Kidney Transplantation With Ultralong-Term (42 Years) Survival of a 100-Year-Old Graft.

BACKGROUND: In kidney transplantation, long-term graft survival has improved over the last few decades. Study to understand ultralong-term graft survival with graft functioning is rare, but a few researchers have tried to explain the factors involved in long-term graft survival. In this report, we explore the predictive factors that can be involved in ultralong-term graft survival. MATERIAL AND METHODS: Immunologic evaluations of the patients were performed using crossmatch (XM), serological, and high-resolution HLA typing for 8 loci. A transplant recipient was treated with azathioprine as immunosuppressive monotherapy for 42 years. Donor-specific antibodies (DSAs) were identified using panel reactive antibody single antigen beads (PRA-SAB) followed by EpVix and Matchmaker epitope analysis to define the immunogenic mismatch eplets. RESULTS: The patient and donor were haploidentical for 7 loci and identical at the HLA-DPA1* locus. Among 61 identified eplet mismatches, DSAs were not detected against 59 eplets after 42 years of exposure to the patient's immune system with the exceptions of antibodies against the public eplets 9Y and 9YL from allele HLA-DPB1*03:01, and the transplanted kidney exhibited preserved structures. CONCLUSION: The transplanted kidney has the preserved structure based on magnetic resonance imaging, the 2 DSAs were not deleterious to the graft until now, and the eplet mismatches were considered acceptable. The patient is in good clinical condition living with a 100-year-old graft, a serum creatinine level of 1.5 mg/dL, and an estimated glomerular filtration rate of 50 mL/1.72 m2.

Description of five novel HLA-B alleles, B*07:184, B*41:27, B*42:19, B*50:32 and B*57:63, identified in Brazilian individuals.

Five novel HLA-B alleles were identified by HLA-SBT typing in seven unrelated Brazilian individuals. The new alleles discovered include HLA-B*07:184, B*41:27, B*42:19, B*50:32 and B*57:63 and were officially named by the World Health Organization (WHO) Nomenclature Committee. All new HLA-B alleles had nonsynonymous nucleotide substitution polymorphisms when compared to their most closely related HLA-B allele.

Kidney transplantation: evaluation and clinical outcome of 237 recipients at low, medium, high, or strong immunological risk of rejection.

BACKGROUND: Donor-specific antibodies (DSAs) play a fundamental role in kidney transplantation. The identification of DSAs is an essential rejection parameter. PATIENTS AND METHODS: We evaluated a protocol in 237 patients receiving kidneys from living (LDs) and deceased donors (DDs). Recipients were classified as being at low (LR), medium (MR), high (HR), or strong (SR) risk of rejection based on Luminex panel reactive antibody (PRA)-single antigen beads (SABs). Grafts that survived for 1 year were evaluated. RESULTS: Of the 237 transplanted patients, 129 (54.43%) received a kidney from an LD and 108 (45.57%) from a DD. Of 95 LR recipients receiving kidneys from LDs, 2 patients lost the graft due to non-immunological causes. Of 34 MR recipients, 13 had rejection episodes, and 2 lost the graft by AMR and one by cellular rejection (CR). Of 108 recipients receiving a kidney from a DD, 59 (54.63%) were LR, 31 (28.70%) MR, 11 (10.19%) HR, and 7 (6.48%) SR. Twenty of all transplanted recipients lost their grafts; 4 were due to clinical causes, 4 by cellular rejection, and 12 by antibody-mediated rejection (AMR) with PRA-SAB mean fluorescent intensity of 530 to 12,591. One-year graft survival for LD transplanted LR and MR patients was 97.6% and 94.1%, respectively (P = .004). In DD recipients, the LR vs MR SD was P = .011, and for LR vs HR + SR it was P = .001. For MR vs HR+SR no SD was found (P = .323). CONCLUSION: Rejections were detected in 51 patients (21.52%). Graft failure occurred in 16 patients (6.75%). A total of 218 (91.98%) recipients maintained good kidney function after 1 year. This protocol based on fluxogram risk assessment of AMR provided fast and precise immunological evaluation of recipients and donors and stratification by immunological risk of AMR.

Four novel HLA alleles, DRB1*04:11:03, DRB1*10:05, DRB1*15:94 and DRB1*16:22, identified in Brazilian individuals.

Four novel human leucocyte antigen (HLA) class II alleles were identified by sequencing-based typing (SBT) and analysis of the closest-matching alleles from volunteer subjects from the Brazilian Bone Marrow Donor Register (REDOME, Brazil). The new HLA alleles discovered include DRB1*04:11:03, DRB1*10:05, DRB1*15:94 and DRB1*16:22. Three of the novel alleles had single-nucleotide substitution polymorphisms when compared to their most homologous allele. Of these, one harboured a single-nucleotide polymorphism (SNP) identified as a silent substitution.

Solanum lycopersicon Mill. and Nicotiana benthamiana L. under high light show distinct responses to anti-oxidative stress.

