Cumplimiento de las medidas de restricción del uso residencial de leña en la ciudad de Valdivia / Compliance with the measures of restrict the residential use of firewood in Valdivia, Chile

BACKGROUND: Atmospheric pollution is a problem that causes great concern and health risks for the population and the earth, as it affects developed countries and third world countries. Locally, there are no studies that prove the fulfillment level of the restriction about the usage of residential firewood, considering that since 2014 there is a procedure called "The Environmental Decontamination Plan" in Valdivia (PDAV). Aim: To determine the fulfillment level of the restriction about residential firewood and its related factors. MATERIAL AND METHODS: The population study were 594 homes that were assigned randomly and proportionally according to 2 territorial areas (A and B) established in the PDAV. The sample's characteristics were described, comparison techniques were applied by subgroups (sociodemographic, home's structures and humidity's perception and percentage of the firewood) to identify factors related mainly with the fulfillment of measurements about firewood usage. RESULTS: 52% of households do not comply with the residential firewood use restriction measure, having sociodemographic factors related with this failure, such as schooling, health insurance and home structure. Besides, it is noted that the knowledge level of PDAV is associated with the accomplish level of restriction measures. When people know more about PDAV, there is a higher proportion of accomplishment. Conclusion: In more than half of the households, the restriction on the use of woodstove is not complied. The lack of knowledge of the population about the PDAV directly influences its compliance, which requires strategies to promote adherence to this program.

Investigation of the safety and feasibility of AAV1/SERCA2a gene transfer in patients with chronic heart failure supported with a left ventricular assist device - the SERCA-LVAD TRIAL.

The SERCA-LVAD trial was a phase 2a trial assessing the safety and feasibility of delivering an adeno-associated vector 1 carrying the cardiac isoform of the sarcoplasmic reticulum calcium ATPase (AAV1/SERCA2a) to adult chronic heart failure patients implanted with a left ventricular assist device. The SERCA-LVAD trial was one of a program of AAV1/SERCA2a cardiac gene therapy trials including CUPID1, CUPID 2 and AGENT trials. Enroled subjects were randomised to receive a single intracoronary infusion of 1 × 1013 DNase-resistant AAV1/SERCA2a particles or a placebo solution in a double-blinded design, stratified by presence of neutralising antibodies to AAV. Elective endomyocardial biopsy was performed at 6 months unless the subject had undergone cardiac transplantation, with myocardial samples assessed for the presence of exogenous viral DNA from the treatment vector. Safety assessments including ELISPOT were serially performed. Although designed as a 24 subject trial, recruitment was stopped after five subjects had been randomised and received infusion due to the neutral result from the CUPID 2 trial. Here we describe the results from the 5 patients at 3 years follow up, which confirmed that viral DNA was delivered to the failing human heart in 2 patients receiving gene therapy with vector detectable at follow up endomyocardial biopsy or cardiac transplantation. Absolute levels of detectable transgene DNA were low, and no functional benefit was observed. There were no safety concerns in this small cohort. This trial identified some of the challenges of performing gene therapy trials in this LVAD patient cohort which may help guide future trial design.

Aspectos clínicos y microbiológicos de la peritonitis asociada a diálisis peritoneal en pacientes adultos con insuficiencia renal crónica en el Servicio de Urgencias / Clinical and microbiological aspects of peritonitis associated with peritoneal dialysis in adult patients with chronic renal failure in the Emergency Department

Resumen Introducción: La peritonitis es la complicación más importante y frecuente de la diálisis peritoneal (DP), las infecciones bacterianas son las responsables en la mayoría de los casos, con sintomatología característica. Objetivo: Determinar los patógenos más frecuentes en peritonitis asociado con la DP en pacientes con insuficiencia renal crónica (IRC). Metodología: Estudio retrospectivo, descriptivo, transversal y observacional, de pacientes con peritonitis en DP con IRC del servicio de urgencias, entre julio de 2012 y junio de 2013. Se evaluaron de los expedientes datos sociodemográficos, de diagnóstico, clínicos y microbiológicos y celulares de líquido de diálisis. Resultados: De 73 expedientes revisados 52% correspondían a pacientes del género masculino, la causa primaria de la IRC fue la diabetes mellitus tipo 2 (67%). Síntomas presentados: dolor abdominal (86%), vómitos (42%) y náuseas (34%), con anemia, azoemia, hiperglicemia hipoalbuminemia e hiponatremia. Los cultivos microbiológicos positivos fueron 59%; y los patógenos identificados fueron Candida tropicalis (9,6%), Staphylococcus epidermidis (8,2%), y Enterococcus faecalis y Staphylococcus haemolyticus (6,8% cada uno), asociados con elevación de leucocitos, azoemia y celularidad alta en el líquido peritoneal (p < 0,05). Conclusiones: El principal microorganismo determinado fue de origen fúngico asociado a leucocitos, azoemia y celularidad alta.

