Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study

OBJECTIVE

To identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), 2 conditions marked by episodes of nausea, vomiting, and abdominal pain.

STUDY DESIGN

We performed a retrospective chart review of patients admitted to a large children's health care system from 2015 through 2022. Patients with CHS and CVS were identified by the electronic medical record using International Classification of Diseases, Ninth and Tenth Revision codes.

RESULTS

Of 201 patients screened, 125 were included. Patients with CHS were older than those with CVS (mean [SD] 18.06 [1.41] vs 14.50 [2.91] years, P < .001). There were no significant differences in sex, race, ethnicity, or hospital length of stay between groups. Patients with CHS were more likely to have a positive urine drug screen (86% vs 2.9%, P < .001), lower mean (SD) serum potassium (3.62 [0.77] vs 3.88 [0.49], P < .001), and greater mean (SD) serum creatinine (0.83 (0.41) vs 0.63 (0.17), P < .001). The average (SD) systolic blood pressure was significantly greater in patients with CHS (systolic blood pressure 124.46 [10.66] vs 118.55 [10.99], P = .032) compared with children of comparable age range with CVS. Imaging was obtained in 36% of all patients, and only 2.4% had abnormalities.

CONCLUSIONS

Clinical features including older age, greater systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.

Multidisciplinary and multidimensional approaches to transplantation in children with rare genetic kidney diseases

In this review, we describe the multidisciplinary, multidimensional care required to optimize outcomes for pediatric transplant recipients with rare genetic kidney diseases. Transplant success, recipient survival, and improvement in quality of life depend on collaboration between patients, families, and a team of specialists with medical, as well as nonmedical expertise. A multidisciplinary transplant team composed of experts from medicine, surgery, nursing, nutrition, social services, transplant coordination, psychology, and pharmacology, is now standard in most transplant centers and is critical to the success of a transplant. In addition to these professionals, other specialists, such as cardiologists, urologists, geneticists, metabolic disease specialists, occupational therapists, case management, child life, chaplain, and palliative care services, have a crucial role to play in the preparation, surgery, and follow-up care, especially when a pediatric patient has a rare genetic disorder leading to renal involvement, and the need for transplantation. In order to describe this multidisciplinary care, we divide the genetic renal diseases into five subgroups-metabolic and tubular disorders, glomerular diseases, congenital anomalies of the kidney and urinary tract, ciliopathies including cystic diseases, and miscellaneous renal conditions; and describe for each, the need for care beyond that provided by the standard transplant team members.

Assessment of Pediatric Kidney Transplant Experience and Exposure During Pediatric Nephrology Fellowship Training

There have been no published studies evaluating competency or perceived competency in kidney transplant–related knowledge and skills among graduates of pediatric nephrology fellowships. There are also no uniform specific transplant requirements within the pediatric nephrology fellowship. We aim to further understand this potential gap to rectify it in the future.

Successful Use of Fosmanogepix for Treatment of Rare Highly Resistant Cutaneous Fusariosis in a Pediatric Patient With STAT3 Hyper-Immunoglobulin E Syndrome and End-Stage Kidney Disease

We describe the successful use of the novel antifungal drug fosmanogepix to treat a chronic case of multidrug-resistant cutaneous Fusarium suttonianum infection in a pediatric patient with STAT3 hyper-IgE syndrome and end-stage kidney disease on peritoneal dialysis.

Vaccine Attitudes and COVID-19 Vaccine Intention Among Parents of Children With Kidney Disease or Primary Hypertension

RATIONALE & OBJECTIVE

Children with kidney disease and primary hypertension may be more vulnerable to COVID-19. We examined COVID-19 vaccine hesitancy among parents of children with chronic kidney disease or hypertension.

STUDY DESIGN

Sequential explanatory mixed-methods design; survey followed by in-depth interviews.

SETTING & PARTICIPANTS

Parents of children aged <18 years with kidney disease or primary hypertension within a large pediatric practice.

EXPOSURE

Parental attitudes toward general childhood and influenza vaccines assessed by the Vaccine Hesitancy Scale. Kidney disease classification, demographic and socioeconomic factors, experiences with COVID-19, COVID-19 mitigation activities and self-efficacy, and sources of vaccine information.

OUTCOME

Willingness to vaccinate child against COVID-19.

ANALYTICAL APPROACH

Analysis of variance (ANOVA) test to compare parental attitudes toward general childhood and influenza vaccination with attitudes toward COVID-19 vaccination. Multinomial logistic regression to assess predictors of willingness to vaccinate against COVID-19. Thematic analysis of interview data to characterize influences on parental attitudes.

RESULTS

Of the participants, 207 parents completed the survey (39% of approached): 75 (36%) were willing, 80 (39%) unsure, and 52 (25%) unwilling to vaccinate their child against COVID-19. Hesitancy toward general childhood and influenza vaccines was highest among the unwilling group (P < 0.001). More highly educated parents more likely to be willing to vaccinate their children, while Black race was associated with being more likely to be unwilling. Rushed COVID-19 vaccine development as well as fear of serious and unknown long-term side effects were themes that differed across the parental groups that were willing, unsure, or unwilling to vaccinate their children. Although doctors and health care teams are trusted sources of vaccine information, perceptions of benefit versus harm and experiences with doctors differed among these 3 groups. The need for additional information on COVID-19 vaccines was greatest among those unwilling or unsure about vaccinating.

LIMITATIONS

Generalizability may be limited.

CONCLUSIONS

Two-thirds of parents of children with kidney disease or hypertension were unsure or unwilling to vaccinate their child against COVID-19. Higher hesitancy toward routine childhood and influenza vaccination was associated with hesitancy toward COVID-19 vaccines. Enhanced communication of vaccine information relevant to kidney patients in an accessible manner should be examined as a means to reduce vaccine hesitancy.

