Factors Influencing Short-Term Patient Survival in Elderly Kidney Transplant Recipients.

BACKGROUND: For the average patient with end-stage renal disease, kidney transplantation improves quality of life and prolongs survival compared with patients on the transplant waiting list who remain on dialysis. Patients ≥65 years of age represent an increasing proportion of adults with end-stage renal disease, and kidney transplantation outcomes remain controversial in this population. The aim of this study was to evaluate factors that may increase 1-year mortality after renal transplantation in older recipients. METHODS: A retrospective study that included 147 patients (75.5% men) ≥65 years old (mean age 67.5 ± 2 years) who were transplanted between January 2011 and December 2020. The mean follow-up was 52.6 ± 27.2 months. RESULTS: Rehospitalization (<1 year) occurred in 39.5% of patients. Infectious complications were present in 18.4% of patients. The overall mortality rate was 23.1%, and 1-year mortality was 6.8%. As 1-year mortality predictors, we found a positive correlation with factors related to kidney transplant, such as cold ischemia time (P = .003), increasing donor age (P = .001); and factors related to the receptor such as pretransplantation dialysis modality as peritoneal dialysis (P = .04), cardiovascular disease (P = .004), delayed graft function (P = .002), early cardiovascular complications after kidney transplant (P < .001), and early rehospitalizations (P < .001). No correlation was found between 1-year mortality and age, sex, race, body mass index, and type of kidney transplant. CONCLUSION: A more rigorous pretransplant evaluation, focusing on cardiovascular disease and strict exclusion criteria, is recommended for patients ≥65 years old.

Renal Transplantation in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Single-Center 10-Year Experience.

BACKGROUND: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of rapidly progressive glomerulonephritis resulting in end-stage renal disease. The optimal timing of kidney transplantation for end-stage renal disease due to AAV and the risk of relapse after kidney are poorly defined. Our study aimed to evaluate the clinical outcomes of AAV after kidney transplantation, namely the risk of relapse, rejection, and oncologic disease. METHODS: This retrospective study included all patients with AAV submitted to a kidney transplant between January 2011 and December 2020. RESULTS: Twenty-seven patients (20 males/7 females; mean age 47 years) received a kidney transplant for end-stage renal disease secondary to microscopic polyangiitis (n = 25) or granulomatosis with polyangiitis (n = 2). All patients were in clinical remission at the time of the kidney transplant, but 11 patients were ANCA-positive. A vasculitis relapse after kidney transplantation occurred in only 1 patient (3.7%). Rejection episodes, proven by allograft biopsy, were present in 3 patients (11.1%), with graft losses in 2 (66.7%). The median time until the graft was lost after the initial rejection diagnosis was 27 ± 8 months. Oncologic complications were present in 9 patients (33.3%). Five patients died (18.5%), and the main cause of death was cardiovascular disease (n = 3, 60.0%), followed by oncologic disease (n = 2, 40.0%). CONCLUSIONS: Kidney transplantation is a safe and effective option for treating end-stage renal disease secondary to AAV. Current immunosuppression regimens make relapses and rejection infrequent but place oncologic complications at a higher incidence.

Treatment of Recurrent Antineutrophil Cytoplasmic Antibody-Associated Vasculitis After Kidney Transplant With Rituximab: A Successful Case Report.

Antineutrophil cytoplasm antibody-associated systemic vasculitis is a rare disease that frequently leads to end-stage renal disease. Kidney transplant should be delayed until patients are in complete clinical remission for at least 6 months, but the persistence of antineutrophil cytoplasmic antibody titers should not delay transplant. Recurrence of disease after kidney transplant is rare, with only a few cases described in the literature with heterogenous clinical manifestations, therapeutic approaches, and prognosis. We describe the case of a young male patient with recurrent antineutrophil cytoplasmic antibody vasculitis, 5 years after kidney transplant, successfully treated with methylprednisolone pulses plus rituximab. Rituximab presents a new valid option for the treatment of antineutrophil cytoplasmic antibody vasculitis relapse in kidney grafts.

A Novice Teacher as Facilitator of Learning During a Hybrid Sport Education/Step-Game Approach Volleyball Season.

