Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation

The use of expanded criteria donors (ECD) has been proposed to help combat the discrepancy between organ availability and need. ECD kidneys are associated with delayed graft function (DGF) and worse long-term survival. The aim of this study is to evaluate the impact of pulsatile perfusion (PP) on DGF and graft survival in transplanted ECD kidneys. From January 2000 to December 2003, 4618 ECD kidney-alone transplants were reported to the United Network for Organ Sharing. PP was performed on 912 renal allografts. The prognostic factors of DGF were analyzed using multivariate logistic regression analysis. Risk factors for reduced allograft viability were greater in donors and recipients of PP kidneys. Three-year graft survival of ECD kidneys preserved with PP was similar to cold storage (CS) kidneys. The incidence of DGF in PP kidneys was significantly lower than CS kidneys (26% vs. 36%, p < 0.001). Despite having a greater number of risk factors for reduced graft viability, the ECD-PP kidneys had similar graft survival compared to ECD-CS kidneys. The use of PP, by decreasing the incidence of DGF, may possibly lead to lower overall costs and increased utilization of donor kidneys.

Role of nucleic acid testing in cadaver organ donor screening: detection of hepatitis C virus RNA in seropositive and seronegative donors

Hepatitis C virus (HCV) transmission by both seropositive and seronegative cadaver organ donors has been documented, yet nucleic acid testing is not routinely used to identify active infection in these donors prior to transplantation. Between November 2001 and February 2004, we screened 1445 cadaver organ donors for anti-HCV antibodies with either HCV EIA-2.0 (Abbott Diagnostics, Chicago, IL, USA) and/or Ortho HCV Version 3.0 ELISA (Ortho-Clinical Diagnostics, Raritan, NJ, USA) and confirmed seropositive samples with Chiron RIBA3.0 SIA (Chiron Corporation, Emeryville, CA, USA). Samples with sufficient volume (n = 726) were tested by the VERSANT HCV [transcription-mediated amplification (TMA)] Qualitative assay (Bayer Healthcare LLC, Tarrytown, NY, USA) which can be performed in approximately 5 h. Those with detectable HCV RNA and sufficient volume were quantified by the VERSANT HCV 3.0 (bDNA) Assay (Bayer Healthcare LLC) and/or the HCV RNA TMA Quantitative Assay (n = 23) and genotyped (n = 57). Seventy-seven of 1445 (5.3%) donors were seropositive, reactive by either one or both anti-HCV assays. Fifty-two of 63 (82.5%) of the seropositive samples had detectable HCV RNA and were genotyped. Seventeen of these samples had quantifications ranging from 128,123 to >7,692,307 IU/mL. Six of 663 (0.9%) seronegative samples had detectable HCV RNA. Their quantifications ranged from <9.3 to 1,464,799 IU/mL, and five of these six were successfully genotyped. As HCV RNA was demonstrated in samples from both our seropositive and seronegative cadaver organ donors, we are now incorporating nucleic acid testing into our donor screening/diagnostic algorithm.

Significant HLA matching effect in a large urban transplant center composed primarily of minorities

In more than 1300 deceased donor transplants, including 75% Hispanics, African-Americans, and Asians, a significant effect of mismatching (MM) was observed for zero to three MM compared to more than three MM (P < .02). There was a significantly better patient survival (P < .002), shorter hospital stay (P < .001), and a trend toward lowered immunosuppression. Zero to three MM were present in 48% of the recipient population in part due to the pre-UNOS algorithm that assigns points for zero MM and other MM grades. However, recently only zero MM receive points, therefore fewer zero to three MM recipients would be expected. The largest minority population is Hispanic. We postulated that at least part of the effect was associated with socioeconomic status and English as a second language parameters of our Hispanic population. Zero to three MM was found to decrease risk and should be used prospectively in minority donor/recipient combinations.

