RESUMEN
BACKGROUND: When designing therapeutic short-interfering RNAs (siRNAs), off-target effects (OTEs) are usually predicted by computational quantification of messenger RNAs (mRNAs) that contain matches to the siRNA seed sequence in their 3' UTRs. It is assumed that the higher the number of predicted transcriptional OTEs, the greater the size of the actual OTE signature and the more detrimental the phenotypic consequences in target-negative cells. METHODS: We tested this general assumption by investigating the OTEs of potential therapeutic siRNAs targeting the human papillomavirus (HPV) type-16 E7 oncogene. We studied HPV-negative squamous epithelial cells, from normal cervix (NCx) and skin (HaCaT), which would be vulnerable to 'bystander' OTEs following transfection in vivo. RESULTS: We observed no correlation between the number of computationally predicted OTEs and the actual number of seed-dependent OTEs (P=0.76). On average only 20.5% of actual transcriptional OTEs were seed-dependent (i.e., predicted). The unpredicted OTEs included stimulation of innate immune pathways, as well as indirect (downstream) effects of other OTEs, which affected important cancer-associated pathways. Although most significant OTEs observed were seen in both NCx and HaCaT cells, only 0-5.9% of differentially expressed genes overlapped between the two cell types. CONCLUSION: These data do not support the assumption that actual OTEs correlate well with predicted OTEs.
Asunto(s)
Papillomavirus Humano 16/genética , Proteínas E7 de Papillomavirus/genética , Neoplasias del Cuello Uterino/virología , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/virología , Línea Celular Tumoral , Cuello del Útero/citología , Células Epiteliales/virología , Femenino , Humanos , Interferencia de ARN , ARN Interferente Pequeño , Piel/citología , Neoplasias del Cuello Uterino/genéticaRESUMEN
Previously we reported that internalized ligand-receptor complexes are transported within the alveolar macrophage at a rate that is independent of the ligand and/or receptor but is dependent on the endocytic apparatus (Ward, D. M., R. S. Ajioka, and J. Kaplan. 1989. J. Biol. Chem. 264:8164-8170). To probe the mechanism of intracellular vesicle transport, we examined the ability of vesicles internalized at different times to fuse. The mixing of ligands internalized at different times was studied using the 3,3'-diaminobenzidine/horseradish peroxidase density shift technique. The ability of internalized vesicles to fuse was dependent upon their location in the endocytic pathway. When ligands were administered as tandem pulses a significant amount of mixing (20-40%) of vesicular contents was observed. The pattern of mixing was independent of the ligands employed (transferrin, mannosylated BSA, or alpha macroglobulin), the order of ligand addition, and temperature (37 degrees C or 28 degrees C). Fusion was restricted to a brief period immediately after internalization. The amount of fusion in early endosomes did not increase when cells, given tandem pulses, were chased such that the ligands further traversed the early endocytic pathway. Little fusion, also, was seen when a chase was interposed between the two ligand pulses. The temporal segregation of vesicle contents seen in early endosomes was lost within late endosomes. Extensive mixing of vesicle contents was observed in the later portion of the endocytic pathway. This portion of the pathway is defined by the absence of internalized transferrin and is composed of ligands en route to lysosomes. Incubation of cells in iso-osmotic medium in which Na+ was replaced by K+ inhibited movement of internalized ligands to the lysosome, resulting in ligand accumulation within the late endocytic pathway. The accumulation of ligand was correlated with extensive mixing of sequentially internalized ligands. Although significant amounts of ligand degradation were observed, this compartment was devoid of conventional lysosomal markers such as acid glycosidases. These results indicate changing patterns of vesicle fusion within the endocytic pathway, with a complete loss of temporal ligand segregation in a prelysosomal compartment.