PLAIN-LANGUAGE SUMMARY

Children with kidney disease or hypertension may do worse with COVID-19. As there are now effective vaccines to protect children from COVID-19, we wanted to find out what parents think about COVID-19 vaccines and what influences their attitudes. We surveyed and then interviewed parents of children who had received a kidney transplant, were receiving maintenance dialysis, had chronic kidney disease, or had hypertension. We found that two-thirds of parents were hesitant to vaccinate their children. Their reasons varied, but the key issues included the need for information pertinent to their child and a consistent message from doctors and other health care providers. These findings may inform an effective vaccine campaign to protect children with kidney disease and hypertension.

Initial attendance and retention in adult healthcare as criteria for transition success among organ transplant recipients

BACKGROUND

Adolescent and young adult (AYA) solid organ transplant recipients experience worsening medical outcomes during transition to adult healthcare. Current understanding and definitions of transition success emphasize first initiation of appointment attendance in adult healthcare; however, declines in attendance over time after transfer remain possible, particularly as AYAs are further removed from their pediatric provider and assume greater independence in their care.

METHODS

The current study assessed health-care utilization, medical outcomes, and transition success among 49 AYA heart, kidney, or liver recipients recently transferred to adult healthcare. Differences in outcomes were examined along two transition success criteria: (1) initial engagement in adult healthcare within 6 or 12 months of last pediatric appointment and (2) retention in adult healthcare over 3 years following last pediatric appointment. Growth curve modeling examined change in attendance over time.

RESULTS

Successful retention in adult healthcare was significantly related to more improved clinical outcomes, including decreased number and duration of hospitalizations and greater medication adherence, as compared to initial engagement. Significant declines in appointment attendance over 3 years were noted, and individual differences in declines were not accounted for by age at transfer or time since transplant.

CONCLUSIONS

Findings underscore support for AYAs after transfer, as significant declines in attendance were noted after initiating adult care. Clinical care teams should examine transition success longitudinally to address changes in health-care utilization and medical outcomes. Attention to interventions and administrative support aimed at maintaining or increasing attendance and identifying risk factors and intervention for unsuccessful transition is warranted.

Specific healthcare responsibilities and perceived transition readiness among adolescent solid organ transplant recipients: Adolescent and caregiver perspectives

OBJECTIVE

Adolescents and young adults (AYAs) with solid organ transplants must attain responsibility for healthcare tasks during transition to adult healthcare. However, healthcare systems often initiate transfer based on age and not independence in care. This study examines specific responsibilities distinguishing AYA organ transplant recipients reporting readiness to transfer.

METHODS

65 AYAs (ages 12-21) with heart, kidney, or liver transplants and 63 caregivers completed questionnaires assessing AYA's transition readiness, healthcare responsibility, and executive functioning. Categorizations included mostly/completely ready versus not at all/somewhat ready to transition; responsibility was compared between groups.

RESULTS

42% of AYAs and 24% of caregivers reported AYAs as mostly/completely ready to transition. AYAs mostly/completely ready reported similar routine healthcare responsibility (e.g., medication taking, appointment attendance), but greater managerial healthcare responsibility (e.g., knowing insurance details, appointment scheduling), compared to AYAs not at all/somewhat ready to transition.

CONCLUSIONS

All AYAs should be competent in routine healthcare skills foundational for positive health outcomes. However, the managerial tasks distinguish AYAs perceived as ready to transfer to adult healthcare.

PRACTICE IMPLICATIONS

Emphasis on developing responsibility for managerial tasks is warranted. The Hierarchy of Healthcare Transition Readiness Skills is a framework by which AYA responsibility can be gradually increased in preparation for transfer.

Binary blended fly ash concrete with improved chemical resistance in natural and industrial environments

This study reports the enhanced chemical resistance of a blended concrete mix (CFNI) made with 40 wt.% fly ash, 2 wt.% nanoparticles, and 2 wt.% sodium nitrite inhibitor as partial replacement of cement against calcium leaching, acid and sulfate attacks. The concrete test specimens of four different compositions were fabricated and immersed in natural seawater, 3% sulfuric acid solution, and 10% magnesium sulfate solution for 120 days. Long-term chemical deterioration of the concrete systems is evaluated by assessing visual changes of the specimens and solutions along with the changes in percentage mass loss, compressive strength of the concrete, pH of the solution, and dimensions. The results indicate that CFNI concrete exhibits a superior resistance against chemical attack under all the three aggressive environments. Detailed chemical characterization of the specimens, carried out using XRD, FTIR, and thermogravimetric analysis, reveal a reduced CaO content, absence of deterioration phases like ettringite, brucite, and enhanced C-S-H content in the CFNI concrete. The addition of nanoparticles and inhibitors into fly ash concrete has lowered w/c ratio, increased surface pH, enabled conversion of soluble calcium hydroxide into insoluble calcium silicate hydrate, filled pores/voids, and reduced shrinkage and cracking. The compact microstructure of the CFNI prevented leaching and reduced the ingress of aggressive chemical ions into the concrete. Our results demonstrate that incorporation of nanoparticles and inhibitor into the fly ash concrete composition is ideally suited for the design of high-quality, low-permeable concrete structures that is the key for enhanced chemical resistance in natural and industrial environments.

Loss to Follow-up in Adolescent and Young Adult Renal Transplant Recipients

BACKGROUND

Patients' loss to follow-up (LFU) has significant impacts on outcomes and is a barrier to improving care, especially in adolescent and young adult (AYA) renal transplant recipients. There is limited information regarding the relationship between transfer of care from pediatric to adult transplant centers, age, and LFU among AYA renal transplant recipients.