Background: Peritonitis is the most important and frequent complication of peritoneal dialysis (PD). Bacterial infections are responsible in most cases, with characteristic symptoms. Aim: To determine the most frequent pathogens in peritonitis associated with PD in patients with chronic renal failure (CRF). Methodos: Retrospective, descriptive, cross-sectional and observational study of patients with peritonitis in PD with CRF of the emergency department, between July 2012 and June 2013. Sociodemographic, diagnostic, clinical and microbiological and cellular data were evaluated from the patient's fluid. Dialysis. Results: From 73 reviewed records, 52% were male. The primary cause of CRF was diabetes mellitus type 2 (67%). Symptoms presented: abdominal pain (86%), vomiting (42%) and nausea (34%), with anemia, azotemia, hyperglycemia, hypoalbuminemia and hyponatremia. The positive microbiological cultures were 59%; and the pathogens identified were Candida tropicalis (9.6%), Staphylococcus epidermidis (8.2%), Enterococcus faecalis and Staphylococcus haemolyticus (6.8% each one), associated with elevated leukocytes, azotemia and high cellularity in peritoneal fluid (p <0.05). Conclusions: The main microorganism determined was of fungal origin associated with leukocytes, azotemia and high cellularity.

Bladder cancer in Spain 2011: population based study.

PURPOSE: We estimate the annual incidence of bladder cancer in Spain and describe the clinical profile of patients with bladder cancer enrolled in a population based study. MATERIALS AND METHODS: Using the structure of the Spanish National Health System as a basis, in 2011 the AEU (Spanish Association of Urology) conducted this study with a representative sample from 26 public hospitals and a reference population of 10,146,534 inhabitants, comprising 21.5% of the Spanish population. RESULTS: A total of 4,285 episodes of bladder cancer were diagnosed, of which 2,476 (57.8%) were new cases and 1,809 (42.2%) were cases of recurrence, representing an estimated 11,539 new diagnoses annually in Spain. The incidence of bladder cancer in Spain, age adjusted to the standard European population, was 20.08 cases per 100,000 inhabitants (95% CI 13.9, 26.3). Of patients diagnosed with a first episode of bladder cancer 84.3% were male, generally older than 59 years (81.7%) with a mean ± SD age of 70.5 ± 11.4 years. Of these patients 87.5% presented with some type of clinical symptom, with macroscopic hematuria (90.8%) being the most commonly detected. The majority of primary tumors were nonmuscle invasive (76.7%) but included a high proportion of high grade tumors (43.7%). According to the ISUP (International Society of Urologic Pathology)/WHO (2004) classification 51.1% was papillary high grade carcinoma. Carcinoma in situ was found in 2.2% of primary and 5.8% of recurrent cases. CONCLUSIONS: The incidence of bladder cancer in Spain, age adjusted to the standard European population, confirms that Spain has one of the highest incidences in Europe. Most primary nonmuscle invasive bladder cancer corresponded to high risk patients but with a low detected incidence of carcinoma in situ.

Mammalian target of rapamycin signal inhibitors could play a role in the treatment of BK polyomavirus nephritis in renal allograft recipients.