Asunto(s)
Endocitosis , Macrófagos/metabolismo , Orgánulos/metabolismo , Albúmina Sérica , Animales , Transporte Biológico , Fraccionamiento Celular , Células Cultivadas , Centrifugación por Gradiente de Densidad , Cinética , Ligandos , Manosa/metabolismo , Fusión de Membrana , Conejos , Albúmina Sérica Bovina/metabolismo , Transferrina/metabolismo , alfa-Macroglobulinas/metabolismoRESUMEN
Rabbit alveolar macrophages which were treated at 0 degrees C with phenylarsine oxide and then incubated at 37 degrees C for 10 min exhibited a two- to threefold increase in surface receptor activity for macroglobulin.protease complexes, diferric transferrin, and mannose-terminal glycoproteins. Analysis of the concentration-dependence of ligand binding indicated that changes in ligand-binding activity were due to changes in receptor number rather than alterations in ligand-receptor affinity. Surface receptor number could also be increased by treatment of cells with three other sulfhydryl reagents, N-ethylmaleimide, p-chloromercurobenzoate, and iodoacetic acid. The increase in receptor activity was maximal after 10 min and decreased over the next hour. This decrease in cell-associated receptor activity was due to the release of large membrane vesicles which demonstrated a uniform buoyant density by isopycnic sucrose gradient centrifugation. Treatment of cells with phenylarsine oxide did not decrease the cellular content of lactate dehydrogenase or beta-galactosidase, indicating that cell integrity was maintained and lysosomal enzyme release did not occur. Our studies indicate that phenylarsine oxide treatment in the presence of extracellular Ca2+ results in the fusion of receptor-containing vesicles with the cell surface.
Asunto(s)
Arsenicales/farmacología , Lectinas Tipo C , Macrófagos/efectos de los fármacos , Lectinas de Unión a Manosa , Receptores de Superficie Celular/metabolismo , Albúmina Sérica , Animales , Calcio/farmacología , Membrana Celular/metabolismo , Exocitosis/efectos de los fármacos , Membranas Intracelulares/metabolismo , Proteína 1 Relacionada con Receptor de Lipoproteína de Baja Densidad , Macrófagos/enzimología , Magnesio/farmacología , Manosa/metabolismo , Receptor de Manosa , Fusión de Membrana/efectos de los fármacos , Metilaminas/farmacología , Alveolos Pulmonares/citología , Conejos , Receptores de Superficie Celular/efectos de los fármacos , Receptores de Concanavalina A/metabolismo , Receptores Inmunológicos/metabolismo , Receptores de Transferrina , Albúmina Sérica Bovina/metabolismo , Reactivos de Sulfhidrilo/farmacología , Tripsina/metabolismo , alfa-Macroglobulinas/metabolismoRESUMEN
Lysosomes are dynamic structures capable of fusing with endosomes as well as other lysosomes. We examined the biochemical requirements for homotypic lysosome fusion in vitro using lysosomes obtained from rabbit alveolar macrophages or the cultured macrophage-like cell line, J774E. The in vitro assay measures the formation of a biotinylated HRP-avidin conjugate, in which biotinylated HRP and avidin were accumulated in lysosomes by receptor-mediated endocytosis. We determined that lysosome fusion in vitro was time- and temperature-dependent and required ATP and an N-ethylmaleimide (NEM)-sensitive factor from cytosol. The NEM-sensitive factor was NSF as purified recombinant NSF could completely replace cytosol in the fusion assay whereas a dominant-negative mutant NSF inhibited fusion. Fusion in vitro was extensive; up to 30% of purified macrophage lysosomes were capable of self-fusion. Addition of GTPgammas to the in vitro assay inhibited fusion in a concentration-dependent manner. Purified GDP-dissociation inhibitor inhibited homotypic lysosome fusion suggesting the involvement of rabs. Fusion was also inhibited by the heterotrimeric G protein activator mastoparan, but not by its inactive analogue Mas-17. Pertussis toxin, a Galphai activator, inhibited in vitro lysosome fusion whereas cholera toxin, a Galphas activator did not inhibit the fusion reaction. Addition of agents that either promoted or disrupted microtubule function had little effect on either the extent or rate of lysosome fusion. The high value of homotypic fusion was supported by in vivo experiments examining lysosome fusion in heterokaryons formed between cells containing fluorescently labeled lysosomes. In both macrophages and J774E cells, almost complete mixing of the lysosome labels was observed within 1-3 h of UV sendai-mediated cell fusion. These studies provide a model system for identifying the components required for lysosome fusion.