METHODS

We studied 16 386 individuals aged 10-29 years who received kidney transplants between January 1, 2005 and December 31, 2015 using the Scientific Registry of Transplant Recipients. The primary outcome was LFU, which was defined as >1 year without follow-up in a transplant clinic/program. Death or graft failure within a year of the last follow-up was not classified as LFU. We performed a retrospective cohort study describing LFU using Pearson's chi-square tests. Multivariable logistic regression was used to estimate the change in likelihood of LFU associated with recipient characteristics and institution transfer.

RESULTS

In total, 22.26% (n = 3647) of our study population met criteria for LFU. About 11.17% (n = 1830) transferred institutions during the study period. LFU occurred in 50.18% of recipients who transferred institutions. LFU peaked at the age of 20 years, with 7.4% of 20-year-olds having LFU. The odds of LFU among renal transplant recipients who transferred institutions were 3.36 times greater (95% confidence interval, 3.1-3.6) than the odds of LFU among those who did not transfer institutions.

CONCLUSIONS

LFU is a critical problem faced by AYA renal transplant recipients, and institution transfer is a significant risk factor for LFU. Additional studies investigating the interplay between age, institution transfer, and LFU in the AYA population are still needed.

Adherence Barriers for Adolescent and Young Adult Transplant Recipients: Relations to Personality

OBJECTIVE

Much of the extant literature on adherence barriers has focused on modifiable factors (e.g., knowledge, social support); however, less is known about how barriers may be associated with relatively stable constructs, such as personality traits. The current study examines associations between personality (i.e., agreeableness, conscientiousness, neuroticism) and adherence barriers in a group of adolescent and young adult (AYA) solid organ transplant recipients. Demonstrating associations between barriers and personality may help in understanding why barriers are stable over time. Additionally, different personality traits may relate to different types of barriers.

METHODS

The sample included 90 AYAs (Mage = 17.31; SD = 2.05; 58% male) who received a kidney (n = 36), liver (n = 29), or heart (n = 25) transplant at least 1 year prior to study enrollment. AYAs completed the Agreeableness, Conscientiousness, and Neuroticism scales from the NEO Five-Factor Inventory and the Adolescent Medication Barriers Scale (AMBS).

RESULTS

Lower levels of agreeableness and conscientiousness and higher levels of neuroticism were related to higher self-reported barrier scores (AMBS; r's = .31- .53, p's < .001). The relations differed by personality factor and barrier type.

CONCLUSION

Adherence barriers showed medium to large associations with personality traits that are known to be relatively stable. Our findings indicate that the temporal stability of barriers to adherence may be due in part to their association with relatively enduring personality characteristics.

Brincidofovir for the treatment of human adenovirus infection in pediatric solid organ transplant recipients: A case series

HAdV viremia can cause significant morbidity among pediatric recipients of SOT with variability in incidence and severity of disease based on the type of allograft. Currently, there are no US FDA-approved treatments for HAdV infections, and historically, the mainstay of treatment has been decreasing immunosuppression, with antiviral therapies reserved for those with severe disease. We describe the treatment of four pediatric SOT recipients (two kidney, one combined kidney-liver, and one liver) presenting with HAdV disease at our institution using brincidofovir. Our case series highlights the variability in presentation and the potential for severe disease in pediatric SOT recipients as we review disease presentation, disease course, complications, and treatment with brincidofovir.

The Improving Renal Outcomes Collaborative: Blood Pressure Measurement in Transplant Recipients

BACKGROUND AND OBJECTIVES

Hypertension is highly prevalent in pediatric kidney transplant recipients and contributes to cardiovascular death and graft loss. Improper blood pressure (BP) measurement limits the ability to control hypertension in this population. Here, we report multicenter efforts from the Improving Renal Outcomes Collaborative (IROC) to standardize and improve appropriate BP measurement in transplant patients.

METHODS

Seventeen centers participated in structured quality improvement activities facilitated by IROC, including formal training in quality improvement methods. The primary outcome measure was the proportion of transplant clinic visits with appropriate BP measurement according to published guidelines. Prospective data were analyzed over a 12-week pre-intervention period and a 20-week active intervention period for each center and then aggregated as of the program-specific start date. We used control charts to quantify improvements across IROC centers. We applied thematic analysis to identify patterns and common themes of successful interventions.

RESULTS

We analyzed data from 5392 clinic visits. At baseline, BP was measured and documented appropriately at 11% of visits. Center-specific interventions for improving BP measurement included educating clinic staff, assigning specific team member roles, and creating BP tracking tools and alerts. Appropriate BP measurement improved throughout the 20-week active intervention period to 78% of visits.

CONCLUSIONS

We standardized appropriate BP measurement across 17 pediatric transplant centers using the infrastructure of the IROC learning health system and substantially improved the rate of appropriate measurement over 20 weeks. Accurate BP assessment will allow further interventions to reduce complications of hypertension in pediatric kidney transplant recipients.

