The addition of Lactobacillus spp. negatively affects Mycoplasma bovis viability in bovine cervical mucus.

BACKGROUND: Mycoplasma bovis is an important pathogen for the cattle industry worldwide causing significant economic losses. Several transmission routes, including those related to reproduction, have been described. Indeed, the pathogen can colonize the female reproductive tract after artificial insemination (AI) with contaminated semen. Lactobacillus spp.-based probiotics have been used for vaginal dysbiosis treatment in women and cows although their role in controlling cervico-vaginal infections due to M. bovis is unknown. The objective of the present work is to assess the viability of M. bovis (PG45, NCTC 10131) in experimentally contaminated cervical mucus after the addition of Lactobacillus spp. at different concentrations as a competing agent and pH acidifier. RESULTS: The addition of probiotic at a concentration higher than 108 colony forming units (CFU/mL had a detrimental effect (P < 0.05) on mycoplasma viability in cervical mucus. This coincided with a significant LAB growth and an important decrease in pH from 8.4 to 5.6 (P < 0.05). However, after the addition of less concentrated probiotic, M. bovis survival was not affected and there was no significant LAB growth despite the drop of pH from 8.4 to 6.73 (P < 0.05). CONCLUSION: The addition of concentrations higher than 108 CFU/mL of Lactobacillus spp. negatively affects M. bovis viability in bovine cervical mucus under in vitro conditions. Although the effect observed on the pathogen viability seems to be related to the pH decrease after LAB proliferation in cervical mucus, further studies are necessary to elucidate if other factors are implicated. Nevertheless, the administration of Lactobacillus spp.-based probiotics might be used in the future to control M. bovis proliferation in the cervico-vaginal tract of cows.

Linfoma cerebral primario en pacientes inmunocompetentes: espectro de hallazgos y características diferenciales / Primary central nervous system lymphoma in immunocompetent patients: spectrum of findings and differential characteristics

El linfoma primario del sistema nervioso central (LPSNC) es infrecuente y su manejo difiere significativamente del resto de los tumores malignos de esta localización. El texto desarrolla cómo los hallazgos radiológicos a menudo sugieren el diagnóstico precozmente. La imagen típica en los pacientes inmunocompetentes es una masa intraaxial supratentorial con realce homogéneo. Otros hallazgos que deben valorarse son la multifocalidad y el realce en anillo incompleto. En el diagnóstico diferencial del LPSNC deben considerarse principalmente otros tumores malignos del SNC, como el glioblastoma y las metástasis. El LPSNC suele tener menor edema y efecto masa, y respeta el córtex adyacente, siendo infrecuentes la necrosis, la hemorragia y la calcificación. Aunque los hallazgos en secuencias morfológicas son típicos, no son por completo específicos y pueden encontrarse formas atípicas. Las técnicas avanzadas, como la difusión y sobre todo la perfusión, muestran valores cualitativos y cuantitativos que desempeñan un papel importante al diferenciar el LPSNC de otros tumores cerebrales

Primary central nervous system (CNS) lymphomas are uncommon and their management differs significantly from that of other malignant tumors involving the CNS. This article explains how the imaging findings often suggest the diagnosis early. The typical findings in immunocompetent patients consist of a supratentorial intraaxial mass that enhances homogeneously. Other findings to evaluate include multifocality and incomplete ring enhancement. The differential diagnosis of primary CNS lymphomas should consider mainly other malignant tumors of the CNS such as glioblastomas or metastases. Primary CNS lymphomas tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are uncommon in primary CNS lymphomas. Although the findings in morphologic sequences are characteristic, they are not completely specific and atypical types are sometimes encountered. Advanced imaging techniques such as diffusion or especially perfusion provide qualitative and quantitative data that play an important role in differentiating primary CNS lymphomas from other brain tumors

Primary central nervous system lymphoma in immunocompetent patients: spectrum of findings and differential characteristics. / Linfoma cerebral primario en pacientes inmunocompetentes: espectro de hallazgos y características diferenciales.

Primary central nervous system (CNS) lymphomas are uncommon and their management differs significantly from that of other malignant tumors involving the CNS. This article explains how the imaging findings often suggest the diagnosis early. The typical findings in immunocompetent patients consist of a supratentorial intraaxial mass that enhances homogeneously. Other findings to evaluate include multifocality and incomplete ring enhancement. The differential diagnosis of primary CNS lymphomas should consider mainly other malignant tumors of the CNS such as glioblastomas or metastases. Primary CNS lymphomas tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are uncommon in primary CNS lymphomas. Although the findings in morphologic sequences are characteristic, they are not completely specific and atypical types are sometimes encountered. Advanced imaging techniques such as diffusion or especially perfusion provide qualitative and quantitative data that play an important role in differentiating primary CNS lymphomas from other brain tumors.