Asunto(s)
Lisosomas/fisiología , Macrófagos Alveolares/fisiología , Adenosina Trifosfato/fisiología , Animales , Avidina/análogos & derivados , Biotinilación , Fusión Celular/efectos de los fármacos , Núcleo Celular/fisiología , Sistema Libre de Células , Proteínas de Unión al GTP/fisiología , Guanosina Trifosfato/farmacología , Peroxidasa de Rábano Silvestre , Lisosomas/química , Lisosomas/efectos de los fármacos , Macrófagos Alveolares/efectos de los fármacos , Microtúbulos/fisiología , Conejos , Sensibilidad y EspecificidadRESUMEN
Incubation of alveolar macrophages in hypoosmotic K(+)-containing buffers results in persistent cell swelling and an inability to undergo regulatory volume decrease. We demonstrate that cells incubated in hypo-K+ show an inhibition of endocytosis without any observed alteration in recycling. The inhibition of endocytosis affected all forms of membrane internalization, receptor and fluid phase. Both increased cell volume and the inhibition of endocytosis could be released upon return of cells to iso-Na+ buffers. The ability to synchronize the endocytic apparatus allowed us to examine hypotheses regarding the origin and maturation of endocytic vesicles. Incubation in hypo-K+ buffers had no effect on the delivery of ligands to degradative compartments or on the return of previously internalized receptors to the cell surface. Thus, membrane recycling and movement of internalized components to lysosomes occurred in the absence of continued membrane influx. We also demonstrate that fluorescent lipids, that had been incorporated into early endosomes, returned to the cell surface upon exposure of cells to hypo-K+ buffers. These results indicate that the early sorting endosome is a transient structure, whose existence depends upon continued membrane internalization. Our data supports the hypothesis that the transfer of material to lysosomes can best be explained by the continuous maturation of endosomes.
Asunto(s)
Endocitosis/fisiología , Endosomas/fisiología , Macrófagos Alveolares/fisiología , Animales , Transporte Biológico , Membrana Celular/fisiología , Tamaño de la Célula , Colorantes Fluorescentes , Metabolismo de los Lípidos , Macrófagos Alveolares/citología , Potasio/fisiología , ConejosRESUMEN
The Amoco Cadiz oil spill (223,000 metric tons) of March 1978 is the largest and best studied tanker spill in history. Of the total oil lost, 30,000 tons (13.5 percent) rapidly became incorporated into the water column, 18,000 tons (8 percent) were deposited in subtidal sediments, 62,000 tons (28 percent) washed into the intertidal zone, and 67,000 tons (30 percent) evaporated. While still at sea, approximately 10,000 tons of oil were degraded microbiologically. After 3 years, the most obvious effects of the spill have passed, although hydrocarbon concentrations remain elevated in those estuaries and marshes that were initially most heavily oiled.