Efficacy of imidazolium and piperidinium based ionic liquids on inhibiting biofilm formation on titanium and carbon steel surfaces

In the present study, the efficacies of three different cationic and anionic ionic liquids (ILs) on biofilm formation on materials used in cooling water systems were evaluated. Two imidazolium based ILs; 1-Ethyl 3-Methylimidazolium tetrafluoroborate - (IL-E) and 1-Butyl-3-methylimidazolium chloride - (IL-I) with anionic fluoride and chloride groups and one piperidinium based IL, N-methyl-N-propylpiperidinium bis(trifluoromethylsulfonyl)imide - (IL-M) with fluoromethyl group as anion were used. The efficacy of these ILs were evaluated on planktonic and sessile cells of major biofilm formers in cooling water systems using Gram negative bacterium Pseudomonas sp. and Gram positive bacterium Bacillus sp. Further their effect on inhibiting biofilm formation on titanium and carbon steel surfaces were also evaluated. Results showed that planktonic cells of Pseudomonas sp. and Bacillus sp. were effectively inhibited by 25 ppm of IL-M and IL-E, respectively. For both bacteria, 50 ppm of IL-I was enough to inhibit and eradicate the sessile cell formation. Among the three ILs, IL-E was the best in inhibiting the adhesion of bacterial cells on Ti and CS surfaces. These results suggest that Imidazolium based ILs are effective in controlling sessile cell formation and eradicating mature biofilm as compared to piperidinium based IL. Further, Imidazolium based IL with fluoride anion (IL-E) was the best in inhibiting adhesion of these bacterial cells and thereby biofilm formation on material surfaces. This study establishes the feasibility of using ILs in cooling water system for bacterial biofilm control along with other conventional biofouling control methods.

Template-Free One-Step Electrodeposition Method for Fabrication of Robust Superhydrophobic Coating on Ferritic Steel with Self-Cleaning Ability and Superior Corrosion Resistance

The corrosion of ferritic steel, a widely used structural material in the power and nuclear industries exposed to humid coastal environments, is a major concern. Here, we present a template-free one-step electrodeposition method for the fabrication of a robust superhydrophobic (SHP) coating on ferritic steel with excellent mechanical stability, enhanced corrosion resistance, and self-cleaning ability. By varying the electrodeposition time and potential, the micronanoscale hierarchical surface structures were optimized. The coated SHP surfaces were characterized by water contact angle measurement, Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The coated surfaces showed a characteristic cauliflower morphology of cerium myristate with micronanoscale features. The maximum water contact angle achieved was 162.8 ± 2.4°. Shear abrasion testing showed good mechanical durability for the prepared coatings. The as-prepared SHP coating showed a five order reduction in corrosion current density (4.14 × 10^-11 A/cm²) and corrosion rate (4.63 × 10^-7 mm/y) as compared to the bare sample. Further, a six order enhancement in the polarization resistance (1.55 × 10⁹ Ω) was also observed in agressive chloride solution, which confirmed the excellent corrosion resistance of the SHP coating. Electrochemical impedance spectroscopy (EIS) studies showed a high impedance modulus for SHP coated surfaces due to the presence of a compact protective layer of cerium myristate. This observed impedance modulus of the SHP surface was approximately four orders higher than the reported value on magnesium alloys. This study provides a new platform for obtaining a robust, mechanically stable, and corrosion resistant SHP coating with a self-cleaning ability on ferritic steel substrates that may be adapted for a range of materials in practical applications.

Renal allograft loss due to renal vascular thrombosis in the US pediatric renal transplantation

BACKGROUND

Renal vascular thrombosis (RVT) is a major cause of early allograft loss in the first year following pediatric kidney transplantation. We examined recent trends in allograft loss due to RVT and identified associated risk factors.

METHODS

We identified 14,640 kidney-only transplants performed between 1995 and 2014 with follow-up until June 30, 2016, in 13,758 pediatric patients aged < 19 years from the US Renal Data System. We examined the 1-year incidence of allograft loss due to RVT by year of transplant, and plotted the trend over time. Cox proportional hazards models were used to investigate the relationship between year of transplant as well as recipient, donor, and transplant characteristics with allograft loss due to RVT.

RESULTS

The incidence of allograft loss due to RVT consistently declined among pediatric kidney transplant performed between 1995 and 2014. Among transplants performed between 1995 and 2004, 128/7542 (1.7%) allografts were lost due to RVT compared to 53/7098 (0.8%) among transplants performed between 2005 and 2014; average 1-year cumulative incidence was 1.5% (95% CI, 1.3-1.9%) and 0.6% (95% CI, 0.5-0.8%), respectively. Increased risk for allograft loss due to RVT was associated with en bloc kidney transplantation (HR, 3.42; 95% CI 1.38-8.43) and cold ischemia time ≥ 12 h (HR, 1.78; 95% CI, 1.15-2.76). Interestingly, these risk factors were more prevalent in the latter decade.

CONCLUSIONS

The incidence of allograft loss due to RVT significantly and continuously declined among pediatric kidney transplants performed between 1995 and 2014. The causes for this improvement are unclear in the present analysis.

T Cells Play a Causal Role in Diastolic Dysfunction during Uremic Cardiomyopathy

BACKGROUND

Uremic cardiomyopathy, characterized by left ventricular hypertrophy, diastolic dysfunction, and impaired myocardial strain, contributes to increased cardiovascular mortality in patients with CKD. Emerging evidence suggests a pathogenic role for T cells during chronic heart failure.

METHODS

To determine whether T cells contribute to uremic cardiomyopathy pathogenesis, we modeled this condition by inducing CKD via 5/6th nephrectomy in mice. We used flow cytometry to assess expression of markers of T cell memory or activation by lymphocytes from CKD mice and controls, as well as lymphocyte capacity for cytokine production. Flow cytometry was also used to quantify immune cells isolated from heart tissue. To test effects of T cell depletion on cardiac function, we gave CKD mice anti-CD3 antibody injections to deplete T cells and compared heart function (assessed by echocardiography) with that of controls. Finally, we correlated T cell phenotypes with structural and functional measures on clinically acquired echocardiograms in children with CKD.

RESULTS

Mice with CKD accumulated T cells bearing markers of memory differentiation (CD44hi) and activation (PD-1, KLRG1, OX40), as reported previously in human CKD. In addition, mice with CKD showed T cells infiltrating the heart. T cell depletion significantly improved both diastolic function and myocardial strain in CKD mice without altering hypertension or degree of renal dysfunction. In children with CKD, increasing frequency of T cells bearing activation markers PD-1 and/or CD57 was associated with worsening diastolic function on echocardiogram.