Neutron spectra and dosimetric features around an 18 mv linac accelerator

Using the difference between responses to neutrons of TLD-600 and TLD-700, three experimental devices were constructed and arranged to measure thermal neutron fluences, neutron spectra, and neutron doses inside the treatment room of a radiotherapy 18 MV Linear electron accelerator (Linac). Thermal neutron fluences were measured with TLD-600/TLD-700 pairs arranged in both a bare and a cadmium (Cd) foil covered methacrylate box. Neutron spectra were measured in 26 energy bins by introducing pairs of TLD-600/TLD-700 in air and into the middle of five polyethylene spheres with diameters of 3, 5, 8, 10, and 12 inches. A PC version of the BUNKI code was used to unfold the six measurements in each sphere to obtain the 26 energy bins. Neutron and photon doses were measured by introducing pairs of TLD-600/TLD-700 into the middle of a single 25-cm-diameter paraffin sphere. The three required neutron calibrations were carried out at the Nuclear Technology Laboratory of the Polytechnique University of Madrid (UPM), using an 241Am-Be neutron source with an alpha activity of 111 GBq and a yield of 6.6 x 10(6) neutrons s(-1). Three devices were needed for the necessary calibrations: a BF3 counter for the thermal neutron fluence calibration, a LUDLUM 42-5 Bonner spectrometer with five 0.95 g cm(-3) polyethylene spheres with a LiI(Eu) 4 x 4 mm2 scintillation counter for the neutron spectrometer calibration and a NEMO 9140 remmeter for the paraffin remmeter calibration. The Monte Carlo code MCNP 4C has been used in two ways: to calculate the neutron kerma contribution to two TLDs (type 600 and 700) both in air and inside the paraffin sphere, and to determine the neutron spectra at those Linac room zones where the neutron spectra were measured. Thermal neutron fluences of 2.9 x 10(4) +/- 8.6 x 10(3) cm(-2) s(-1), measured around the Linac head plane, and 2.3 x 10(4) +/- 2.3 x 10(3) cm(-2) s(-1), measured at the patient couch plane, are in agreement with previous independent measurements from other authors. The calculated and measured neutron spectra obtained in the treatment room showed three distinct regions: a peak around 0.1 MeV, a flat epithermal region and a thermal region with values similar to those mentioned above. Patient dose equivalents of 0.5 mSv and 5 mSv from neutrons and photons, respectively, were obtained per treatment Gray.

Treatment of Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms: Translumbar Puncture and Injection of Thrombin into the Aneurysm Sac

OBJECTIVES

The aim of this article is to report our experience in the use of a new technique for the treatment of type II endoleaks which appear after the endovascular treatment of abdominal aortic aneurysms.

MATERIALS AND METHODS

In three patients with secondary type II endoleaks, we performed a translumbar puncture, introducing a 22-Gauge needle into the aneurysm sac under CT guidance. Once intrasac pressure had been registered, 1000U (2 ml) of human thrombin were slowly injected into the sac.

RESULTS

Complete sealing of the endoleak was achieved in all three patients, confirmed by the lack of contrast filling of the sac in the CT scans performed 5 min and 24 h after the procedure. Initial intrasac pressure was equal to systolic arterial pressure in the three patients. After the procedure, the pressure decreased by 30-40 mmHg. There were no complications during the procedure, which lasted 45-90 min. No endoleak recurrence has been observed in any of the three cases 6 months later.

CONCLUSIONS

We present an alternative method of treating type II endoleaks, which could become the treatment of choice if and when a wider experience confirms our initial good results.

A novel titrimetric method for monitoring toxicity on nitrifying biofilms

A titrimetric method for monitoring toxicity in suspended biomass was applied in order to measure the activity of nitrifying biofilms and to determine the effect of several toxic compounds on the biofilm. Three typical tannery compounds, quebracho extract, NaCl and Cr+3 were selected to study their toxicity on the biofilms. The results obtained showed an acceptable repeatability of the method for all the toxicants tested with an average standard deviation of less than 10%. Biofilm systems showed higher resistance to the toxicants, when the results obtained using suspended nitrifying biomass, were compared with those found in the literature. The IC50 obtained with quebracho was 8.8 g/L of quebracho extract, while around 65% of maximum activity was attained with 8.7 g/L of NaCl or 120 mg/L Cr+3. The quebracho extract, NaCl and Cr+3 were 26%, 38% and 18%, respectively, less toxic in the biofilm system than for a suspended biomass culture.