RESUMEN
This review summarizes a decade of research in which we have used molecular methods, in conjunction with more traditional approaches, to study hot spring cyanobacterial mats as models for understanding principles of microbial community ecology. Molecular methods reveal that the composition of these communities is grossly oversimplified by microscopic and cultivation methods. For example, none of 31 unique 16S rRNA sequences detected in the Octopus Spring mat, Yellowstone National Park, matches that of any prokaryote previously cultivated from geothermal systems; 11 are contributed by genetically diverse cyanobacteria, even though a single cyanobacterial species was suspected based on morphologic and culture analysis. By studying the basis for the incongruity between culture and molecular samplings of community composition, we are beginning to cultivate isolates whose 16S rRNA sequences are readily detected. By placing the genetic diversity detected in context with the well-defined natural environmental gradients typical of hot spring mat systems, the relationship between gene and species diversity is clarified and ecological patterns of species occurrence emerge. By combining these ecological patterns with the evolutionary patterns inherently revealed by phylogenetic analysis of gene sequence data, we find that it may be possible to understand microbial biodiversity within these systems by using principles similar to those developed by evolutionary ecologists to understand biodiversity of larger species. We hope that such an approach guides microbial ecologists to a more realistic and predictive understanding of microbial species occurrence and responsiveness in both natural and disturbed habitats.
Asunto(s)
Bacterias/genética , Fenómenos Fisiológicos Bacterianos , Cianobacterias/fisiología , Ecosistema , Microbiología del Agua , Bacterias/clasificación , Bacterias/crecimiento & desarrollo , Bacterias/aislamiento & purificación , Cianobacterias/crecimiento & desarrollo , Agua Dulce , Genes Bacterianos , Calor , Filogenia , ARN Ribosómico 16S/genéticaRESUMEN
A microbial species concept is crucial for interpreting the variation detected by genomics and environmental genomics among cultivated microorganisms and within natural microbial populations. Comparative genomic analyses of prokaryotic species as they are presently described and named have led to the provocative idea that prokaryotes may not form species as we think about them for plants and animals. There are good reasons to doubt whether presently recognized prokaryotic species are truly species. To achieve a better understanding of microbial species, we believe it is necessary to (i) re-evaluate traditional approaches in light of evolutionary and ecological theory, (ii) consider that different microbial species may have evolved in different ways and (iii) integrate genomic, metagenomic and genome-wide expression approaches with ecological and evolutionary theory. Here, we outline how we are using genomic methods to (i) identify ecologically distinct populations (ecotypes) predicted by theory to be species-like fundamental units of microbial communities, and (ii) test their species-like character through in situ distribution and gene expression studies. By comparing metagenomic sequences obtained from well-studied hot spring cyanobacterial mats with genomic sequences of two cultivated cyanobacterial ecotypes, closely related to predominant native populations, we can conduct in situ population genetics studies that identify putative ecotypes and functional genes that determine the ecotypes' ecological distinctness. If individuals within microbial communities are found to be grouped into ecologically distinct, species-like populations, knowing about such populations should guide us to a better understanding of how genomic variation is linked to community function.
Asunto(s)
Cianobacterias/clasificación , Cianobacterias/genética , Ecosistema , Genómica , Ambiente , Genética de PoblaciónRESUMEN
Endocytosis in alveolar macrophages can be reversibly inhibited, permitting the isolation of endocytic vesicles at defined stages of maturation. Using an in vitro fusion assay, we determined that each isolated endosome population was capable of homotypic fusion. All vesicle populations were also capable of heterotypic fusion in a temporally specific manner; early endosomes, isolated 4 min after internalization, could fuse with endosomes isolated 8 min after internalization but not with 12-min endosomes or lysosomes. Lysosomes fuse with 12-min endosomes but not with earlier endosomes. Using homogenous populations of endosomes, we have identified Syntaxin 7 as a soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) required for late endosome-lysosome and homotypic lysosome fusion in vitro. A bacterially expressed human Syntaxin 7 lacking the transmembrane domain inhibited homotypic late endosome and lysosome fusion as well as heterotypic late endosome-lysosome fusion. Affinity-purified antibodies directed against Syntaxin 7 also inhibited lysosome fusion in vitro but had no affect on homotypic early endosome fusion. Previous work suggested that human VAMP-7 (vesicle-associated membrane protein-7) was a SNARE required for late endosome-lysosome fusion. A bacterially expressed human VAMP-7 lacking the transmembrane domain inhibited both late endosome-lysosome fusion and homotypic lysosome fusion in vitro. These studies indicate that: 1) fusion along the endocytic pathway is a highly regulated process, and 2) two SNARE molecules, Syntaxin 7 and human VAMP-7, are involved in fusion of vesicles in the late endocytic pathway in alveolar macrophages.