CONCLUSIONS

CKD results in an accumulation of proinflammatory T cells that appears to contribute to myocardial dysfunction.

Carbapenem-resistant Enterobacteriaceae dispersal from sinks is linked to drain position and drainage rates in a laboratory model system

BACKGROUND

Hospital sinks, waste traps and drains can harbour carbapenem-resistant Enterobacteriaceae (CRE).

AIM

To investigate the dispersal of CRE from sinks in which water delivered from the tap flows directly into the drain and from clinical handwash basins with the drain at the rear. The effect of fast and slow drainage rates was also assessed.

METHODS

Waste traps, known to be colonized with CRE, were taken from a hospital and installed within a model laboratory system. New waste traps were also installed and artificially inoculated with CRE. The potential for bacteria to be dispersed from sinks was assessed using cyclone air samplers and/or settle plates.

FINDINGS

When the waste traps were artificially contaminated and CRE colonization was confined to the waste trap water, significantly fewer bacteria were dispersed from sinks that drained quickly (P = 0.004) and/or from rear-draining sinks (P = 0.002). When the waste traps were naturally contaminated and CRE colonized the trap, pipework and drain, there was significant interaction between sink drainage and position of the drain (P < 0.001). When drainage was slow, dispersal from rear-draining sinks was almost 30-fold less than from sinks with the drain underneath the tap (P < 0.001). When drainage was fast, rear-draining sinks again released comparatively fewer CRE, although, in this case, the difference was not statistically significant (P = 0.7). Contaminated splashes travelled up to 1 m from the sink.

CONCLUSION

Slow drainage rates and sink designs with the drain directly underneath the tap increase the risk of CRE present in waste traps and drains contaminating the ward environment.

Physical Activity and Kidney Injury in Pediatric and Young Adult Kidney Transplant Recipients

OBJECTIVES

To quantify physical activity and grip strength in pediatric kidney transplant recipients and describe attitudes about exercise and exercise counseling given concerns about allograft injury.

STUDY DESIGN

This was a cross-sectional analysis of 101 kidney transplant recipients (7-21 years old) >6 months post-transplant. Patients completed the Physical Activity Questionnaire (PAQ). Grip strength was measured with a dynamometer. We asked about activity limitations and provider counseling. Univariate analysis and multiple linear regression were used to determine independent predictors of PAQ score and grip strength z score.

RESULTS

We enrolled 101 of 122 eligible patients. Median PAQ score was 2.2 (range 0-5) and was lower compared with controls (P < .001). The average grip strength z score was -1.1 and -0.7 in the right and left hand, respectively. Predictors of lower grip strength were younger age (P = .036), non-African American race (P = .029), lower height z score (P = .010), and longer percentage of lifetime with kidney disease (P = .029). Although 49% and 67% limited exercise before and after transplant, respectively, 67% reported increased activity after transplant. By parent report, provider counseling included limiting certain activities (71%) and encouraging regular exercise (45%).

CONCLUSION

Physical activity and grip strength are low after kidney transplant. Patients perceive an emphasis on exercise limitations rather than the benefits of regular exercise. Interventions that encourage physical activity may be beneficial.

Premature T Cell Senescence in Pediatric CKD

An individual's immune function, susceptibility to infection, and response to immunosuppressive therapy are influenced in part by his/her T cell maturation state. Although childhood is the most dynamic period of immune maturation, scant information regarding the variability of T cell maturation in children with renal disease is available. In this study, we compared the T cell phenotype in children with renal failure (n=80) with that in healthy children (n=20) using multiparameter flow cytometry to detect markers of T cell maturation, exhaustion, and senescence known to influence immune function. We correlated data with the degree of renal failure (dialysis or nondialysis), prior immunosuppression use, and markers of inflammation (C-reactive protein and inflammatory cytokines) to assess the influence of these factors on T cell phenotype. Children with renal disease had highly variable and often markedly skewed maturation phenotypes, including CD4/CD8 ratio reversal, increased terminal effector differentiation in CD8⁺ T cells, reduction in the proportion of naïve T cells, evidence of T cell exhaustion and senescence, and variable loss of T cell CD28 expression. These findings were most significant in patients who had experienced major immune insults, particularly prior immunosuppressive drug exposure. In conclusion, children with renal disease have exceptional heterogeneity in the T cell repertoire. Cognizance of this heterogeneity might inform risk stratification with regard to the balance between infectious risk and response to immunosuppressive therapy, such as that required for autoimmune disease and transplantation.

Folliculotropic Mycosis Fungoides as a Posttransplant Lymphoproliferative Disorder

Posttransplant lymphoproliferative disorder (PTLD) is a known complication of solid organ transplantation. The majority are B cell in origin and related to Epstein-Barr virus infection. T-cell PTLD is much less common; most are Epstein-Barr virus negative and have a worse prognosis. Primary cutaneous T-cell lymphoma (CTCL) as a presentation of PTLD is rare. CTCL has a less favorable prognosis in transplant patients compared with that in immune-competent patients. Herein, we report a case of a 13-year-old boy who developed folliculotropic mycosis fungoides, a rare subtype of CTCL, subsequent to renal transplantation. To our knowledge, this is the first report of this type of PTLD in a pediatric patient.

Vector competence of two Indian populations of Culex quinquefasciatus (Diptera: Culicidae) mosquitoes to three West Nile virus strains

BACKGROUND & OBJECTIVES

Culex quinquefasciatus is one of the principal vectors of West Nile virus (WNV). The mosquito also acts as a bridge vector as it feeds on both birds and humans. In the background of the recent reports of WNV activity in Kerala and Assam with fatalities, a study was initiated to determine the growth kinetics and transmission mechanisms of three strains of WNV in two populations of Cx. quinquefasciatus.