This study aimed to examine how a novice Physical Education teacher unfolded her pedagogical practice as a facilitator of learning during a hybrid Sport Education/Step-Game-Approach volleyball season; and to investigate students' perceptions about their lived learning experiences and active involvement in building their own learning process. For this purpose, an insider action-research design was implemented throughout one school term (20 lessons of 45 minutes each in total). Twenty-five students (aged between16 and17 years old), enrolled in the 12th grade at a Portuguese high school took part in this investigation. The novice teacher, who held two years of professional experience, assumed the dual role of teacher-researcher, facilitating an in-depth understanding of the complexity featuring of the teaching-learning process. Qualitative data were collected using multiple data sources (i.e., teacher's lesson plans and field diary, and student's focus-group interviews), and analyzed using a hybrid approach of inductive and deductive thematic analysis. The results revealed that the use of this hybrid season helped the teacher to act as facilitator of learning, namely by: (i) using two student-centered models with unique internal structures and functionalities, (ii) increasing the level of responsibility taken by students for their own learning experiences, (iii) adapting the lesson plans to students' individual needs, and (iv) combining a more supportive intervention with the use of more indirect teaching strategies. Together, these strategies seemed to prompt students' autonomy and sense of active control of the class activities, the development of students' abilities and volleyball-based knowledge, leading them to be more interested and engaged in Physical Education. In conclusion, the alliance between the student-centered environment (Sport Education) and the specificity of the content subject-knowledge (Step-Game Approach for non-invasion games) seems to have allow the novice teacher to adjust her pedagogical intervention as facilitator of learning to students' individual learning needs.

Corksorb Enhances Alkane Degradation by Hydrocarbonoclastic Bacteria.

Biosorbent materials are effective in the removal of spilled oil from water, but their effect on hydrocarbonoclastic bacteria is not known. Here, we show that corksorb, a cork-based biosorbent, enhances growth and alkane degradation by Rhodococcus opacus B4 (Ro) and Alcanivorax borkumensis SK2 (Ab). Ro and Ab degraded 96 ± 1% and 72 ± 2%, respectively, of a mixture of n-alkanes (2 g L-1) in the presence of corksorb. These values represent an increase of 6 and 24%, respectively, relative to the assays without corksorb. The biosorbent also increased the growth of Ab by 51%. However, no significant changes were detected in the expression of genes involved in alkane uptake and degradation in the presence of corksorb relative to the control without the biosorbent. Nevertheless, transcriptomics analysis revealed an increased expression of rRNA and tRNA coding genes, which confirms the higher metabolic activity of Ab in the presence of corksorb. The effect of corksorb is not related to the release of soluble stimulating compounds, but rather to the presence of the biosorbent, which was shown to be essential. Indeed, scanning electron microscopy images and downregulation of pili formation coding genes, which are involved in cell mobility, suggest that cell attachment on corksorb is a determinant for the improved activity. Furthermore, the existence of native alkane-degrading bacteria in corksorb was revealed, which may assist in situ bioremediation. Hence, the use of corksorb in marine oil spills may induce a combined effect of sorption and stimulated biodegradation, with high potential for enhancing in situ bioremediation processes.

Sequencing batch airlift reactors (SBAR): a suitable technology for treatment and valorization of mineral oil wastewaters towards lipids production.

Produced water (PW) and spent oil-based wastewaters are some of the largest mineral oil wastewaters produced. Due to the high toxicity of hydrocarbons, several countries set stringent discharge limits and its treatment is compulsory before discharge. In this work, biological treatment of mineral oil wastewaters coupled with the production of bacterial lipids is demonstrated in sequential batch airlift reactors (SBAR). Two SBAR (2 L working volume) were used for treatment of PW and lubricant-based wastewater (LW), inoculated with Alcanivorax borkumensis SK2 (SBARAb+PW) and Rhodococcus opacus B4 (SBARR.o+LW), respectively. A total petroleum hydrocarbon removal (TPH) efficiency up to 96% and 80% were achieved for SBARAb+PW and SBARR.o+LW, respectively. Intracellular lipids production in SBARAb+PW increased when lower TPH/N ratios and higher feast stage duration were applied (up to 0.74 g g-1 cell dry weight (CDW)), whereas in SBARR.o+LW higher lipids production was observed for higher TPH/N ratios (0.94 g g-1 in CDW). Triacylglycerols (TAG) were the main intracellular lipid accumulated in both SBARAb+PW and SBARR.o+LW operations, while wax ester (WE) production was only observed extracellularly in the SBARAb+PW.

Accuracy of 12-hour urine collection in the diagnosis of pre-eclampsia.

OBJECTIVE: To evaluate the accuracy of a 12-hour urine collection to diagnose pre-eclampsia and to determine whether time of collection influences the performance of this test. METHODS: A prospective observational study was conducted in a tertiary obstetric center in Portugal between November 1, 2015, and November 30, 2016. Pregnant women (≥20 weeks) admitted for observation with suspected pre-eclampsia were eligible for inclusion. Two consecutive 12-hour urine samples were collected (07:00-19:00 hours vs 19:00-07:00 hours). Protein levels were measured in each 12-hour sample, as well as in a pooled sample (07:00-07:00 hours). The diagnostic cut-off values for pre-eclampsia were 150 mg (12-hour samples) and 300 mg (24-hour sample). RESULTS: The study included 99 patients and diagnoses of pre-eclampsia were confirmed among 42 (42%) patients. In all, 456 12-hour urine samples were analyzed (equivalent to 228 24-hour samples). Qualitative analysis (pre-eclampsia vs no pre-eclampsia) indicated substantial agreement between the 12- and 24-hour samples (Cohen κ 0.779). The sensitivity was 85.9% (95% confidence interval [CI] 81%-90%) and the specificity was 91.7% (95% CI 88%-95%). No statistically significant difference was found between the two 12-hour collections. CONCLUSION: The 12-hour test showed acceptable accuracy for detecting pre-eclampsia, regardless of the time of collection.