Asunto(s)
Endosomas/fisiología , Lisosomas/fisiología , Macrófagos Alveolares/fisiología , Proteínas de la Membrana/metabolismo , Proteínas de Transporte Vesicular , Animales , Células Cultivadas , Endocitosis/fisiología , Humanos , Macrófagos Alveolares/citología , Macrófagos Alveolares/metabolismo , Fusión de Membrana/fisiología , Proteínas de la Membrana/genética , Proteínas Qa-SNARE , Proteínas R-SNARE , Conejos , Ratas , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/metabolismo , Proteínas SNARE , Solubilidad , Factores de TiempoRESUMEN
OBJECTIVE: Small-for-gestational-age (SGA) neonates, infants of diabetic mothers (IDM) and very-low-birth weight premature neonates (VLBW) are reported to have increased risk for developing iron deficiency and possibly associated neurocognitive delays. STUDY DESIGN: We conducted a pilot study to assess iron status at birth in at-risk neonates by measuring iron parameters in umbilical cord blood from SGA, IDM, VLBW and comparison neonates. RESULTS: Six of the 50 infants studied had biochemical evidence of iron deficiency at birth. Laboratory findings consistent with iron deficiency were found in one SGA, one IDM, three VLBW, and one comparison infant. None of the infants had evidence of iron deficiency anemia. CONCLUSIONS: Evidence of biochemical iron deficiency at birth was found in 17% of screened neonates. Studies are needed to determine whether these infants are at risk for developing iron-limited erythropoiesis, iron deficiency anemia or iron-deficient neurocognitive delay.
Asunto(s)
Anemia Ferropénica/sangre , Recién Nacido Pequeño para la Edad Gestacional/sangre , Recién Nacido de muy Bajo Peso/sangre , Hierro/sangre , Estudios de Casos y Controles , Diabetes Gestacional , Femenino , Ferritinas/sangre , Sangre Fetal/química , Humanos , Recién Nacido , Modelos Lineales , Masculino , Proyectos Piloto , Embarazo , Embarazo en Diabéticas , Estudios Prospectivos , Factores de Riesgo , UtahRESUMEN
Direct molecular analyses of natural microbial populations reveal patterns that should compel microbiologists to adopt a more natural species concept that has been known to biologists for decades. The species debate can be exploited to address a larger issue - microbiologists need, in general, to take a more natural view of the organisms they study.
Asunto(s)
Bacterias/clasificación , ADN Ribosómico , Ecología , Evolución Molecular , Bacterias/genéticaRESUMEN
Molecular methods are beginning to reveal inhabitants of natural microbial communities which have never before been cultured. Our approach involves selective cloning of naturally occurring 16S rRNA sequences as cDNA, and comparison of these sequences to a database which includes 16S rRNA sequences of isolated community members. We provide here an overview of the method and its potential for community analysis. A 16S rRNA sequence retrieved from the well-studied hot spring cyanobacterial mat in Octopus Spring (Yellowstone National Park) is shown as an example of one contributed by an uncultured member of the community.