Carbon and nitrogen removal from tannery wastewater with a membrane bioreactor

A 3.5 L Membrane Sequencing Batch Reactor (MSBR) was used for the treatment of a wastewater coming from the beamhouse section of a tannery. The wastewater, produced after the oxidation of sulphide compounds, contained average COD and ammonium concentrations of 550 and 90 mg/L respectively. The system was operated for a period of 150 days, with no sludge removal during the whole period of operation. The biomass concentration inside the reactor varied considerably, with maximum values close to 10 g/L at the end of operation. Low biomass yield values were achieved probably due to the low feed/microorganisms (F/M) ratio. An important accumulation of organic matter in the reactor was noticed, although the COD effluent was not affected due to the permeation through the membrane. The nature of this organic matter is finally discussed. Removal efficiencies close to 100% in ammonium and 90% in COD were achieved and the TN removal efficiency ranged from 60 to 90%.

Expiratory muscle endurance in middle-aged healthy subjects

To evaluate expiratory muscle endurance in middle-aged healthy subjects using incremental as well as constant expiratory loads, 14 healthy volunteers (51 +/- 16 years) were submitted to a specific endurance test, which was performed breathing against a threshold valve, and was divided into two parts. In part I, the load was progressively increased (50 g each 2 min) until task failure occurred. The mean mouth pressure generated against the highest load held for at least 60 sec was defined as the maximal expiratory sustainable pressure (Pth(max)). In part II, each subject breathed against a constant submaximal expiratory load (80% Pth(max)) until task failure occurred (expiratory endurance time or Tth(80)). Both parts of the test were repeated 24-48 h later. Progressive expiratory loading induced a linear increase in mouth expiratory pressure and the Pth(max) obtained was 141 +/- 43 cm H(2)O, representing 74 +/- 28% of the maximal expiratory pressure (PE(max)). Under constant loads, the Tth(80) was 17 +/- 9 min. At the end-point of both parts, the tension time index for expiratory muscles was dramatically increased (>0.25), and both EMG central frequency and PE(max) were decreased with no changes in maximal inspiratory pressure or inspiratory capacity. Extreme dyspnea was present in most of the subjects but no complications were observed. The endurance of expiratory muscles can be easily assessed in healthy subjects using this method, which has acceptable reproducibility and tolerance.

Autotrophic denitrification for combined hydrogen sulfide removal from biogas and post-denitrification

In this paper we describe an alternative flow-chart for full treatment of wastewaters rich in organic substrates, ammonia (or organic nitrogen), and sulfate, such as those generated in fish cannery industries. Biogas generated during anaerobic pretreatment of these wastewaters is rich in hydrogen sulfide that needs to be removed to enable application of the biogas. Nitrogen elimination is traditionally achieved by subsequent nitrification and denitrification of the effluent of the anaerobic reactor. Alternatively, the hydrogen sulfide in the biogas can be applied as an electron donor in an autotrophic post-denitrification step. In order to study whether sufficient hydrogen sulfide containing biogas for denitrification was produced in the anaerobic reactor, the biogas composition as a function of the anaerobic reactor-pH was estimated based on a typical wastewater composition and chemical equilibrium equations. It is demonstrated that typical sulfate and nitrogen concentrations in fish cannery wastewater are highly appropriate for application of autotrophic post-denitrification. A literature review furthermore suggested that the kinetic parameters for autotrophic denitrification by Thiobacillus denitrificans represent no bottleneck for its application. Initial experimental studies in fixed-film reactors were conducted with sodium sulfide and nitrate as an electron donor-acceptor couple. The results revealed that only moderate volumetric treatment capacities (< 1 g-NO3- N l(-1) day(-1)) could be achieved. Mass balances suggested that incomplete sulfide oxidation to elemental sulfur occurred, limiting biomass retention and the treatment capacity of the reactor. Future research should clarify the questions concerning product formation from sulfide oxidation.