UNLABELLED: BK virus (BKV) nephropathy is a common viral infection in renal transplant patients, with a prevalence of 1-9% at approximately 12 months after surgery. While it is widely agreed that reduction of immunosuppression should be the first intervention after diagnosis of BKV infection, there is no consensus on whether calcineurin inhibitors or antiproliferative drugs should be reduced first. Furthermore, target levels of immunosuppressive drugs are poorly defined, as are criteria for replacing one immunosuppressive agent with another. RESULTS: We report our series of 15 renal transplant patients who underwent surgery between September 2004 and March 2010 and who developed BKV infection. The first 8 patients were treated with reduction of immunosuppression; 7 of these patients received cidofovir and 6 received intravenous immunoglobulin. The remaining 7 renal transplant recipients received mammalian target of rapamycin inhibitors (imTOR). In this group, we observed faster and more efficacious BKV clearance in plasma and urine and a steady improvement in allograft function, with no episodes of acute allograft rejection during follow-up. The polymerase chain reaction assay for BKV in urine became positive in 2 patients in whom imTOR were stopped due to severe side effects. CONCLUSIONS: The use of imTOR should be considered a first step in the treatment of renal transplant recipients with BKV infection. In our experience, this change in treatment was safe and resulted in viral clearance.

The effect of preservative-free HP-Guar on dry eye after phacoemulsification: a flow cytometric study.

PURPOSE: To assess the effect of hydroxypropyl (HP)-Guar added to regular post-phacoemulsification treatment in dry eye signs and symptoms, and its influence on the expression of various inflammatory markers by flow cytometry (FCM) in impression cytology specimens. METHODS: This prospective, interventional, single-centre study included 48 eyes of 48 patients with age-related cataract. After phacoemulsification, patients were randomised to the usual treatment group (UT), with 21 patients who received tobramycin and dexamethasone eye drops (Tobradex, Alcon Cusí, Spain), and the HP-Guar group, with 27 patients who received the UT plus preservative-free artificial tears (Systane UD, Alcon Cusí, Spain). Corneal and conjunctival staining with fluorescein and lissamine green, tear film break-up time (TBUT), Schirmer's I test with anaesthesia (Jones test), tear clearance, and ocular surface disease index (OSDI) were assessed preoperatively and 1 month after surgery. Besides, conjunctival impression cytology was performed in order to investigate inflammatory markers (CD3, CD11b, and HLA-DR) using FCM. RESULTS: HP-Guar group shows statistical better results compared with the UT group in TBUT (6.4+/-0.7 vs 9+/-2.5, P=0.0004), OSDI (11.5+/-8.2 vs 3.3+/-2.5, P=0.0002), ocular symptoms subscale (7.3+/-6.1 vs 1.7+/-1.8, P=0.0004), vision-related function subscale (2.2+/-1.8 vs 0.4+/-0.6, P=0.0002), CD3 (2.5+/-1.4 vs 1.1+/-1.1, P=0.011), and HLA-DR (6.8+/-4.5 vs 1.8+/-1.7, P=0.0002). CONCLUSION: The addition of HP-Guar to regular treatment after cataract surgery reduces ocular surface inflammation and dry eye signs and symptoms.

Graft outcome and mycophenolic acid trough level monitoring in kidney transplantation.

BACKGROUND: Large inter- and intrapatient variabilities have been observed in the pharmacokinetics of mycophenolic acid (MPA). As a consequence, the efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic drug monitoring. MATERIALS AND METHODS: In this retrospective study we analyzed; 7536 12-hour trough MPA samples obtained during the first year posttransplantation among 314 kidney recipients treated with tacrolimus, MMF, and corticosteroids. RESULTS: Despite taking similar MMF doses, patients with delayed graft function (DGF) showed lower 12-hour trough MPA levels than patients without DGF 1.4 +/- 0.1 vs 2.1 +/- 0.1 microg/mL; P = .001). There was a significant correlation between 12-hour trough MPA levels and creatinine clearance (r = .32; P < .001). Logistic regression analysis showed that creatinine clearance was a predictive factor of adequate 12-hour trough MPA levels (>1.6 microg/mL) at 7 days posttransplantation. Twelve-hour trough MPA levels at 7 days posttransplantation were lower among patients who developed an acute rejecton episode (1.5 +/- 0.1 vs 2.1 +/- 0.1 microg/mL; P < .001), whereas those with gastrointestinal side effects showed high levels (4.1 +/- 0.5 microg/mL). CONCLUSIONS: In patients with delayed or poor graft function, MMF doses greater than 2 g/d may be necessary to achieve adequate MPA levels. Therapeutic drug monitoring of MPA may be useful to prevent acute rejection episodes or toxicity.

Intracellular ATP levels in CD4+ lymphocytes are a risk marker of rejection and infection in renal graft recipients.