Asunto(s)
Cianobacterias/genética , ARN Ribosómico 16S/genética , ARN Ribosómico/genética , Secuencia de Bases , ADN/genética , Sistemas de Información , Datos de Secuencia Molecular , Filogenia , Homología de Secuencia de Ácido Nucleico , TemperaturaRESUMEN
PURPOSE: The trial was undertaken to study the effect of administering granulocyte-macrophage colony-stimulating factor (GM-CSF) with and without peripheral-blood progenitor cells (PBPC) on the hematologic and nonhematologic toxicity observed with multiple cycles of high-dose carboplatin chemotherapy. PATIENTS AND METHODS: Eighteen patients with a variety of solid tumors received a total of 40 cycles of carboplatin, 1,200 mg/m2 per cycle, administered by continuous infusion over 96 hours. All 40 courses were administered with a daily 4-hour intravenous (IV) infusion of either 5 or 10 micrograms/kg/d of recombinant human Escherichia coli-derived GM-CSF. The first 20 courses were administered without PBPC support (treatment A). Because of severe neutropenia and thrombocytopenia, the next 20 courses of therapy were administered with GM-CSF, PBPC, and oral antibiotic prophylaxis (treatment B). RESULTS: The addition of PBPC support led to a significant reduction in the duration of neutropenia (10.5 v 7.5 days; P = .027) and thrombocytopenia (12.4 v 5.2 days; P = .001), number of RBC transfusions (six v three; P = .01) and platelet transfusions (10.3 v 3.7; P = .013), number of hospital days (12.6 v 2.9; P = .01), and days of IV antibiotics (11.8 v 2.4; P = .007) per cycle. Significant increases in the weekly dose intensity (206 v 285 mg/m2/wk; P = .014) and total dose (2,287 v 3,600 mg/m2; P = .018) of carboplatin delivered were also observed with treatment B. The overall response rate in this study was 70%, with 11 of 16 assessable patients achieving either a complete (three patients) or partial (eight patients) remission. CONCLUSION: This combination of GM-CSF and PBPC infusion represents an effective method for delivering multiple cycles of high-dose carboplatin chemotherapy and may serve as a model for the administration of high-dose chemotherapy in future trials.
Asunto(s)
Carboplatino/efectos adversos , Factor Estimulante de Colonias de Granulocitos y Macrófagos/uso terapéutico , Neoplasias/tratamiento farmacológico , Neutropenia/prevención & control , Trasplante de Células Madre , Trombocitopenia/prevención & control , Adulto , Carboplatino/administración & dosificación , Terapia Combinada , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , Proteínas Recombinantes/uso terapéutico , Trombocitopenia/inducido químicamenteRESUMEN
A double-blind crossover comparison was made in 18 nonedematous hypertensive subjects with glomerular filtration rates exceeding 70 ml/min/1.73 m2 of the effects of 5 mg metolazone and 5 mg bendroflumethiazide on blood pressure and metabolic parameters. After a 4-wk run-in placebo period, patients received either metolazone or bendroflumethiazide for 6 wk in a crossover fashion with an intervening washout period of 4 wk. Metolazone induced a more sustained and greater blood pressure response than bendroflumethiazide. Changes in plasma potassium, urate, bicarbonate, renin, and angiotensin II occurred during treatment with both metolazone and bendroflumethiazide; the only significant difference, however, was in changes in plasma bicarbonate. Total body potassium (TBK), measured by whole-body monitor, did not fall outside the normal range with either metolazone or bendroflumethiazide, although metolazone induced a greater reduction in TBK (6.2 gm, 5.5% of TBK) than bendroflumethiazide (1.2 gm, 1.1% of TBK, p < 0.05). Our results suggest that metolazone is a more effective antihypertensive and induces similar but greater metabolic changes than bendroflumethiazide. The results of our comparison suggest that although changes in plasma potassium and TBK are minor, they are greater with metolazone, and potassium supplements may not be necessary in nonedematous hypertensive patients with normal renal function.