Rexpression of HLA class I antigens and restoration of antigen-specific CTL response in melanoma cells following 5-aza-2'-deoxycytidine treatment

Cell surface expression of HLA class I/peptide complexes on tumor cells is a key step in the generation of T-cell-based immune responses. Several genetic defects underlying the lack of HLA class I expression have been characterized. Here we describe another molecular mechanism that accounts for the complete absence of HLA class I molecule expression in a tumor line (MSR3-mel) derived from a melanoma patient. Hypermethylation of the MSR3-mel DNA, specifically of HLA-A and -B genes, was identified, which resulted in loss of HLA class I heavy chain transcription. Treatment of MSR3-mel cells with the demethylating agent 5'-aza-2'-deoxycytidine (DAC) allowed HLA-A and -B transcription, restoring cell surface expression of HLA class I antigens and tumor cell recognition by MAGE-specific cytotoxic T lymphocytes. The MSR3-mel line was obtained from a metastatic lesion of a nonresponding patient undergoing MAGE-3.A1 T-cell-based peptide immunotherapy. It is tempting to speculate that the hypermethylation-induced lack of HLA class I expression is the cause of the impaired response to vaccination. This study provides the first evidence that DNA hypermethylation is used by human neoplastic cells to switch off HLA class I genes, thus providing a new route of escape from immune recognition.

Fine-scale mapping of a locus for severe bipolar mood disorder on chromosome 18p11.3 in the Costa Rican population

We have searched for genes predisposing to bipolar disorder (BP) by studying individuals with the most extreme form of the affected phenotype, BP-I, ascertained from the genetically isolated population of the Central Valley of Costa Rica (CVCR). The results of a previous linkage analysis on two extended CVCR BP-I pedigrees, CR001 and CR004, and of linkage disequilibrium (LD) analyses of a CVCR population sample of BP-I patients implicated a candidate region on 18p11.3. We further investigated this region by creating a physical map and developing 4 new microsatellite and 26 single-nucleotide polymorphism markers for typing in the pedigree and population samples. We report the results of fine-scale association analyses in the population sample, as well as evaluation of haplotypes in pedigree CR001. Our results suggest a candidate region containing six genes but also highlight the complexities of LD mapping of common disorders.

CPEB phosphorylation and cytoplasmic polyadenylation are catalyzed by the kinase IAK1/Eg2 in maturing mouse oocytes

In both vertebrates and invertebrates, the expression of several maternal mRNAs is regulated by cytoplasmic polyadenylation. In Xenopus oocytes, where most of the biochemical details of this process have been examined, polyadenylation is controlled by CPEB, a sequence-specific RNA binding protein. The activity of CPEB, which is to recruit cleavage and polyadenylation specificity factor (CPSF) and poly(A) polymerase (PAP) into an active cytoplasmic polyadenylation complex, is controlled by Eg2-catalyzed phosphorylation. Soon after CPEB phosphorylation and resulting polyadenylation take place, the interaction between maskin, a CPEB-associated factor, and eIF4E, the cap-binding protein, is destroyed, which results in the recruitment of mRNA into polysomes. Polyadenylation also occurs in maturing mouse oocytes, although the biochemical events that govern the reaction in these cells are not known. In this study, we have examined the phosphorylation of CPEB and have assessed the necessity of this protein for polyadenylation in maturing mouse oocytes. Immunohistochemistry has revealed that all the factors that control polyadenylation and translation in Xenopus oocytes (CPEB, CPSF, PAP, maskin, and IAK1, the murine homologue of Eg2) are also present in the cytoplasm of mouse oocytes. After the induction of maturation, a kinase is activated that phosphorylates CPEB on a critical regulatory residue, an event that is essential for CPEB activity. A peptide that competitively inhibits the activity of IAK1/Eg2 blocks the progression of meiosis in injected oocytes. Finally, a CPEB protein that acts as a dominant negative mutation because it cannot be phosphorylated by IAK1/Eg2, prevents cytoplasmic polyadenylation. These data indicate that cytoplasmic polyadenylation in mouse oocytes is mediated by IAK1/Eg2-catalyzed phosphorylation of CPEB.