Effect of exogenous progesterone administration on luteal sensitivity to PGF during the early development of the corpus luteum in mares and cows.

The objective of this study was to determine the effect of exogenous progesterone administration at ovulation and during the early development of the CL, on its future sensitivity to a single administration of PGF2a in mares and cows. Horse Retrospective reproductive data from an equine clinic in the UK during three breeding seasons were used. Mares were divided into: control group, cycles with single ovulations; double ovulation group cycles with asynchronous double ovulations; and PRID group: cycles with single ovulations and treatment with intravaginal progesterone device (CIDR) immediately after the ovulation. All mares were treated with d-cloprostenol (PGF) at either: (i) 88 hr; (ii) 96 hr; (iii) 104 hr; or (iv) 112 hr after the last ovulation. Cattle A total of nine non-lactating Holstein cows were used. All cows were administered PGF14 d apart and allocated to one of two groups control group GnRH was administered 56 hr after the second PGF administration. CIDR group CIDR was inserted at the same time of GnRH administration. All cows were administered PGF at 120 hr post-ovulation. The complete luteolysis rate of mares with double ovulation (66.7%) and those treated with exogenous progesterone (68.4%) was significantly higher than the rate of mares with single ovulation (35.6%) at 104 hr. In the cow, however, the treatment with CIDR did not increase the luteolytic response in cows treated at 120 hr post-ovulation. In conclusion, the degree of complete luteolysis can be influenced by increasing the concentration of progesterone during the early luteal development in mares.

Environmental variables associated with an increased risk of invasive aspergillosis.

Information on the environmental variables that may affect the incidence of invasive aspergillosis (IA) is scarce. We sought to determine the relationship between airborne spore counts, climatic conditions and IA. We also examined whether circulating respiratory viruses predispose patients to IA in a multicentre cohort study of hospitalized adults with IA. Data on environmental mould spores, climatic conditions and circulating respiratory viruses were obtained from the Environmental Department of the Autonomous University of Barcelona, the Meteorological Service of Catalonia and the Acute Respiratory Infection Surveillance Project in Catalonia, respectively. Between 2008 and 2011, 165 patients with IA were identified. Diagnosis was based on one or more of the following: culture (125 cases), galactomannan antigen (98) and histology (34). One hundred and twenty-seven cases (77%) had criteria for probable IA and the remainder for proven IA. Environmental mould spore counts from the period 28-42 days preceding infection presented significant associations with admissions due to IA. None of the climatic conditions were associated with an increased risk of IA, but the presence of circulating respiratory viruses was associated with a higher risk of infection: the most strongly associated viruses were respiratory syncytial virus, influenza A(H1N1)pdm09 and adenovirus. In conclusion, the presence of high numbers of spores in the air increases the risk of admission due to IA. Circulating respiratory viruses appear to be associated with a higher risk of developing IA. Physicians should be aware of this association in order to optimize prevention and diagnosis strategies for IA during viral epidemic periods.

Primary gastrointestinal aspergillosis 6 months after allogeneic hematopoietic cell transplantation: a case report.

Invasive fungal infections (IFI) represent one of the most aggressive infectious complications among hematopoietic cell transplantation (HCT) recipients. Aspergillosis is the most frequent cause of IFI in allogeneic HCT (allo-HCT), with most of the cases involving the respiratory tract. Other infrequent and usually more aggressive forms of invasive aspergillosis include hepatic, neurological, and gastrointestinal (GI). We report herein a case of GI aspergillosis diagnosed in a living patient, off all systemic immunosuppression after an allo-HCT, who had undergone a permanent colostomy because of colon carcinoma 35 years before hematological diagnosis.

Use of a split or single prostaglandin F(2α) treatment in a 6-day synchronization protocol for nonlactating dairy cows.