Estudo de anticorpos IgM para vigilância epidemiológica da esquistossomose mansoni em área de baixa endemicidade / IgM antibodies for epidemiological vigilance of schistosomiasis mansoni in a low endemic area

O controle da esquistossomose no Estado de São Paulo iniciou-se ao final da década de 60, tendo como linhas mestras o uso de moluscidas e a de quimioterapia. Apesar da aparente redução nos níveis de infecção, o Sistema de Vigilância Epidemiológica do Estado de São Paulo tem registrado continuamente casos autóctones da doença, tendo-se observado ampliação das áreas de transmissão. Com o objetivo de buscar-se método diagnóstico mais sensível para fins epidemiológicos em áreas de baixa endemicidade, onde o exame de fezes se mostra pouco eficiente, uma técnica sorológica foi avaliada em quatro áreas consideradas endêmicas para Schistosoma mansoni (Sm) no Estado. Amostras de fezes e de sangue absorvido em papel-filtro foram coletadas de populações de quatro áreas de transmissão com diferentes perfis epidemiológicos, acompanhando-as, por um período de 2 anos, com cinco inquéritos, a intervalos semestrais. Dados de prevalência e incidência obtidos pela aplicação da reação de imunofluorescência para anticorpos IgM contra tubo digestivo de Sm (RIF-IgM) e do exame de fezes (Kato-Katz) foram analisados comparativamente nas quatro áreas estudadas com maior sensibilidade que pelo método parasitológico e detectar sazonidade em algumas das áreas, através da observação de taxas de soroconversão de RIF-IgM. Esta soroconversäo, passando de negativo para positivo, indicando provável infecção recente, foi mais frequente nos inquéritos realizados no primeiro semestre do ano (pós-veräo). A RIF-IgM demonstrou sert útil para estudos epidemiológicos da esquistossomose, podendo constituir método diagnóstico, tanto na fase aguda como crônica. (AU)

The control of schistosomiasis in the State of S"o Paulo started at the end of the sixties. Themain control measures included the application of molluscicides and chemotherapy. Despite the apparentdecrease of the infection levels, the Epidemiological Vigilance System of the State has continually recordedcases of the disease, and expansion of transmission areas has been observed. Since the stool examinationshowed to be insufficiently sensitive for epidemiological purposes in areas with low transmission, aserological technique was evaluated in four schistosomiasis endemic areas of the State with the aim offinding a more efficient diagnostic method. For a period of two years, five follow-up measures of prevalenceand incidence rates were obtained for the four areas, through the stool examination (Kato-Katz method)and detection of IgM antibodies to gut antigens by the immunofluorescence test (IgM-IFT) on filter paperblood samples. The comparative analysis of the data showed the occurrence of seasonal transmission insome of the studied areas, detected by the observation of differences in the seroconversion taxes.Seroconversion from IgM-IFT negative to positive, indicating newly acquired Schistosoma mansoniinfection, was observed more frequently in surveys carried out after summer holidays.The IgM-IFTproved to be a useful technique for epidemiological purposes in shistosomiasis, so that it can be appliedfor diagnosis of both acute and chronic forms of the disease. . (AU)

Pesquisa de anticorpos IgM contra tubo digestivo do verme para prognóstico da esquistossomose mansônica / Detection of IgM antibodies to worm gut: associated antigen for immunodiagnosis of Shistosomiasis mansoni

A pesquisa de anticorpos de classe IgM contra antígenos de natureza polissacarídica associados ao epitélio digestivo do S. mansoni, pela reaçåo de imunofluorescência em cortes de vermes parafinados, foi avaliada para fins diagnósticos da esquistossomose mansônica. Foram estudadas amostras de soro de 90 pacientes, 40 com forma aguda e 50 com forma crônica de esquistossomose, além de 60 nåo esquistossomóticos, 15 normais e 45 com outras afecçöes. Anticorpos IgM foram detectados em todos os pacientes de forma aguda, exceto um, e em 92 por cento daqueles com forma crônica. Falsos resultados positivos foram observados em 3 por cento das amostras incluídas neste estudo