Hypermethylation leads to silencing of the SYK gene in human breast cancer

A number of cancer-associated genes have been shown to be inactivated by hypermethylation of CpG islands during breast tumorigenesis. SYK, a candidate tumor suppressor, has been found not expressed in a subset of breast cancer cell lines, but the mechanism by which SYK is silenced is unclear. In this study, we examined the 5' CpG island methylation status of the SYK gene in breast cancer cell lines and primary breast cancer tissues. We found SYK 5' CpG hypermethylation in 30% (6/20) of breast cancer cell lines, and the aberrant methylation status was strongly associated with loss of SYK gene expression. Treatment of cells with a methylation inhibitor, 5-aza-2'-deoxycytidine, led to a reactivation of SYK expression in SYK-negative cells, as detected by reverse transcription-PCR. Using methylation-specific PCR, we demonstrated that SYK is hypermethylated in 32% (12/37) of unselected breast tumors, whereas all of the matched neighboring normal breast tissues exhibited unmethylated DNA status. We concluded that SYK is frequently inactivated through an epigenetic pathway in breast cancer. Because SYK has been shown to function as a tumor suppressor, and its loss of expression in breast cancer has been correlated with tumor invasiveness, the aberrant SYK methylation is responsible for the loss of expression and may consequently play a permissive role for tumor aggressiveness.

Translational control by CPEB: a means to the end

The regulated translation of messenger RNA is essential for cell-cycle progression, establishment of the body plan during early development, and modulation of key activities in the central nervous system. Cytoplasmic polyadenylation, which is one mechanism of controlling translation, is driven by CPEB--a highly conserved, sequence-specific RNA-binding protein that binds to the cytoplasmic polyadenylation element, and modulates translational repression and mRNA localization. What are the features and functions of this multifaceted protein?

Analysis of HLA class I expression in different metastases from two melanoma patients undergoing peptide immunotherapy

We characterized the HLA class I alterations in five metastases obtained from two patients with melanoma immunized with Melan A/MART-1, tyrosinase and gp100 tumor peptides. All three metastases analyzed in the first patient (NW145) showed a similar HLA class I alteration with a dual population of melanoma cells. One population was HLA class I antigen positive and the other had loss of heterozygosity (LOH) in the short arm of chromosome 6 leading to an HLA haplotype loss (A02011, B4007, Cw1). The absence of HLA-A2 antigen may explain why this patient did not develop HLA-A2 restricted, Melan A/MART-1 specificity immunization, since this HLA molecule is the restriction element for the tumor peptides used. However, this HLA-deficient population was not selected after peptide immunotherapy. The primary tumor in this patient presented LOH in region 6q, but only in the vertical growth phase of the lesion, whereas LOH at 6p was observed only in DNA from metastatic material. The second patient (NW16) also presented two metastatic lesions with an identical HLA molecular defect, i.e. HLA B locus downregulation (HLA B51011: serological B51; B1503: serological B70). One lesion expressed the tumor antigen (Melan A/ MART-1), but the other did not. Interestingly, the antigen-positive metastasis regressed after peptide immunotherapy, whereas the other progressed rapidly. These findings provide the first indication that multiple metastases generated in the same host can have identically altered HLA class I phenotypes.

Genome screening for linkage disequilibrium in a Costa Rican sample of patients with bipolar-I disorder: a follow-up study on chromosome 18

Linkage disequilibrium (LD) methods offer great promise for mapping complex traits, but have thus far been applied sparingly. In this paper we describe an LD mapping study of severe bipolar disorder (BP-I) in the genetically isolated population of the Central Valley of Costa Rica. This study provides the first complete screen of a chromosome for a complex trait using LD mapping and presents the first application of a new LD mapping statistic (ancestral haplotype reconstruction (AHR)) that evaluates haplotype sharing among affected individuals. The results of this chromosome-wide analysis are instructive for genome-wide LD mapping in isolated populations. Furthermore, the analysis continues to support a possible BP-I locus on 18pter, suggested by previous analyses in this population. Evidence for a possible BP-I locus on 18q12.2 is also described.