The 6-d timed artificial insemination protocol has been designed to advance luteolysis after the first administration of GnRH so that the preovulatory follicular diameter at second GnRH is reduced and thereby pregnancy outcome may be improved. To achieve an earlier and complete luteolysis (5 to 6 d after the first GnRH treatment), an extra PGF(2α) treatment must be administered to cows 24 h after the initial PGF(2α) treatment. Although the use of 2 PGF(2α) treatments increases labor costs resulting from the increased handling of cows, no alternative and efficient protocol with a single PGF(2α) treatment has been found to date. The objective of this study was to compare the effect of a modified 6-d synchronization protocol on the luteolytic response and final preovulatory follicle diameter. The study followed a crossover design: 14 nonlactating dairy cows were included in 2 treatment doses. All cows received a presynchronization treatment consisting of 2 administrations of a PGF(2α) analog (PGF) 14 d apart followed by treatment with GnRH 11 d later. After the first GnRH administration, one treatment consisted of 150 µg of d-cloprostenol 5 and 6 d later (split dose) and the other treatment consisted of 375 µg of d-cloprostenol as a single dose 6 d after the first GnRH (single large dose). All cows were then treated with a second GnRH 8 d after the first. The luteolytic response to treatment was evaluated by blood progesterone concentration and CL area regression -1 to 3 d relative to the last PGF treatment obtained by ELISA and ultrasonography, respectively. Fewer cows of the split dose tended to have complete luteolysis 3 d after the last PGF treatment compared with the cows of the single large dose (35.7 and 64.3%, respectively). The final preovulatory diameter of the dominant follicle was similar in cows from the split dose and single large dose (13.7 ± 0.3 and 13.1 ± 0.5mm, respectively). Our results support the modification of the 6-d synchronization protocol by administering a single high dose of PGF 6 d after GnRH (with the subsequent reduction in labor resulting from reduced handling of animals) without detrimental effects on the luteolytic response of dairy cows and preovulatory diameter of the dominant follicle compared with the original protocol. However, this modification of the 6-d synchronization protocol should be tested in a large field study involving fertility data with lactating cows before its use can be recommended.

Effect of the bovine oviductal fluid on in vitro fertilization, development and gene expression of in vitro-produced bovine blastocysts.

Oviductal microenvironment generally provides better conditions for early embryo development than the conventional in vitro system. In an attempt to simulate the oviduct conditions or the main potentially influencing factors, the effect was studied of a bovine oviductal fluid (bOF) treatment applied prior to IVF on (i) IVF parameters, (ii) cleavage rate, (iii) blastocyst yield and (iv) blastocyst quality. Embryo quality was assessed by morphological embryo quality and relative transcript abundance of several developmental genes in bovine blastocysts. Furthermore, to study the effect of bOF without the male effect and zona-sperm interaction, artificially activated metaphase II oocytes were also treated with bOF. In vitro-matured bovine oocytes from abattoir ovaries were treated or untreated with bOF for 30 min and then washed prior to IVF or activation. Subsequently, in vitro-fertilized and parthenogenetic embryos were in vitro cultured for 7 to 8 days. The bOF treatment had no effect on fertilization parameters, cleavage, blastocyst rates both on parthenogenetic and IVF bovine embryos and neither on morphological quality of IVF blastocysts. G6PD and SOD2 genes from IVF blastocysts showed significant changes in their expression after a bOF treatment. Significant differences were found for the expression of SCL2A1, GPX1, BAX, AKR1B1 and PLAC8 genes between excellent or good blastocysts (Grade 1) and fair blastocysts (Grade 2). To our knowledge, this is the first study that evaluates the effect of bOF oocyte treatment on fertilization parameters, development and quality of bovine embryos.

Effects of d-cloprostenol dose and corpus luteum age on ovulation, luteal function, and morphology in nonlactating dairy cows with early corpora lutea.

Luteolysis is a key event in cattle reproduction. A standard dose of exogenous PGF(2α) will induce full luteolysis in the majority of cows with a matured corpus luteum (CL). However, this will not occur in cows with a CL <5d old. To date, it is not known whether a larger dose will have a more potent luteolytic effect in cows during early diestrus. The objective of this study was to characterize the effect of 2 doses of d-cloprostenol (150 and 300 µg) on the progesterone concentration, luteal diameter, and ovulation rate in nonlactating dairy cattle 96 to 132 h postovulation. Twenty nonlactating dairy cows were included in the study. Each cow received 2 treatments of d-cloprostenol in 2 consecutive cycles: a standard dose of 150 µg and a double dose of 300 µg. The cows were allocated randomly to 1 of 4 groups (5 cows in each group) according to the age of the CL at the time of treatment: 96, 108, 120, and 132 h. The exact time of ovulation was known within 12h, because of twice per day ultrasound examination. The CL diameter and progesterone concentration were measured before treatment (d 0) and 2 and 4d after treatment. Within each CL age group, the effect of d-cloprostenol dose on luteolysis was determined. More cows treated with double dose tended to have full luteolysis compared with the standard dose (8/10 vs. 4/10, respectively). This effect was only apparent in cows with CL of 120 and 132 h but not in earlier CL. The interval from treatment to ovulation was shorter (3.3 ± 0.1d) in cows treated with a double dose than in cows treated with the standard dose (4.5 ± 0.4d).