OBJECTIVE: The immune monitoring of transplant patients may allow us to minimize adverse events of immunosuppression and predict risks of rejection. Herein we have evaluated the capacity of an immune cell function assay to predict episodes of rejection and infections as well as its correlation with immunosuppressive drug trough levels and CD4, CD8, CD25, and DR cell counts. PATIENTS AND METHODS: This prospective study of 38 kidney transplant patients was performed from January to June 2008. Blood samples were obtained at several times posttransplantation until the sixth month. We measured intracellular adenosine triphosphate (iATP) levels following CD4 cell activation for comparison with the clinical courses. RESULTS: Patients with >or=525 ng/mL levels of iATP in the first week posttransplantation were 6.6 times more likely to develop an acute rejection episode (ARE) than those with lower immune response values (P = .014). Those who had an ARE with iATP < 525 ng/mL were generally highly sensitized (4/5). Statistically significant variations in iATP levels were observed among patients who had an ARE (P = .006). There was a relationship between infections and iATP levels also. Infections were more frequent with iATP

Sirolimus and everolimus induced pneumonitis in adult renal allograft recipients: experience in a center.

Mammalian target of rapamycin (mTOR) inhibitors induce pneumonitis, an unusual but potentially fatal side effect of this drug group. We retrospectively collected the cases of pneumonitis induced by sirolimus or everolimus among 1471 adult cadaveric renal transplant recipients who were grafted at our institution from 1980-2008. Due to chronic transplant dysfunction or tumor, 205 patients were switched from calcineurin inhibitors to sirolimus (n = 88) or to everolimus (n = 117). Six patients (2.9%) developed pneumonitis: 1 was associated with sirolimus and 5 with everolimus (5 males and 1 female; median age, 60 years [range, 47-73 years]). Median times from conversion to pneumonitis onset were 34 days in 4 patients (range, 24-46 days) and 491 days in 2 subjects (range, 454-528 days). The mean drug trough level at presentation was 8.2 microg/L (range, 5.5-13.8 microg/L). The most common symptoms were dry cough (n = 6), fever (n = 5), and dyspnea (n = 4). Imaging tests revealed lower lobe involvement in all patients. Bronchoalveolar lavage performed in 4 patients showed lymphocytic alveolitis. All patients completely recovered after drug withdrawal. Five patients received steroids, 5 were switched to a calcineurin inhibitor, and 1 was switched to the other mTOR inhibitor. In conclusion, mTOR inhibitor-associated pneumonitis is a rare disease. Sirolimus did not cause more cases of pneumonitis than everolimus. Pneumonitis development was not dependent upon the drug blood level. Lower lobe involvement and lymphocytic alveolitis were usually present. Discontinuation of the mTOR inhibitor with steroid prescription resulted in adequate outcomes. A change to the other mTOR inhibitor should be contemplated if patient circumstances require this type of immunosuppression.

Intimidación en colegios estatales de secundaria del Perú / Bullying in secondary national schools of Perú

Objetivo: conocer la frecuencia de intimidación en colegios nacionales de las tres regiones del Perú donde ha existido violencia política y determinar los factores de riesgo asociados.Métodos: estudio transversal, analítico, acerca de la intimidación en cinco departamentos del país: Ayacucho (Huamanga), Cusco (Sicuani), Junín (Satipo), Huancavelica y Lima (Ñaña). Después de determinar el tamaño de muestra de los estudiantes y efectuar la selección aleatoria de los salones de clase se empleó un cuestionario previamente validado para efectuar una encuesta en 1633 estudiantes. Estadísticamente se buscaron porcentajes, asociación de variables con intimidación, regresión logistica y se construyó una curva R.O.C.Resultados: la incidencia de intimidación tuvo un promedio de 50.7 por ciento. Las variables asociadas significativamente con intimidación en la regresión logistica fueron apodos, golpes, falta de comunicación, llamar homosexual, defectos físicos, necesidad de trabajar, necesidad de atención médica, acoso, escupir, obligar a hacer cosas que no se quiere, discriminación e insulto por correo electrónico.Conclusiones: la intimidación tiene origen multicausal, ocasiona problemas en la salud, fobia escolar, y el pronóstico a largo plazo para víctimas y agresores es negativo, pudiendo verse envueltos en problemas con la ley.