The influence of donor age on kidney graft survival in the 1990s

Based on analyses of the UNOS Registry data for cadaver kidney transplants performed between 1991-1999 we showed that: 1. 15-40 year old donor kidneys provided the best one-year graft survival rates. When donors were analyzed with recipients, younger (0-10) and older (70-90) donors and recipients (Table 2) had the lowest one-year graft success rates. 2. Chronic loss rate, the constant rate of graft loss between one and 5 years, showed younger donor kidneys had a significantly lower chronic loss rate compared with each older donor category. Apparently the younger donor kidneys have a resiliency and nephron reserve that provides better long-term function. However, they may have lower short-term (1-yr) graft survival rates, possibly due to their small size. 3. Black and White donor kidneys had similar one-year graft survival rates; however, in every age group, recipients of White donor kidneys had significantly better 5-year graft survival rates than Black donor kidneys. There was also a noticeably lower chronic loss rate among recipients of White than Black donor kidneys. 4. HLA-matched White donor kidneys had better one- and 5-year graft survival rates and lower chronic loss rates than HLA-mismatched kidneys. The matching effect was lost when the donor age increased beyond age 40. PRA had an effect both at one and 5 years after transplantation. The chronic loss rate was similar with high and low PRA. Therefore, PRA had a relatively short-term effect. 5. Cold ischemia time had a modest effect after 35 hours both at one and 5 years. However, the chronic loss rate was unaffected by CIT, suggesting prolonged ischemia time had a relatively short-term effect. 6. More focused attention on sensitization and lowered CIT can both have a significant effect on short-term graft survival rates. However, both matching and younger donor organs provide the best opportunity for better long-term graft success rates.

Phosphorylation of CPEB by Eg2 mediates the recruitment of CPSF into an active cytoplasmic polyadenylation complex

The release of Xenopus oocytes from prophase I arrest is largely driven by the cytoplasmic polyadenylation-induced translation of dormant maternal mRNAs. Two cis elements, the CPE and the hexanucleotide AAUAAA, and their respective binding factors, CPEB and a cytoplasmic form of CPSF, control polyadenylation. The most proximal stimulus for polyadenylation is Eg2-catalyzed phosphorylation of CPEB serine 174. Here, we show that this phosphorylation event stimulates an interaction between CPEB and CPSF. This interaction is direct, does not require RNA tethering, and occurs through the 160 kDa subunit of CPSF. Eg2-stimulated and CPE-dependent polyadenylation is reconstituted in vitro using purified components. These results demonstrate that the molecular function of Eg2-phosphorylated CPEB is to recruit CPSF into an active cytoplasmic polyadenylation complex.

CPEB, maskin, and cyclin B1 mRNA at the mitotic apparatus: implications for local translational control of cell division

In Xenopus development, the expression of several maternal mRNAs is regulated by cytoplasmic polyadenylation. CPEB and maskin, two factors that control polyadenylation-induced translation are present on the mitotic apparatus of animal pole blastomeres in embryos. Cyclin B1 protein and mRNA, whose translation is regulated by polyadenylation, are colocalized with CPEB and maskin. CPEB interacts with microtubules and is involved in the localization of cyclin B1 mRNA to the mitotic apparatus. Agents that disrupt polyadenylation-induced translation inhibit cell division and promote spindle and centrosome defects in injected embryos. Two of these agents inhibit the synthesis of cyclin B1 protein and one, which has little effect on this process, disrupts the localization of cyclin B1 mRNA and protein. These data suggest that CPEB-regulated mRNA translation is important for the integrity of the mitotic apparatus and for cell division.