Correction to: Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings : A Midwest Pediatric Nephrology Consortium (MWPNC) study

The original version of this article unfortunately contained a mistake. The subtitle "A Midwest Pediatric Nephrology Consortium (MWPNC) study" was missing. The correct title including subtitle is given above.

Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings

BACKGROUND AND OBJECTIVES

Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence.

METHODS

Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence.

RESULTS

We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3-23.7) compared to FSGS predicted disease recurrence.

CONCLUSIONS

Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence.

Turbulence level effects on conventional reflectometry using 2D full-wave simulations

Numerical simulations are critical in improving the capabilities of microwave diagnostics. In this work, the 2D finite-difference time-domain full-wave code REFMUL was applied to broadband turbulent plasmas using the conventional reflectometry setup. Simulations were performed with O-mode waves, fixed frequency probing, and I/Q detection. The plasma density, determining O-mode propagation, was modeled as the sum of a slab background plasma with a fluctuating component following a Kolmogorov-like amplitude k-spectrum. The density turbulence level δn _e/n _e was scanned over several orders of magnitude for simulated plasma flows of constant plasma velocity in either the radial or the poloidal direction. Simulations show trends, such as spectral broadening of the complex A(t)e^iφ(t) signals and increasing fluctuations in A(t) and φ(t) with increasing δn _e/n _e, that are similar for both plasma flow directions. These together with possibilities to reconstruct a poloidal wavenumber spectrum are discussed in view of extending the measuring capabilities. The onset of non-linear effects associated with phase runaway, as previously observed with other 1D and 2D codes, as well as radial Doppler effects is also observed and discussed.

Country-wide surveillance of norovirus outbreaks in the Portuguese Army, 2015–2017

Introduction

Gastrointestinal infections are among the most common foodborne and waterborne diseases in military populations, with direct implications in operational efficiency and force readiness. Through the surveillance system of reportable acute gastrointestinal illness in the Portuguese Army, four norovirus outbreaks were identified between October 2015 and October 2017 in mainland Portugal and the Azores archipelago. The present study documents the epidemiological, clinical and laboratory investigations of these norovirus outbreaks.

Methods

Cases were investigated and epidemiological questionnaires were distributed to all soldiers in each military setting where the outbreaks occurred. Stool samples from soldiers with acute gastroenteritis illness were collected and screened for common enteropathogenic agents. Food and water samples served on the settings were also collected for microbiological investigation. Norovirus-positive samples were further characterised by sequence analysis using a public automated genotyping tool.

Results

The four outbreaks affected a total of 99 soldiers among the 618 stationed on base units and in a military exercise. A total of 27 soldiers provided a stool sample, of which 20 were positive for norovirus by real-time PCR. Phylogenetic analysis showed that the noroviruses involved were all genogroup II, namely GII.17, GII.Pe-GII.4 Sydney 2012, GII.P2-GII.2 and GII.P16-GII.2. Of note, 30 soldiers had to receive treatment at the military hospital due to severity of symptoms.

Conclusion

In this short, two-year surveillance period, a total of four norovirus gastroenteritis outbreaks were detected in the Portuguese Army which caused a considerable morbidity, showing once again the impact of norovirus on Army effectiveness and force readiness.

168 The Effect of Prematuration Culture Using Epidermal Growth Factor Receptor Kinase Inhibitor on Nuclear Maturation of Bovine Oocytes and Cumulus Cell Gene Expression