METHODS

Mosquitoes were infected by oral feeding and growth on different post-infection days was determined with the three strains. Horizontal transmission was determined by confirming sickness and mortality in infant mice after infected mosquito bite. F1 generation eggs, larvae, pupae and adults of experimentally infected mosquitoes were screened for WNV to determine vertical (transovarial) transmission. Trans-stadial transmission was determined by detecting WNV in adult mosquitoes emerged from infected larvae.

RESULTS

Both the mosquito populations replicated and maintained WNV for a prolonged period with high titers (≥ 5log10 PFU/ml). WNV could be detected in saliva from Days 2 to 32 post-infection. Horizontal transmission by both the populations could be established but no vertical transmission was observed. However, parenterally infected larvae transmitted WNV to adults.

INTERPRETATION & CONCLUSION

WNV has been isolated from >10 mosquito species from India, however, vector competence of none of the species has been studied. The present study demonstrates efficient transmission of WNV by Cx. quinquefasciatus mosquitoes. With its country wide prevalence and high vector competence, the mosquitoes could create grave consequences especially when virulent strains with potential to cause acute flaccid paralysis and death are circulating.

A silver nanoparticle loaded TiO2 nanoporous layer for visible light induced antimicrobial applications

A nanoporous TiO2 layer was formed on commercially pure titanium by a simple anodization method in aqueous hydrofluoric acid (HF) medium. Silver nanoparticles (AgNP) were loaded into the nanoporous TiO2 layer by UV light irradiation. The morphology, chemical composition and photocatalytic activity of the modified titanium surfaces were characterized by scanning electron microscopy, Raman spectroscopy, X-ray photoelectron spectroscopy and UV-vis absorption spectroscopy techniques. The redox behavior of the AgNP loaded TiO2 layer was analyzed by cyclic voltammetry (CV) studies. The impedance behavior of the nanoporous TiO2 layer with and without AgNP was investigated by electrochemical impedance spectroscopy (EIS). The antibacterial effect of the AgNP loaded TiO2 layer was evaluated using Pseudomonas sp. and Bacillus sp. cultures. The efficacy of this modified layer to act as an antibacterial agent to minimize biofouling of titanium is demonstrated in this investigation.

Vectorial capacity of Culex gelidus (Theobald) mosquitoes to certain viruses of public health importance in India

BACKGROUND & OBJECTIVES

Culex gelidus, a widely prevalent mosquito in India and Southeast Asia region, is an important vector of Japanese encephalitis virus (JEV). Experimental studies have shown its potential to transmit West Nile, Kunjin, Murray Valley encephalitis and Ross River viruses. An attempt was therefore made to study its susceptibility and vector competence to some of the arboviruses of public health importance in India.

METHODS

Mosquitoes were infected with six viruses, viz. JEV, chikungunya (CHIKV), Chandipura (CHPV), Chittoor (CHITV), Ingwavuma (INGV) and Umbre (UMBV) by intra thoracic inoculation to determine virus susceptibility and vector competence. Growth kinetics of the viruses were studied by determining the titres of inoculated mosquitoes on different days post-infection by titration in Vero E6 cells. Vector competence was studied by detecting the presence of the viruses in saliva of infected mosquitoes.

RESULTS

All the six viruses were replicated in Cx. gelidus. JEV, CHPV, CHIKV and CHITV yielded > 5 log10TCID50/ml virus while UMBV and INGV yielded approx 4log10TCID50/ml virus. JEV, CHIKV and CHITV could be detected in the saliva of the infected mosquitoes, while CHPV, INGV and UMBV could not be detected in the saliva of the infected mosquitoes.

INTERPRETATION & CONCLUSION

Replication potential and vector competence of Cx. gelidus to some of the viruses of public health importance in India, viz. JEV, CHIKV, CHITV etc, pose a serious threat to general population, especially in the wake of spurt in its population in certain parts of India.

Replication potential and different modes of transmission of West Nile virus in an Indian strain of Culex gelidus Theobald (Diptera: Culicidae) mosquitoes

BACKGROUND & OBJECTIVES

Culex gelidus mosquito, an important vector of Japanese encephalitis virus, has shown to transmit West Nile virus (WNV), Kunjin and Murray Valley encephalitis viruses experimentally. An attempt was, therefore, made to study the replication kinetics and vector competence of an Indian strain of Cx. gelidus to WNV.

METHODS

Mosquitoes were infected by both intrathoracic inoculation and oral feeding and studied the growth kinetics by determining the virus titre on different days post-infection (PI). Vector competence was studied by determining the presence of WNV in saliva on subsequent days PI. Horizontal transmission was determined by demonstrating infection in infant mice by bite of mosquitoes that were fed on viraemic mice previously. Vertical transmission was studied by screening progeny derived from infected mosquitoes. Trans-stadial transmission was determined by screening adult mosquitoes emerged from parenterally inoculated IV instar larvae.

RESULTS

The mosquito replicated WNV to 7log10 TCID50/ml on Day 8 PI and maintained the titre for 14 days. Virus dissemination to legs and salivary glands could be detected, but not to ovaries up to Day 10 PI. The mosquitoes picked up infection from viraemic blood and transmitted successfully to infant mice on subsequent feeding. Trans-stadial transmission also could be demonstrated. However, vertical transmission could not be demonstrated.

INTERPRETATION & CONCLUSION

The replication potential, maintenance of WNV for prolonged periods and ability to transmit WNV experimentally makes the mosquito a serious threat to public health especially in the wake of active WNV activity in certain parts of India.

