Adjuvant diagnosis of tuberculosis in hemodialysis patients using fourth generation interferon γ releasing assay.

INTRODUCTION: Dialysis patients have a 10-25 times higher risk of reactivation of tuberculosis (TB). In this study, we investigated the diagnostic ability of QuantiFERON (QFT)-plus for TB in hemodialysis patients. QFT-plus, an interferon gamma release assay, is characterized by its use of CD4 and CD8 T cell signals. METHODS: Hemodialysis patients aged 20 years or older who underwent QFT-plus measurement in our hospital were included, inclusion criteria being fever above 37°C, high inflammatory response, and infiltrative pulmonary shadows. RESULTS: Forty-six patients were enrolled. Of these, 15% were QFT positive, 4% were diagnosed with active TB, 76% were QFT negative, 8% had inconclusive results. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 87.5%, 28%, and 100%, respectively. CONCLUSIONS: QFT-plus may be useful for the diagnosis of active TB in dialysis patients. Further studies in cohorts with larger sample sizes are expected.

Full Stereocontrol in α-Glycosidation of 3-Deoxy-d-manno-2-octulosonic Acid (Kdo) Using Macrobicyclic Glycosyl Donors.

We describe a method for the α-selective glycosidation of 3-deoxy-d-manno-2-octulosonic acid (Kdo) using a macrobicyclic Kdo donor as the precursor of a bridgehead oxocarbenium ion, whose stereoselectivity is not affected by the substrate structure and reaction conditions. Strapping Kdo via tethering in the α-configuration at the C1 and C5 positions completely blocked nucleophilic attack to the ß-face of the anomeric center by sterically hindering the bicyclic system, realizing full α-selectivity during glycosidation.