Two experimentally important species, Solanum lycopersicon Mill. and Nicotiana benthamiana L., were propagated in vitro under low light (50 micromol m(-2) s(-1)) and transferred to HL (200 micromol m(-2) s(-1)) under a protocol previously developed for grapevine and chestnut. Compared with photooxidative stress parameters already tested in those species, imaging of hydrogen peroxide and superoxide revealed an accumulation on d2-3 and d6 in S. lycopersicon and d1-2 and d5-7 in N. benthamiana. SOD, CAT and APX activities matched ROS accumulation. The expression of the respective transcripts showed a significant increase on d1 in S. lycopersicon while in N. benthamiana a bimodal pattern was found, with peaks on d2 and d7. These results, together with the relative timing of root expansion and new leaf emergence, indicate that these two apparently similar species display different strategies when responding to light stress, evidencing further the uniqueness of the response of each species. The behaviour of N. benthamiana falls closely into the pattern already reported for wood species including grapevine.

Integration of stress produced reactive oxygen species in the stomatal regulation of micropropagated Vitis vinifera L. plantlets impaired in ABA signaling.

Reactive oxygen species (ROS) have been repeatedly implicated as cellular second messengers important in the modulation of almost every ontogenic phase of plant development, from seedling to cell death. In all of these processes, ROS production and detoxification are highly regulated and its levels are kept under tight control, in order to achieve the desired effect at the cellular or plant level. Micropropagated Vitis vinifera L. transferred to ex vitro growth under increased irradiance gave an additional insight into ROS signaling by integrating stress produced hydrogen peroxide (H(2)O(2)) into normal signaling pathways with distinctive effects critical for the survival, growth and development of these plants. Here we discuss in further detail the relevance of these results and propose a model that may explain this phenomenon.

Gain of function of stomatal movements in rooting Vitis vinifera L. plants: regulation by H(2)O(2) is independent of ABA before the protruding of roots.

Reactive oxygen species (ROS), namely superoxide radical (O2(-)) and hydrogen peroxide (H(2)O(2)) are generated when plant tissues endure a variety of environmental stresses, including light stress. The extremely short life times of ROS makes the study of their production in planta very difficult. The use of ROS-specific tracer dyes, 3-3' diaminobenzidine and nitroblue tetrazolium, together with high-resolution imaging provides the opportunity to identify sites of photooxidative stress response by ROS accumulation. This technique was applied to grapevine during the first 7 days after transfer from in vitro to ex vitro under an irradiance 4-fold higher than in vitro. ROS accumulation was detected in the first days of analysis, which gradually decreased to levels comparable to greenhouse leaves. (O2(-)) was uniformly distributed while H(2)O(2) accumulated preferentially in veins, wounds and stomatal guard and surrounding cells. To evaluate the role of H(2)O(2 )in stomatal functioning and its crosstalk with abscisic acid (ABA) we focused on the percentage of coloured structures, stomatal aperture and ABA concentration. We propose that the high H(2)O(2) level triggered by increased light is responsible for the activation of a signalling pathway over stomatal cells, in a process apparently irrespective of ABA regulation prior to root protrusion. This could explain the gain of function of a low yet consistent percentage of stomatal cells, essential for plant survival during the ontogenic period in analysis.

Lymphoid hypophysitis in a patient with lymphoid thyroiditis, lymphoid adrenalitis, and idiopathic retroperitoneal fibrosis.

We describe the autopsy findings in a 24-year-old woman with a clinical picture of pituitary and adrenal insufficiency which had its onset shortly after a normal pregnancy and delivery of a normal infant, two years before the mother's death. There were heavy lymphocytic infiltrations of the adenohypophysis, thyroid, and adrenals as well as diffuse retroperitoneal fibrosis with numerous perivascular lymphocytic infiltrates. It is concluded that lymphoid hypophysitis probably represents the hypophyseal counterpart of other endocrine autoimmune disorders and that immune mechanisms may also play a role in the pathogenesis of the so-called idiopathic retroperitoneal fibrosis.

Diagnóstico, tratamento e investigaçäo de casos de esquitossomose realizados em uma área do Município de Säo Paulo; resumo

Foi efetuado um esforço de integraçäo de serviços a nível local, realizando um trabalho em conjunto com a Superintendência de Controle de Endemias (SUCEN). O objetivo é diagnosticar, tratar e investigar os casos de esquitossomose e comunicantes na populaçäo atendida pelos postos do Departamento de Saúde da Comunidade, Regiäo Sul. Demonstram que é possível, com os recursos a nível local, sem necessidade de recursos adicionais, viabilizar um projeto de ampliaçäo da atuaçäo dos Postos de Atendimento Médico da Prefeitura de Säo Paulo nos programas de Saúde Pública

Equipe volante de saúde: uma alternativa para o atendimento da populaçäo rural do Município de Säo Paulo; resumo

O objetivo das equipes volantes de Saúde é dar atendimento a populaçäo da zona rural do Município de Säo Paulo. A equipe volante é constituída por um médico, um auxiliar de enfermagem, um atendente de enfermagem e um motorista, sendo o transporte da mesma efetuado por veículo tipo furgäo que leva também vacinas, medicamentos, suplemento alimentar, material e prontuários necessários ao atendimento. Os locais de atendimento säo fixos, indicados e cedidos pela comunidade, obedecendo a uma frequência semanal de 1 até 3 vezes por semana, de acordo com a demanda. Esse projeto foi implantado em dezembro de 1980 e vem sendo avaliado continuamente