Asunto(s)
Antihipertensivos/uso terapéutico , Bendroflumetiazida/uso terapéutico , Diuréticos/uso terapéutico , Hipertensión/tratamiento farmacológico , Metolazona/uso terapéutico , Adolescente , Adulto , Anciano , Bendroflumetiazida/efectos adversos , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Metolazona/efectos adversos , Persona de Mediana Edad , Potasio/análisisRESUMEN
Previous studies have demonstrated impaired complex I activity in platelets from Parkinson's disease (PD) patients who were receiving levodopa and other medications for their disease. Eleven patients with early PD underwent three sequential plateletphereses: while on no medication, after receiving carbidopa/levodopa for 1 month, and after receiving carbidopa/levodopa plus selegiline for 1 additional month. As expected, carbidopa/levodopa and selegiline significantly improved motor function in these patients. Treatment with carbidopa/levodopa alone and carbidopa/levodopa plus selegiline did not affect the activities of complexes I, II/III, and IV and citrate synthetase. These observations support the hypothesis that impaired complex I activity in PD patients is a characteristic of the disease and not due to medications.
Asunto(s)
Plaquetas/enzimología , Carbidopa/uso terapéutico , Levodopa/uso terapéutico , Mitocondrias/enzimología , Enfermedad de Parkinson/sangre , Enfermedad de Parkinson/tratamiento farmacológico , Selegilina/uso terapéutico , Adulto , Anciano , Análisis de Varianza , Plaquetas/efectos de los fármacos , Citrato (si)-Sintasa/sangre , Transporte de Electrón , Complejo II de Transporte de Electrones , Complejo III de Transporte de Electrones/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mitocondrias/efectos de los fármacos , Complejos Multienzimáticos/sangre , NAD(P)H Deshidrogenasa (Quinona)/sangre , Oxidorreductasas/sangre , Plaquetoferesis , Succinato Deshidrogenasa/sangreRESUMEN
The incidence of systemic bleeding events and extracorporeal clotting was studied in 57 critically ill acute renal failure patients treated with intermittent hemodialysis (IHD) and/or continuous arteriovenous hemodialysis (CAVHD), using heparin (Hep), saline-flush (Sal, no anticoagulant), and citrate (Cit) anticoagulation protocols. Thirty-seven patients received a single dialysis modality, and 20 changed modalities one or more times, each change of dialysis type (IHD or CAVHD) or anticoagulant protocol being considered as a new course of treatment. The study was non-randomized, with a demonstrable bias towards using Hep for patients at lower risk of bleeding, and Sal or Cit for higher risk patients. Despite this bias, new bleeding events occurred during 26% of 35 courses of HepIHD and HepCAVHD, and during 0% of 24 courses of CitIHD and CitCAVHD (P < 0.009). Troublesome dialyzer/filter clotting occurred during one course of HepCAVHD, and during 12% of 129 SalIHD procedures; 28% of 29 courses of SalIHD were terminated for this reason. CitCAVHD was well tolerated and proved superior to other modalities in freedom from bleeding events and clotting problems. Alternatives to heparin anticoagulation should be made available for high risk patients requiring acute extracorporeal therapy.
Asunto(s)
Lesión Renal Aguda/terapia , Hemofiltración , Hemorragia/terapia , Diálisis Renal , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Heparina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , RiesgoRESUMEN
Seventy-seven patients underwent transplantation, using a cyclosporine-prednisone immunosuppression protocol. No recipients died, and graft survival at one year was 100% for living related donor (LRD) recipients and 84% for cadaver donor (CD) recipients. Nineteen percent of locally harvested, flush-cooled kidney recipients required dialysis, whereas imported kidneys had a 66% dialysis rate. Infectious complications occurred in 17% of patients. Mean hospitalization was 12.8 days for LRD recipients and 13.6 days for CD recipients. Twenty-eight patients required 37 readmissions, mostly for treatment of rejection and infections. Total two-year cost for LRD transplants was +21,400; for CD transplants, +23,900.
