying pathology. The relative risks (RR) or "odd ratios" of creatinine and LDH were, respectively, 2.8 and 2.9 in the UFA; 3 and 3.3 in the multivariant analysis (MVA). In the older patients developing sepsis within their communities, RR were respectively 2.7 and 1.98 in the UFA and 1.1 and 2.7 in the MFA. The results of the univariant and multivariant analysis showing the relative risk (odd ratio) associated to each of these variables with statistical significance, demonstrate that the mortality rate due to sepsis increases with age, nosocomial etiology and elevation of creatinine and lactodehydrogenase (LDH) levels. We stress the great importance of the LDH as a prognostic factor of sepsis.

[Primary Sjogren's syndrome in men: evolution to acute lymphoblastic leukemia]. / Síndrome de Sjögren primario en varón: evolución a leucemia linfoblástica aguda.

A clinical case of a 55-year-old man with syndrome of primary Sjögren, seronegative, normoglobulinemic and normocomplementary with 7 years of evolution, which developed acute lymphoblastic leukemia, having suffered recurrent lympho-adenopathy and paresthetic meralgia as previous clinical signs, is presented. Clinical, serological and immunologic characteristics of this syndrome are reviewed, highlighting its rare appearance among men. While appearance of malignant lymphoproliferation disorders is well known, evolution to acute or chronic myeloid leukemia is very rare and so far, an acute lymphoblastic leukemia as the one presented in this study has never been described.