Epidermal growth factor receptor (EGFR) activation is an essential step in triggering LH-induced meiotic resumption. Here, we used an EGFR kinase inhibitor (AG1478) to assess the blockage and reversal of meiosis block in bovine oocytes, the competence of such oocytes for the embryonic development, and the gene expression of cumulus cells (CC). Cumulus-oocyte complexes (COC, n = 583) were pre-matured (PM) during 8 h in TCM-199 with 1 μM AG1478 (EGFR-group). Next, COC were washed from meiotic inhibitor and cultured for 22 h in in vitro maturation (IVM) medium (TCM-199 with bicarbonate, 0.5 mg mL−1 FSH, 100 IU mL−1 hCG, and 10% FCS). The control group was only cultured for 22 h in IVM medium. Meiosis progression in oocytes was evaluated after PM (blocked_GV) and after IVM of PM oocytes (blocked_MII) or immediately after follicle aspiration (immature control = control_GV) and IVM (matured control = control_MII); oocytes were classified as immature (germinal vesicle; GV) or mature (metaphase II; MII). Another sample of matured oocytes was fertilized and cultured to the blastocyst stage. Abundance of 81 transcripts was evaluated by qPCR using a microfluidic platform (BioMark HD System™, Fluidigm®, South San Francisco, CA, USA) in CC collected at the same time as oocyte evaluation. Relative mRNA abundance was calculated by ΔCt (target genes were normalized by 2 reference genes: PPIA and RPL15). Data were analysed by ANOVA followed by Tukey’s test (P ≤ 0.05). The GV rates after 8-h PM differed (P ≤ 0.05) between 0-h oocytes (96.4 ± 2.2%) and EGFR- (59.8 ± 2.2%). After 22-h IVM, meiosis block was fully reversed and there was no difference (P ≥ 0.05) in MII rates between treatments (84.8%, averaged). Blastocyst rates (38.2%, averaged) were unaffected by treatment (P ≥ 0.05). Abundance of several transcripts was modulated by PM culture (blocked_GV v. control_GV), including up-regulation of genes that control the expansion of CC/COC competence markers (GREM1 and VCAN), cell proliferation/survival control (IGF1R and EGFR) and maintenance of cellular structural integrity/prediction of embryo quality (KRT8 and GATM), and down-regulation of genes associated with failures in pregnancy establishment/glucose metabolism (AKR1B1), endoplasmic reticulum stress (ATF4), meiotic arrest (ADCY3 and NOS2) and cell survival(HSPA1A). After IVM (blocked_MII v. control_MII), it was found an up-regulation in the relative abundance of PTX3 and PTGS2 (expansion of CC), RGS2 (regulator of G-protein signalling), LUM (embryo quality) and FOXO3 (apoptosis and oxidative stress resistance), whereas relative abundance of PFKP (glucose metabolism) was down-regulated. Our results indicate that blockade of meiosis with the EGFR kinase inhibitor before IVM is reversible and does not affect subsequent embryonic development. The gene expression profile of CC indicates a possible improvement in the quality of COC; however, more studies will be necessary to evaluate whether these improvements will be maintained until the embryonic stage. Financial support provided by FAPESP (#2015/06733-5 and #2012/50533-2) and CNPq (#307416/2015-1).

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

HLA-DQA1 and APOL1 as Risk Loci for Childhood-Onset Steroid-Sensitive and Steroid-Resistant Nephrotic Syndrome

BACKGROUND

Few data exist for the genetic variants underlying the risk for steroid-sensitive nephrotic syndrome (SSNS) in children. The objectives of this study were to evaluate HLA-DQA1 and APOL1 variants as risk factors for SSNS in African American children and use classic HLA antigen types and amino acid inference to refine the HLA-DQA1 association.

STUDY DESIGN

Case-control study.

SETTING & PARTICIPANTS

African American children with SSNS or steroid-resistant nephrotic syndrome (SRNS) were enrolled from Duke University and centers participating in the Midwest Pediatric Nephrology Consortium.

FACTOR

Genetic variants in HLA-DQA1 (C34Y [rs1129740]; F41S [rs1071630]) and APOL1 high-risk alleles.

OUTCOMES

SSNS and SRNS.

MEASUREMENTS

Direct sequencing for the HLA-DQA1 and APOL1 variants in 115 African American children (65 with SSNS and 50 with SRNS). Imputation of classic HLA alleles and amino acids was done in 363 South Asian children.