Studies to control biofilm formation by coupling ultrasonication of natural waters and anodization of titanium

The main objective of this study was to investigate the combined effect of ultrasonication of natural waters and anodization of titanium on microbial density and biofilm formation tendency on titanium surfaces. Application of 24 kHz, 400 W high power ultrasound through a 14 mm horn type SS (stainless steel) Sonicator with medium amplitude of 60% for 30 min brought about three order decrease in total bacterial density of laboratory tap water, cooling tower water and reservoir water and two order decrease in seawater. Studies on the effect of ultrasonication on dilute pure cultures of Gram-negative and Gram-positive bacteria showed five order and three order decrease for Pseudomonas sp. and Flavobacterium sp. respectively and two order and less than one order decrease for Bacillus sp. and Micrococcus sp. respectively. Ultrasonication increased lag phase and reduced logarithmic population increase and specific growth rate of Gram-negative bacteria whereas for Gram-positive bacteria specific growth rate increased. Studies on the biofilm formation tendency of these ultrasonicated mediums on titanium surface showed one order reduction under all conditions. Detailed biofilm imaging by advanced microscopic techniques like AFM, SEM and epifluorescence microscopy clearly visualized the lysed/damaged cells and membrane perforations due to ultrasonication. Combination of ultrasonication and anodization brought about maximum decrease in bacterial density and biofilm formation with greater than two order decrease in seawater, two order decrease in Bacillus sp. culture and more than four order decrease in Flavobacterium sp. culture establishing the synergistic effect of anodization and ultrasonication in this study.

Studies of detailed biofilm characterization on fly ash concrete in comparison with normal and superplasticizer concrete in seawater environments

In cooling water systems, many concrete structures in the form of tanks, pillars and reservoirs that come in contact with aggressive seawater are being deteriorated by chemical and biological factors. The nuclear industry has decided to partially replace the Portland cement with appropriate pozzolans such as fly ash, which could densify the matrix and make the concrete impermeable. Three types of concrete mixes, viz., normal concrete (NC), concrete with fly ash and superplasticizer (FA) and concrete with only superplasticizer (SP) were fabricated for short- and long-term exposure studies and for screening out the better concrete in seawater environments. Biofilm characterization studies and microscopic studies showed excellent performance of FA concrete compared to the other two. Laboratory exposure studies in pure cultures of Thiobacillus thiooxidans and Fusarium oxysporum were demonstrated for the inhibition of microbial growth on fly ash. Epifluorescence and scanning electron microscopic studies supported the better performance of the FA specimen. Thus, the present study clearly showed that FA concrete is less prone to biofilm formation and biodeterioration.

Studies on microbiologically influenced corrosion of SS304 by a novel manganese oxidizer, Bacillus flexus

A manganese oxidizing bacterium was isolated from the surface of steel scraps and biochemical tests and 16S rRNA sequencing analysis confirmed the isolate as Bacillus flexus. Potentiodynamic polarization curves showed ennoblement of open circuit potential, increased passive current, a lowering of breakdown potential, active re-passivation potential and enhanced cathodic current in the presence of B. flexus. Adhesion studies with B. flexus on SS304 specimens with different surface treatments demonstrated decreased adhesion on passivated and FeCl(3) treated specimens due to the removal of MnS inclusions. The present study provides evidence that surface treatment of stainless steels can reduce adhesion of this manganese oxidizing bacterium and decrease the probability of microbiologically influenced corrosion.

Effect of biofouling on anodized and sol-gel treated titanium surfaces: a comparative study

Anodization and sol-gel treatments of titanium (Ti) were evaluated as biofilm control measures on surfaces exposed to seawater exposed to ultraviolet light. Anodized and sol-gel treated specimens were characterized using Raman spectroscopy to confirm the presence of TiO(2). The single anatase phase was observed at the anodized surfaces whereas the anatase/rutile mixed phase was detected on the sol-gel coated surfaces. After exposure of the specimens to seawater, biofilms were characterized by total viable counts, and epifluorescence and Raman microscopy. These techniques confirmed the reduction in biofilm formation on both the anodized and sol-gel coated Ti specimens compared to the untreated specimens. Biofilm control by anodization was found to be more effective than by sol-gel treatment of the specimens. The higher particle size and the inhomogeneity at the sol-gel coated surfaces produced less effective biofilm control.

Antibacterial copper-nickel bilayers and multilayer coatings by pulsed laser deposition on titanium

Biofouling, especially microfouling, is a major concern with the use of titanium (Ti) in the marine environment as a condenser material in cooling water systems. Earlier, copper-nickel (Cu/Ni) alloys were extensively used in marine environments due to their high corrosion and biofouling resistance. However, the choice of condenser material for the new fast breeder reactor in Kalpakkam is Ti to avoid steam side corrosion problems, which may pose a threat to steam generator parts having sodium as the secondary coolant. This study evaluates the surface modification of Ti using nano films of copper (Cu) and nickel (Ni) to utilize the antibacterial property of copper ions in reducing microfouling. The surface modification of Ti was carried out by the deposition of a Cu/Ni bilayer and (Cu/Ni)(10) multilayer films using a pulsed laser deposition technique. Various surface characterization studies revealed that the deposited Cu/Ni films were thin and nanocrystalline in nature. The antibacterial properties were evaluated using total viable count and epifluorescence microscopic techniques. The results showed an apparent decrease in bacterial attachment on multilayered and bilayered Cu/Ni thin films on Ti surfaces. Comparative studies between the two types of films showed a bigger reduction in numbers of microorganisms on the multilayers.