Objective: To know the frequency of bullying in national schools in the three peruvian regions where has existed political violence, and determine the associated risk factors. Methods: cross section study, analytic, about bullying in national schools of five departments Ayacucho (Huamanga), Cusco (Sicuani), Junín (Satipo), Huancavelica and Lima (Ñaña). After determine the sample size of students in each school and the aleatory election of the classrooms a questionnaire validated previously was used, and we did a survey in 1633 students. Statistically We look for percentage,s, associations, logistic regression measures and build a R.O.C curve. Results: The incidente of bullying was in average 50,7 percent The variables significant associated with bullying in the logistic regression were nicknames, beats, no communication, homosexual insult, physical defect, work need, medical attendance, pursue, spitted, forced to do thing than they didn't want, discrimination and e-mail inssult. Conclussions: The bullying has multicausal origin, give health problems, scholar phobia, and at long time the prognosis for victims and agressors is negative and they could be involved in problems with the law.

Detección precoz de enfermedad renal en escolares asintománticos de 5-12 años en el centro Educativo 6097 "Mateo Pumacahua" en Surco - Lima * Setiembre - Octubre 2007 / Early detection of renal disease in school children 5-12 years of asintománticos at school 6097

El nuevo enfoque para el tratamiento de pacientes pediátricos renales se orienta a la detección temprana de la enfermedad renal. El objetivo fue identificar la presencia de patología urinaria precoz en pacientes sin síntomas renales y determinar su factibilidad para prevenir el desarrollo de insuficiencia renal crónica terminal, en escolares asintomáticos de 5-12 años del CE. 6097 "Mateo Pumacahua" en el distrito de Surco en Lima. Se realizó un exámen de orina mediante tiras reactivas. A los resultados positivos para leucocituria se les tomó una muestra adicional el mismo día para realizar un sedimento y urocultivos. Las muestras positivas para hematuria y proteinuria fueron incluidos en una segunda toma de muestras dos semanas después. De persistir éstas, se procedió a realizar un sedimento urinario. Durante la primera toma de muestra se encontraron: Hematíes positivos (2,84%), nitritos positivos (1,54%), proteinas positivas (1,03%) y leucocitos positivos (0,77%). Se encontró que el 75% de las hematurias y el 100% de las proteinurias y leucociturias correspondían a pacientes de sexo femenino. Además se halló una mayor incidencia de resultados patológicos en el grupo etáreo de 9-12 años que en el de 5-8 años. Los porcentajes de leucocituria, hematuria y proteinuria (5,41%) fueron menores que en la bibliografía consultada. Un mayor (4,12%) al reportado por anteriores investigaciones, persistió con una muestra patológica al realizar una nueva toma de muestras y sedimento. Es recomendable realizar campañas preventivas de detección de patología renal precoz ya que se enncuentran un alto porcentaje de niños con resultados persistentes patológicos.

The new approach for treating pediatric kidney patients is aimed at early detection of kidney disease. Our goal was to identify the presence of patology early urinary symptoms in patients without kidney and determine their feasibility to prevent the development of chronic renal failure terminal, asymptomatic school children 5-12 years of Estatal Center. 6097 "Matthew Pumacahua" of Surco district. A review was conduted using urine test strips. The positive result for leucocituria they took and additional sample the same day for a urine culture and sediment. Positive samples for hematuria and proteinuria were included in a second sampling two weeks later. Of these persist, it proceeded to conduct a urine sediment. During the first sampling were found: red cells positive (2.84%) and nitrates positive (1.54%), proteins positive (1.03%) and positive leukocytes (0.77%) was found that 75% from hematuria and 100% of proteinuria and leucocituria corresponded to female patients. Also found was a higter incidence o pathological findieng in the age group 9-12 years than in the rates of 5-8 years. The percents of leucocituria, hematuria and proteinuria (5.41%) were lower than in the literature. A higher percentage (4.12%) reported by previous investigations, pathological persisted with a sample to make a new sampling and sediment. We recommend preventive campaigs to detect early kidney disease because there is a high percentage of children with persistent pathological results.

Secondary amyloidosis associated with histiocytosis X.