RESULTS

The 2 HLA-DQA1 variants were significantly associated with SSNS in African American children (C34Y: P=5.7 × 10^-11; OR, 3.53; 95% CI, 2.33-5.42; F41S: P=1.2 × 10^-13; OR, 4.08; 95% CI, 2.70-6.28), but not with SRNS (C34Y: P=0.6; F41S: P=0.2). APOL1 high-risk variants were not associated with SSNS (P=0.5) but showed significant associations with SRNS (P=1.04 × 10^-7; OR, 4.17; 95% CI, 2.23-7.64). HLA-DQA1*0201, HLA-DQB1*0201, and HLA-DRB1*0701 were the classic HLA alleles with the most significant associations with SSNS risk. The most significantly associated amino acid positions were HLA-DQα1 56 and 76 (both P=2.8 × 10^-7). Conditional analysis revealed that these variants most likely account for the observed association.

LIMITATIONS

Modest sample size and limited statistical power to detect small to moderate effect sizes. Children studied may not be representative of all African American children in the United States.

CONCLUSIONS

HLA-DQA1 is a risk locus for SSNS, but not SRNS, in African American children, consistent with its role in SSNS risk in children of European, Asian, and African ancestries. There is little evidence of a significant role for the APOL1 high-risk alleles in childhood SSNS in African American children. Refinement of the HLA-DQA1 association identified the critical classic HLA antigen types and amino acids of the HLA-DQ α1 molecule.

Mão Reumatóide: revisão de 124 Próteses Mcf de Silicone

Objectivos: O tratamento consensual na doença articular avançada da metacarpofalângica é a artroplastia com interposição de prótese. O objectivo deste trabalho foi avaliar o resultado das artroplastias de silicone realizadas em mãos reumatóides, no serviço de Ortopedia do Hospital de Santo António, nos últimos 15 anos.

Material e método: foram revistas 124 próteses de 26 doentes operados nos últimos 15 anos, avaliando-os clínica e radiologicamente, com aplicação de escalas e algoritmos de avaliação de dor, função pré e pós operatória, resultado estético e satisfação global.

Resultados: A maioria dos doentes apresentava artrite reumatóide, atingimento bilateral sendo avaliado o follow-up entre 18 meses e 13 anos. A indicação cirúrgica predominante foi a dor seguida e acompanhada pelo défice de função. Utilizou-se a prótese de Swanson em 82% dos doentes, com correcção do desvio cubital associado em 47%. Houve uma recuperação média de 28 graus do arco de mobilidade articular e 4 graus na escala decimal de dor. Registaram-se 10 complicações (seis fracturas e quatro luxações de prótese). A satisfação global dos doentes foi positiva (67%) com melhoria das actividades da vida diária e deformidade das mãos.

Conclusão: A prótese de silicone demonstrou ser uma boa opção de tratamento para a doença articular reumatóide das MCF com excelentes resultados funcionais, estéticos e dor.

Cirurgia paliativa do ombro em paralisia obstétrica do plexo braquial

A paralisia obstétrica do plexo braquial é rara originando disfunção grave e défice marcado da rotação externa e da abdução do ombro. Reviram-se retrospectivamente 11 casos de paralisia obstétrica do plexo braquial (sete com paralisia alta e quatro com paralisia completa) tratados cirurgicamente pela técnica de L’Épiscopo modificada por Hoffer. Estes resultados foram padronizados segundo o tipo de lesão (grupo A – lesão alta; grupo B – lesão completa) e a idade (grupo I ≤ 4 anos; grupo II > 4 anos). O seguimento médio foi de 35 meses. A idade média aquando da cirurgia era de 6,5 anos (r= 2–11). Todos, excepto um, apresentaram melhoria funcional, com aumento da pontuação média de Mallet de 4,6 pontos. Os dois subtipos de paralisia tiveram pontuação média de Mallet sobreponível (grupo A – 4.6; grupo B – 4.7); a idade aquando da cirurgia não influenciou o resultado clínico (pontuação média (grupo I) – 4.8; (grupo II) – 4.4). Não foram registadas complicações. A técnica de L’Épiscopo modificada por Hoffer é eficaz no tratamento paliativo do ombro em paralisia obstétrica do plexo braquial, permitindo recuperação da abdução e rotação externa do ombro. Está indicada em paralisias altas e completas, quando associada a outras cirurgias de recuperação da função do cotovelo, punho e/ou mão. Idade superior a 4 anos não contra-indica a cirurgia desde que sejam excluídas alterações da articulação glenoumeral.