Viability of ICSI oocytes after caffeine treatment and sperm membrane removal with Triton X-100 in pigs.

Non-adequate decondensation of injected sperm nucleus is one the main problems of intracytoplasmic sperm injection (ICSI) in porcine. With the aim of improving pronuclear formation, the effects on activation and embryo development rates of 0.1% Triton X-100 (TX) sperm pre-treatment for membrane removal and/or 5 mM Caffeine (CAF) addition in oocyte manipulating and culture medium for 2 h after ICSI or artificial activation were studied. The effects of 4 different Ca(2+) concentrations contained in the injection medium on embryo development after sham injection were also analysed. In Experiment 1, no significant effect on cleavage or blastocyst rate was detected independently of Ca(2+) concentration contained in the injection medium. In Experiment 2, oocytes injected with TX pre-treated sperm showed a significant higher rate of male pronuclear formation in comparison with oocytes from control group (2PN; 54.1 vs 36.6%). However, no differences on in vitro embryo development, cleavage or blastocyst rates were observed. In Experiment 3, oocytes treated with CAF during and after micromanipulation and injected with sperm pre-treated with TX had a significantly lower oocyte activation rate than any other experimental groups (25.7 vs 56.3-66.3%). No differences were observed in cleavage rates among different experimental groups. However, the CAF group showed a higher blastocyst rate significantly different from TX+CAF group (12.0 vs 1.9%, respectively). In a second approach, the effect of electric field strengths and CAF treatments on oocyte activation was studied. In Experiment 4, oocytes submitted to 0.6 kV/cm showed significant higher activation rates than 1.2 kV/cm ones regardless of the caffeine treatment (83.7 vs 55.9% and 75.7 vs 44.3%; in control and caffeine groups, respectively). No effect of caffeine treatment was observed in any experimental group. In conclusion, TX sperm treatment before ICSI without an additional activation procedure improved male pronuclear formation, but did not improve embryo development until blastocyst stage. No significant effect of caffeine was found when sperm was not treated with TX, although in membrane absence caffeine avoided oocyte activation and embryo development. Finally, caffeine had no effect on female pronuclear formation regardless of electric field strengths applied to the parthenogenetic activation.

The effect of a single high dose of PGF2α administered to dairy cattle 3.5 days after ovulation on luteal function, morphology, and follicular dynamics.

A single treatment with PGF2α is assumed to have no luteolytic effect on cows with corpora lutea < 5 days old. The objective of this study was to determine the effect of a single high dose of PGF2α administered to dairy cattle on the morphology and function of the early CL. The study followed a crossover design with a treatment cycle in which 50 mg of dinoprost were administered 3.5 days postovulation and a control untreated cycle. Ultrasound examination and blood samples were performed during the two consecutive cycles. Corpus luteum (CL) diameter, progesterone concentration, and follicular dynamics characteristics were compared between control and treated cycles. Two of nine cows (22%) developed full luteolysis. The remaining seven cows (78%) had partial luteolysis with a decrease (P < 0.05) in progesterone concentration and CL diameter for two and 12 days post-treatment, respectively. The interovulatory interval of treated cycles (19.7 ± 2.4 days) was not different (P > 0.05) from that of controls (23.8 ± 0.9 days). The transient reduction in progesterone of cows with partial luteolysis had no effect on the proportion of cows with two or three follicular waves, follicle growth rate, or preovulatory diameter (P > 0.05). Two cows developed ovarian cystic degeneration during the PGF2α-induced cycle. In conclusion, the treatment of cows with a high dose of PGF2α 3.5 days postovulation induced some degree of luteolysis in all treated cows. This resulted in partial luteolysis in 78% of treated animals and in full luteolysis in the remaining 22%.

Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre diagnóstico y tratamiento de la candidiasis invasiva / The Spanish Society of Paediatric Infectious Diseases (SEIP) recommendations on the diagnosis and management of invasive candidiasis

Las levaduras del género Candida son comensales ubicuos, que pueden causar infección oportunista en cualquier localización del organismo; la fuente de infección puede ser tanto endógena como exógena. La candidiasis invasiva engloba entidades distintas que van desde la candidemia o invasión limitada al torrente circulatorio a la candidiasis diseminada o infección multiorgánica. La candidemia constituye la tercera causa de infección del torrente circulatorio en la IN y la cuarta de todas las infecciones. También constituye la IFI más frecuente en el paciente crítico no neutropénico, habiendo sufrido un incremento muy notable en los últimos 20 años, debido tanto a una mayor supervivencia de los pacientes críticamente enfermos como a una mayor complejidad de los procedimientos diagnóstico terapéuticos y quirúrgicos. Su incidencia en lactantes, según revisiones recientes, se sitúa en 38,8 casos/100.000 menores de 1 año. La especie más frecuentemente implicada en infecciones invasoras sigue siendo Candida albicans, aunque en los últimos años existe un incremento de infecciones causadas por especies distintas: es relevante la aparición de Candida kruseiy Candida glabrata y el incremento de candidemia por Candida parapsilosis asociada principalmente al manejo de catéteres intravenosos centrales, especialmente en unidades neonatales. La mortalidad global de la candidiasis invasiva es elevada, llegando a cifras del 20 al 44% a los 30 días en determinadas series que incluyen a pacientes pediátricos. Este documento recoge una revisión actualizada sobre incidencia, epidemiología, diagnóstico, tratamiento y evolución, de la infección invasiva por Candida spp. en el paciente pediátrico (AU)

Candida yeasts are ubiquitous commensals, which can cause opportunistic infection in any location of the body. The source of infection may be both endogenous and exogenous. Invasive candidiasis encompasses different entities ranging from invasive candidiasis to disseminated multiorgan infection. Invasive candidiasis is the third leading cause of nosocomial bloodstream infection and the fourth of all nosocomial infections. It is also the most common invasive fungal infection in non-neutropenic critically ill patients, with a remarkable increase in the last 20 years owing to the increased survival of these patients and to more complex diagnostic, therapeutic and surgical procedures. Its incidence in infants, according to recent reviews, stands at 38.8 cases/100,000 children younger than 1 year. Candida albicans remains the most frequent isolate in invasive infections, although infections caused by other species have risen in the last years, such as C. kruzsei, C. glabrata and C. parapsilosis; the latter causing invasive candidiasis mainly associated with central venous catheter management, especially in neonatal units. The overall mortality of invasive candidiasis is high, with 30-day mortality reaching20-44% in some series involving paediatric patients. This report provides an update on incidence, epidemiology, clinical presentation, diagnosis, treatment and outcome of invasive infection by Candida spp. in the paediatric patient (AU)

[The Spanish Society of Paediatric Infectious Diseases (SEIP) recommendations on the diagnosis and management of invasive candidiasis]. / Recomendaciones de la Sociedad Española de Infectología Pediátrica sobre diagnóstico y tratamiento de la candidiasis invasiva.

Candida yeasts are ubiquitous commensals, which can cause opportunistic infection in any location of the body. The source of infection may be both endogenous and exogenous. Invasive candidiasis encompasses different entities ranging from invasive candidiasis to disseminated multiorgan infection. Invasive candidiasis is the third leading cause of nosocomial bloodstream infection and the fourth of all nosocomial infections. It is also the most common invasive fungal infection in non-neutropenic critically ill patients, with a remarkable increase in the last 20 years owing to the increased survival of these patients and to more complex diagnostic, therapeutic and surgical procedures. Its incidence in infants, according to recent reviews, stands at 38.8 cases/100,000 children younger than 1 year. Candida albicans remains the most frequent isolate in invasive infections, although infections caused by other species have risen in the last years, such as C. kruzsei, C. glabrata and C. parapsilosis; the latter causing invasive candidiasis mainly associated with central venous catheter management, especially in neonatal units. The overall mortality of invasive candidiasis is high, with 30-day mortality reaching 20-44% in some series involving paediatric patients. This report provides an update on incidence, epidemiology, clinical presentation, diagnosis, treatment and outcome of invasive infection by Candida spp. in the paediatric patient.

Sry-negative XX sex reversal in a French Bulldog.