We report a 34-year-old man diagnosed with Langerhans cell histiocytosis (LCH) or histiocytosis X in 1980. He had multiple focal osseous lesions, difficult control of the disease activity and was treated many times with chemo- and radiotherapy for symptomatic control. His kidney disease started 20 years after the diagnosis with progressive renal failure and increasing non-nephrotic proteinuria, coinciding with two flares of LCH. A percutaneous renal biopsy demonstrated amyloidosis. There is only one case described in the amyloidosis literature associated with LCH.

BCL6 represses NFkappaB activity in diffuse large B-cell lymphomas.

BCL6 is a transcriptional repressor whose deregulated expression plays a key role in diffuse large B-cell lymphomas (DLBCLs). BCL6 expression characterizes one of the two main subtypes (GC type) of DLBCL, while the other (ABC type) is recognized by increased NFkappaB activation. The mechanistic basis of this distinction remains unclear and the BCL6 targets have been only partially explored. Here we describe how NFkappaB activity is increased after BCL6 silencing by shRNA in DLBCL cells, leading us to propose that BCL6 represses NFkappaB activity. We also demonstrate that this repression is brought about by a mechanism involving protein-protein interaction between BCL6 and NFkappaB members, both in vitro and in vivo. Analysis of a series of DLBCLs shows a negative correlation between the expression of NFkappaB target genes and BCL6. This combined approach using silenced cells and a series of human DLBCL samples leads us to a better understanding of the role of BCL6 as an NFkappaB regulator in B-cells.

Evaluation of the efficacy and safety of the conversion from a calcineurin inhibitor to an everolimus-based therapy in maintenance renal transplant patients.

Everolimus has recently been introduced into clinical practice with promising perspectives due to its efficacy, lack of nephrotoxicity, and antitumor effects. Experience in clinical trials associated with low-dose cyclosporine showed good results, but there is almost no experience in calcineurin inhibitor (CNI) elimination learning it as the primary immunosuppressant. We describe our experience in a series of 78 stable renal transplant patients who were switched to Everolimus with complete and quick elimination of the CNI: the procedure of conversion, pharmacokinetic results after conversion, evolution of renal parameters (renal function, proteinuria, and others), and safety data (acute rejection and adverse events). An initial dose of 3 mg/d was adequate to obtain the recommended trough levels between 5 and 10 ng/mL. Our results demonstrated that conversion to Everolimus was a simple, safe procedure that must be considered in patients CNI toxicity, especially those with malignant neoplasms and progressive deterioration of renal function due to chronic allograft nephropathy.

Conversion to sirolimus in renal transplant patients with tumors.

BACKGROUND: Conversion from calcineurin inhibitors (CNI) to sirolimus (SRL) is an option for renal transplant patients who develop a tumor. This strategy, however, may be associated with an increased risk of rejection. AIM: We sought to evaluate a series of renal transplant patients who underwent conversion from CNI to SRL because they developed a tumor during the posttransplant period. METHODS: This prospective study of 29 patients included 2 patients with skin cancer (1 melanoma and 1 squamous cell carcinoma) and 27 patients who developed other tumors: lung (n = 6), prostate (n = 4), lymphoma (n = 2), colon adenocarcinoma (n = 2), kidney (n = 2), Kaposi sarcoma (n = 2), urothelium (n = 1), parotid (n = 1), larynx (n = 1), gastric (n = 1), breast (n = 1), tongue (n = 1), liver (n = 1), xanthoastrocytoma (n = 1), and aggressive angiomyxoma of the perineum (n = 1). RESULTS: CNI were withdrawn in 28 patients and reduced in the remaining patient. Renal function was better when CNI were rapidly or abruptly suspended, with maintenance of cyclosporine (CsA) + SRL for more than 3 months being especially detrimental. Proteinuria worsened in patients whose preconversion levels were >0.5 g/d, particularly those treated with CsA. There was no episode of rejection. CONCLUSIONS: SRL is a promising option for the management of posttransplant tumors. The switch in immunosuppression should be undertaken quickly, especially in patients under treatment with CsA.

[Rapid recurrence of ANCA-MPO positive vasculitis after non-heart beating donor renal transplantation]. / Recurrencia rápida de una vasculitis ANCA-MPO positivo tras trasplante renal de donante en asistolia.