Asunto(s)
Ciclosporinas/uso terapéutico , Rechazo de Injerto/efectos de los fármacos , Trasplante de Riñón , Prednisona/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Diálisis Renal , Reoperación , Obtención de Tejidos y ÓrganosRESUMEN
OBJECTIVE: The primary purpose of this study was to determine whether multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, can serve as a clinically viable alternative to inpatient psychiatric hospitalization. METHOD: One hundred sixteen children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization. Assessments examining symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction were conducted at 3 times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment). RESULTS: MST was more effective than emergency hospitalization at decreasing youths' externalizing symptoms and improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths' self-esteem. Consumer satisfaction scores were higher in the MST condition. CONCLUSIONS: The findings support the view that an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents.
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Servicios de Atención de Salud a Domicilio , Trastornos Mentales/terapia , Evaluación de Resultado en la Atención de Salud , Actividades Cotidianas , Adolescente , Servicios de Salud del Adolescente , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Masculino , Psicoterapia , AutoimagenRESUMEN
OBJECTIVES: To evaluate the effect of oral potassium citrate therapy on urinary excretion rates of citrate. Tamm-Horsfall protein (THP), and on calcium oxalate monohydrate crystal agglomeration inhibition [tm], in patients with recurrent calcium stone formation. METHODS: To evaluate the effect of oral therapy with potassium citrate on urinary citrate, THP, and [tm], 24-hour urine samples were collected before and at least 2 months after initiation of oral potassium citrate therapy in 33 calcium stone-forming patients who had no dietary restrictions. The citrate concentration was measured by an adaptation of a citrate lyase method. Urinary disaggregated THP concentration was determined with a quantitative enzyme-linked immunosorbent assay. The [tm] was determined by observing the effects of patients' urine, before and after oral potassium citrate therapy, on the uptake of 45Ca2+ onto the surfaces of added preformed calcium oxalate crystals in a supersaturated solution of calcium oxalate, using the in vitro kinetic method described by other investigators. RESULTS: We observed an increased urinary excretion rate of citrate from a mean of 1.9 mmol/24 h prealkali to 2.6 mmol/24 h postalkali (P < 0.0004) and of THP from a mean of 94.0 mg/24 h prealkali to 199.3 mg/24 h postalkali (P < 0.0016). A corresponding increase in [tm] from a mean of 177.1 minutes prealkali to 221.0 minutes postalkali (P < 0.024) was also observed. CONCLUSIONS: To our knowledge this is the first report correlating increased urinary citrate with THP excretion rate following oral alkalinization with potassium citrate in calcium stone formers. Of clinical importance is the corresponding increase in [tm], which was previously shown to be inversely related to stone-forming activity. Moreover, urinary citrate and THP are known to have a synergistic effect on [tm]. Our data suggest that the effectiveness of potassium citrate therapy in calcium stone-forming patients may, at least in part, be due to increased levels of THP.
Asunto(s)
Citratos/uso terapéutico , Cálculos Renales/orina , Mucoproteínas/orina , Adulto , Anciano , Calcio/análisis , Oxalato de Calcio/farmacocinética , Citratos/orina , Ácido Cítrico , Cristalización , Femenino , Humanos , Cálculos Renales/química , Cálculos Renales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , UromodulinaRESUMEN
Through an effort to characterize aerobic chemoorganotrophic bacteria in the Octopus Spring cyano-bacterial mat community, we cultivated four Thermus isolates with unique 16S rRNA sequences. Isolates clustered within existing Thermus clades, including those containing Thermus ruber, Thermus aquaticus, and a subgroup closely related to T. aquaticus. One Octopus Spring isolate is nearly identical (99.9% similar) to isolates from Iceland, and two others are closely related to a T. ruber isolated from Russia. Octopus Spring isolates similar to T. aquaticus and T. ruber exhibited optimal growth rates at high (65-70 degrees C) and low (50 degrees C) temperatures, respectively, with the most abundant species best adapted to the temperature of the habitat (50-55 degrees C). Our results display a diversity of Thermus genotypes defined by 16S rRNA within one hot spring microbial community. We suggest that specialization to temperature and perhaps other local environmental features controls the abundance of Thermus populations.