Here, we describe a 3-month-old XX male French Bulldog. The diagnosis was based on the clinical signs, gonadal histology and cytogenetic analysis. Additionally, the dog was confirmed to be Sry negative by semi-quantitative reverse transcription polymerase chain reaction (sqRT-PCR). Canine Sry-negative XX sex reversal is a disorder of gonadal development where individuals who have a female karyotype develop testes or ovotestes. To our knowledge, this case is the first XX male sex reversion described in a French Bulldog.

Timing, etiology, and location of first infection in first year after heart transplantation.

BACKGROUND: Infections are the leading cause of death in the first year after heart transplantation (HTx) after the postoperative period. OBJECTIVE: To describe the timing, etiology, and location of the first infection occurring in the first year after HTx. PATIENTS AND METHODS: The study included 604 HTx procedures performed at our center from November 1987 to September 2009. Infections were classified as those requiring hospital admission or that prolonged hospital stay. Infection was established on the basis of clinical findings and supplementary test results. Etiologic diagnosis was established at microbiological culture. Infections were categorized as bacterial, viral, fungal, protozoal, or of unknown origin, and were grouped according to microorganism family. Time to occurrence of infection is given as mean (interquartile range). Locations considered were systemic, pulmonary, genitourinary, cutaneous, oropharyngeal, mediastinal, sternal, gastrointestinal, and other. RESULTS: Mean (SD) patient age was 51 (12) years, and 83.8% of patients were men. Almost half of all patients (42.9%) experienced some type of infection in the first year after HTx. The most frequently occurring infections were bacterial (49.6%) and viral (38.7%), with fewer fungal (6.3%), protozoal (1.2%), and of unknown origin (4.3%). Staphylococci were the most commonly isolated organisms (10.5%) in bacterial infections, cytomegalovirus (21.1%) in viral infections, and Candida (2.3%) and Aspergillus (2.3%) in fungal infections. Early-onset infections (n=2; 1-7 days) were caused by Candida spp, and late-onset infections (n=110; 14-182 days) by a mixed group of bacteria. The sternum was the site of early-onset infections (n=9; 6-14 days), and the genitourinary tract was the site of late-onset infections (n=110; 28-180 days). CONCLUSIONS: Nearly half of HTx recipients experience a significant infection during the first year posttransplantation. Early-onset infections occur in critical care units, are caused by nosocomial organisms, and involve the sternum or mediastinum, whereas late- onset infections have a more varied etiology and preferentially affect the skin and genitourinary tract.

Mycophenolate acid vs mycophenolate mofetil therapy.

BACKGROUND: Mycophenolate mofetil (MMF) is included in the basic immunosuppression regimen in heart transplantation (HTx). Classically, the mycophenolic acid (MPA) concentration has not been considered to provide clinical information. OBJECTIVE: To perform a comparative analysis of MMF dosage and MPA concentration and their effect on post-HTx renal function. PATIENTS AND METHODS: Sixty patients underwent HTx between January 2007 and April 2009, and were followed up at 4 scheduled visits in 6 months. The standard MMF dose was 1000 mg/12 h, with adjustment according to clinical criteria. The MPA concentration was determined using an enzyme-multiplied immunoassay (EMIT 2000; Siemens Healthcare Diagnostics Inc, Deerfield, Illinois), without change in dosage. The correlation between mean MMF dosage and MPA concentrations at all visits vs renal function values was analyzed using serum creatinine concentration, creatinine clearance (CrCl; Modification of Diet in Renal Disease), and glomerular filtration rate (GFR; Cockcroft-Gault formula). RESULTS: Mean (SD) patient age was 50 (13) years, and 45 of 60 (75.4%) were men. Pre-HTx values were as follows: creatinine concentration, 1.13 (0.47) mg/dL; CrCl, 81.59 (36.84) mL/min/1.73 m2; and GFR, 77.46 (30.60) mL/min. In the first 6 months post-HTx, significant negative correlations were observed between mean MPA concentration and creatinine concentration (r=.42; P=.001), CrCl (r=-.36; P=.01), and GFR (r=-.45; P=.001). No correlation was observed with mean MMF dosage. CONCLUSION: There are important differences in the relationship of MPA concentration vs MMF dosage and post-HTx renal function. Although studies with a larger number of patients are needed, treatment guided by MPA concentration seems reliable for evaluation of renal function.

[Emerging invasive fungal infections]. / Infecciones fúngicas invasivas emergentes.