We report a patient with end stage renal disease with lesions compatibles with renal vasculitis antineutrophil cytoplasmic autoantibody (ANCA)-associated in phase of sclerosis that underwent renal transplantation from a non-heart beating donor after one year of haemodialysis treatment, without evidence of active vasculitis. Post-transplantation management was performed according to our protocol in this kind of donors with immunosuppressive treatment based on daclizumab, half-doses of tacrolimus, mycophenolate mofetil and steroids. In the third week the renal biopsy showed an acute necrotizing vasculitis associated with crescent glomerulonephritis. The patient was initially diagnosed of acute vascular rejection and initiated treatment with 6-metilprednisolone and anti-CD3 monoclonal anti-bodies. Two days later he developed a cutaneous purpura and the skin biopsy showed an acute necrotizing vasculitis. The determination of circulating ANCA-anti-myeloperoxidase (MPO) was positive. We initiated treatment with oral cyclophosphamide plus mycophenolate mofetil discontinuation with rapid improvement of cutaneous lesions and initiation of renal function recovery.

The perfusion pressure in non-heart-beating donors may expand the glomeruli.

INTRODUCTION: We have observed expanded glomeruli in biopsies of kidneys from non-heart-beating donors (NHBDs). We sought to determine the differences in glomerular size between NHBDs and brain-dead donors and to assess whether glomerular size impacted graft outcome. METHODS: We estimated the glomerular area using the maximal planar area (MPA) method in 198 pretransplant biopsies from 119 donors: 54 (45.4%) NHBDs and 65 (54.6%) brain-dead donors. Donor data and graft outcomes were correlated with MPA and percentage of glomerulosclerosis. The range of follow-up was 1 to 3 years. Uni- and multivariate analyses were performed. RESULTS: MPA was larger among NHBDs. MPA and GS both significantly correlated with donor age. The association between MPA and age was independent of nephron loss (ie; GS). Increased glomerular size was only observed among donors younger than 50 years. Graft survival and function were not independently associated with MPA. Donor age was a better predictor of graft outcome. CONCLUSIONS: The perfusion pressure used in NHBDs may expand the glomeruli, but this maneuver does not have any effect on graft outcome. Among donors without severe changes, glomerular size increment shows a limit around the sixth decade of life. In our study, MPA was not an independent predictor of graft survival or function.

Identification of a nuclear export signal in the KSHV latent protein LANA2 mediating its export from the nucleus.

LANA2 is a latent protein detected in Kaposi's sarcoma-associated herpesvirus (KSHV)-infected B cells that inhibits p53-dependent transcriptional transactivation and apoptosis and PKR-dependent apoptosis, suggesting an important role in the transforming activity of the virus. It has been reported that LANA2 localizes into the nucleus of both KSHV-infected B cells and transiently transfected HeLa cells. In this study, we show that LANA2 is a nucleocytoplasmic shuttling protein that requires a Rev-type nuclear export signal located in the C-terminus to direct the protein to the cytoplasm, through an association with the export receptor CRM1. In addition, a functional protein kinase B (PKB)/Akt phosphorylation motif partially overlapping with the nuclear export signal was identified. Nuclear exclusion of LANA2 was negatively regulated by the phosphorylation of threonine 564 by Akt. The ability of LANA2 to shuttle between nucleus and cytoplasm has implications for the function of this viral protein.

[BK virus in kidney allografts: a search for histologic evidence of the infection]. / Virus BK en injertos renales: evidencia histológica de la infección.

BACKGROUND: BK virus (BKV) associated interstitial nephritis is a complication in renal transplantation recipients. Its incidence is controversial. The aim of the present study is to determine the incidence of histopathologic evidence of BKV-infection in a single centre. MATERIALS AND METHODS: Renal allograft tissue samples (n = 838) from 526 patients undergoing renal transplant were evaluated by light microscopy. Polymerase chain reaction (PCR) assay for BKV DNA was performed in 41 microdissected cell populations from cases with viral inclusions, cases with other nuclear changes, and cases without nuclear changes. RESULTS: Polyomavirus-inclusions were identified in six cases (five with interstitial nephritis and other one with only urothelial infection). In one case with interstitial nephritis the DNA was degraded. PCR confirmed BKV infection in the other five and was negative in cases without inclusions. CONCLUSIONS: Five patterns of inclusions bodies are observed and they appear to be characteristic. PCR assay seemingly have a high specificity for BKV detection and it does not usually detect latent viral infection.