The frequency and diversity of invasive fungal infections has changed over the last 25 years. The emergence of less common, but medically important fungi has increased, and the children at risk has expanded, with the inclusion of medical conditions such as cancer, mainly haematological malignancy or stem cell transplant, immunosuppressive therapy, prolonged neutropenia, and T-cell immunodeficiency. Among mould infections, fusariosis and phaeohyphomycosis (Dematiaceous fungi) have been increasingly reported in this group of patients. To successfully manage these challenging infections, it is imperative that paediatricians and sub-specialists remain aware of the optimal and timely diagnosis and therapeutic options. Unlike other common mycoses that cause human disease, there no simple antigen or serological tests available to detect these pathogens in tissue or blood. The outcome for these disseminate, and often refractory fungal infections in neutropenic patients and transplant recipients remains extremely poor, requiring early and aggressive therapy. Unfortunately there are no guidelines outlining the choices for optimal therapy in the treatment of paediatric invasive fungal infections do not exist, and on the other hand are limited paediatric data available comparing antifungal agents in children with proven, probable or suspected invasive fungal infection. The options for treatment rest mainly on some adult guidelines that comment on the treatment of these emerging and uncommon important fungi in children. Despite the sparse clinical trials available on treatment and its poor outcome, options for treatment of invasive fungal infections have increased with the advance of new antifungal agents, with improved tolerability and increased range of activity. The epidemiology, clinical manifestations, diagnosis and treatment of fusariosis and phaeohyphomycosis are discussed in this article.

Infecciones fúngicas invasivas emergentes / Emerging invasive fungal infections

La frecuencia y diversidad de las infecciones fúngicas ha cambiado en los últimos 25 años. La aparición de hongos menos frecuentes pero con importancia médica está aumentando y ahora son más los niños en riesgo al añadirse procesos médicos predisponentes como los debidos al cáncer, principalmente neoplasias malignas hematológicas, trasplantes de médula ósea o de progenitores hematopoyéticos (TPH), tratamientos inmunosupresivos, neutropenias prolongadas e inmunodeficiencias de células T. Entre las infecciones por hongos, fusariosis y feohifomicosis (hongos dematiáceos) están siendo comunicadas con más frecuencia en este grupo de pacientes.Para tratar con éxito estas desafiantes infecciones es prioritario que pediatras y subespecialistas se mantengan informados sobre el diagnóstico oportuno y óptimo y así como de las opciones terapéuticas. Al contrario que otras micosis más frecuentes que causan enfermedad en humanos, no hay disponibilidad de pruebas diagnósticas simples antigénicas o serológicas para detectar estos microorganismos en sangre o tejidos(AU)

En pacientes neutropénicos y en receptores de trasplantes, el pronóstico de estas infecciones fúngicas diseminadas y a menudo refractarias es particularmente malo por lo que se requiere un tratamiento precoz y agresivo. Por desgracia no existen guías o protocolos que esbocen la elección más óptima del tratamiento de las infecciones fúngicas invasivas pediátricas y por otro lado hay pocas referencias disponibles que permitan comparar los diversos agentes antifúngicos en niños con sospecha probable o probada infección fúngica invasiva. Las opciones de tratamiento se basan principalmente en algunas guías de adultos donde se comenta el tratamiento de estos hongos emergentes, poco frecuentes e importantes en niños. A pesar de esta insuficiente disponibilidad de estudios clínicos sobre el tratamiento y el mal pronóstico, las opciones terapéuticas de las infecciones fúngicas invasivas han aumentado con el desarrollo de nuevos agentes antifúngicos de mejor tolerancia y mayor espectro de actividad.La epidemiología, manifestaciones clínicas, diagnóstico y tratamiento de la fusiariosis y feohifomicosis (hongos dematiáceos) se revisan en este artículo(AU)

The frequency and diversity of invasive fungal infections has changed over the last 25 years. The emergence of less common, but medically important fungi has increased, and the children at risk has expanded, with the inclusion of medical conditions such as cancer, mainly haematological malignancy or stem cell transplant, immunosuppressive therapy, prolonged neutropenia, and T-cell immunodeficiency. Among mould infections, fusariosis and phaeohyphomycosis (Dematiaceous fungi) have been increasingly reported in this group of patients.To successfully manage these challenging infections, it is imperative that paediatricians and sub-specialists remain aware of the optimal and timely diagnosis and therapeutic options. Unlike other common mycoses that cause human disease, there no simple antigen or serological tests available to detect these pathogens in tissue or blood.The outcome for these disseminate, and often refractory fungal infections in neutropenic patients and transplant recipients remains extremely poor, requiring early and aggressive therapy. Unfortunately there are no guidelines outlining the choices for optimal therapy in the treatment of paediatric invasive fungal infections do not exist, and on the other hand are limited paediatric data available comparing antifungal agents in children with proven, probable or suspected invasive fungal infection. The options for treatment rest mainly on some adult guidelines that comment on the treatment of these emerging and uncommon important fungi in children. Despite the sparse clinical trials available on treatment and its poor outcome, options for treatment of invasive fungal infections have increased with the advance of new antifungal agents, with improved tolerability and increased range of activity.The epidemiology, clinical manifestations, diagnosis and treatment of fusariosis and phaeohyphomycosis are discussed in this article(AU)

Histological findings of early graft biopsies in old donor renal transplant patients receiving induction therapy.

Since recipients of transplants from elderly donors are exposed to an increased risk of delayed graft function (DGF) and acute rejection episodes, administration of induction treatment represents an alternative to preserve renal mass and improve graft survival. We compared the evolution and histological findings of early graft biopsies among 38 recipients treated with Thymoglobulim (33.6%) versus 75 (66.4%) with basiliximab. No differences were observes in the rate of DGF (P = .39). Forty kidneys were biopsed during the first 2 weeks after transplantation: 9 in the Thymoglobulin group (23.68%) and 31 in the basiliximab group (41.3%). Histological evaluation showed: acute tabular necrosis in 7 (78%) Thymoglobulin patients versus 14 (45%) basiliximab patients, with calcineurin nephrotoxicity in 2 (22%) and 1 (3.2%), respectively. An acute rejection episode was not diagnosed in the Thymoglobulin group, but 13 patients (17.3%) in the basiliximab group experienced this complication (P = .006). Banff classification showed: 6 grade IA (19.4%), 1 grade IB (3.2%), 3 grade IIA (9.7%), 1 grade IIB (3.2%), and 2 grade III (6.5%). Six of these patients required rescue treatment with Thymoglobulin. Serum creatinine and proteinuria levels between the 2 groups were not different (P > .05). There were no differences in cytomegalovirus (CMV) disease (P = .152), admission due to infection (P = .120), or neoplasia (P = .29). Graft and patient survivals at 3 years did not show a difference. The histological findings revealed that low doses of Thymoglobulin were much more effective to prevent renal inflammation and acute rejection episodes than basiliximab among renal transplant recipients, albiet without differences in survival at a mean of 3 years follow-up.

Effect of sperm treatment on efficiency of EGFP-expressing porcine embryos produced by ICSI-SMGT.

Intracytoplasmic sperm injection-sperm-mediated gene transfer (ICSI-SMGT) is a useful tool for the production of transgenic mice but is still rather inefficient in farm animals. In the current study, we evaluated the effect of the sperm treatments on the efficiency for producing enhanced green fluorescent protein (EGFP)-expressing pig embryos by ICSI-SMGT. Four different sperm treatments were assayed: (1) fresh (control), (2) frozen-thawing (FT), (3) quick freezing without cryoprotectant agents (QF), and (4) Triton X-100 treatment (TX-100). First, we evaluated the DNA-binding ability and the viability of sperm under the different treatments coincubated with exogenous DNA (EGFP) by flow cytometry. Second, we evaluated the embryo production rate and the efficiency in transgene expression in embryos after using these spermatozoa to fertilize oocytes by ICSI. Sperm treatment significantly increased DNA-binding capacity but reduced sperm viability compared with that of the control group. Treatments damaging the spermatozoa's membranes (QF and TX-100) resulted in a greater capacity of sperm binding exogenous DNA than that after FT treatment (P<0.01). Similar rates of EGFP-expressing embryos were obtained from the control, FT, and TX-100 groups (37.04+/-3.52%, 43.54+/-5.41%, and 29.03+/-8.29%, respectively), but were significantly higher in the QF group (80.43+/-5.91%). These results demonstrate that the integrity of the sperm plasma membrane plays a critical role in DNA interaction, and altered plasma membranes facilitate interactions between an injected exogenous DNA and the sperm chromatin. However, severe sperm treatments such as QF and TX-100 may damage the sperm nucleus, induce DNA fragmentation, and/or lead to chromosomal breakage with a detrimental effect on further embryonic development.