Surface modification of titanium using nanothin films of copper for biofouling control

Biofouling is one of the major impediment in the use of titanium, which is otherwise excellent material with respect to corrosion resistance and mechanical properties, for seawater-cooled condensers of power plants. The routine chlorination treatment and sponge ball cleaning may not be successful to keep the titanium condenser tube clean over a period extending to years. This brings into focus the relevance of surface modification of titanium to improve the antimicrobial properties, which can effectively supplement the present treatment programmes. In this study antimicrobial thin film of copper (Cu) is developed on titanium surfaces, as copper is known to be very toxic to microorganisms and effectively kills most of the microbes by blocking the respiratory enzyme system. The preparation of nanocrystalline thin films of copper on titanium surfaces was done by pulsed DC magnetron-sputtering technique. Then this thin film was characterized using Glancing Incidence X-ray Diffraction (GIXRD) and Atomic Force Microscopy (AFM). Antimicrobial properties of these specimens were evaluated by exposure studies in seawater. Results showed two order decrease in the bacterial density on copper coated surface and epifluorescence micrographs depicted very few fluorescing cells and no biofilm formation clearly demonstrating the superior antibacterial capability of this nanocrystalline copper thin film.

Biomineralisation of manganese on titanium surfaces exposed to seawater

A 2-year long study was carried out to isolate and characterise various bacterial species present in the biofilm formed on titanium surfaces exposed to seawater and to assess the manganese oxidizing potential of the marine isolates. The amount of manganese present in the biofilm was also measured using atomic absorption spectrometry (AAS). The results showed that titanium was susceptible to biofouling. More than 50% of the culturable marine bacterial isolates were capable of bringing about oxidation of Mn(II). All these manganese oxidizing bacteria were heterotrophic. Autotrophic manganese oxidizing bacteria such as Leptothrix was not isolated in the present study. The AAS results confirmed that the manganese content in the biofilms increased with increasing exposure time. Hence, the study indicates that the titanium surfaces when exposed to seawater were colonised by a large number of heterotrophic bacteria, which have the ability of bringing about biomineralisation of manganese.

Photocatalytic inhibition of microbial adhesion by anodized titanium

Biofouling is one of the concerns in the use of titanium for seawater cooled condensers of power plants. Earlier studies have shown that anodized titanium and its alloys with a thin film of anatase (TiO(2)) on its surface can inhibit attachment of Pseudomonas sp. when illuminated with near-UV light (350 - 380 nm). In the present study, a comparison of the photocatalytic inhibition of microbial attachment on titanium surfaces anodized at different voltages was carried out. Thin films of anatase of varying thickness were produced on titanium grade-2 by anodizing in dilute orthophosphoric acid solution at 30 V, 50 V and 100 V. The photocatalytic efficiency of these anodized surfaces was measured by the methylene blue degradation method. The anodised surfaces were exposed to liquid cultures of Gram-negative Pseudomonas sp., Gram-positive Micrococcus sp. and to a mixed algal culture. Photocatalytic inhibition of microbial attachment was maximum on the titanium surface anodized at 30 V, followed by the surface anodized at 50 V and then at 100 V. The photocatalytic inhibition of microbial attachment was also found to be dependent on the cell wall characteristics of the organism. The Gram-negative Pseudomonas sp. with a lipoproteinaceous outer membrane was the most susceptible to the photocatalytic effect, while the Gram-positive Micrococcus sp. with peptidoglycan cell wall showed moderate susceptibility and the algae with siliceous cell wall showed no susceptibility at all.

Influence of surface characteristics and microstructure on adhesion of bacterial cells onto a type 304 stainless steel

A study was carried out to understand the influence of the surface characteristics/microstructure of a type 304 stainless steel on bacterial adhesion by exposing solution-annealed, sensitized and air-oxidized stainless steel specimens in a culture of Pseudomonas sp. in dilute nutrient broth. Epifluorescence microscopy of the exposed surfaces revealed that the pattern of adhesion as well as number density of bacterial cells was different depending on the metallurgical condition of the substratum. Among the specimens with different microstructures, the sensitized specimens had the highest bacterial density, followed by the solution annealed and the oxidized specimens. The same trend was shown by the total viable counts on the various surfaces, estimated by a plate count technique. The study assumes significance in the context of the widely reported observation of preferential attack of the welded region during microbiologically influenced corrosion of fabricated components.

Characterization of human tissue carnosinase

Human tissue carnosinase (EC 3.4.13.3) had optimum activity at pH9.5 and was a cysteine peptidase, being activated by dithiothreitol and inhibited by p-hydroxymercuribenzoate. By optimizing assay conditions, the activity per g of tissue was increased 10-fold compared with values in the literature. The enzyme was present in every human tissue assayed and was entirely different from serum carnosinase. Highly purified tissue carnosinase had a broader specificity than hog kidney carnosinase. Although tissue carnosinase was very strongly inhibited by bestatin, it did not hydrolyse tripeptides, and thus appears to be a dipeptidase rather than an aminopeptidase. It had a relative molecular mass of 90 000, an isoelectric point of 5.6, and a Km value of 10 mM-carnosine. Two forms of kidney and brain carnosinase were separated by high-resolution anion-exchange chromatography, although only one form was detected by various electrophoretic methods. Homocarnosinase and Mn2+-independent carnosinase were not detected in human tissues, although these enzymes are present in rat and hog kidney.

Human serum carnosinase: characterization, distinction from cellular carnosinase, and activation by cadmium

Human serum carnosinase was assayed using a simple and sensitive fluorometric method. Under optimum conditions, the average adult serum hydrolyzed 42 mu mol of carnosine per ml per hour, about 17 times the average activity reported in the literature. Cadmium was twice as effective as manganese as an activator of this enzyme. Serum carnosinase was found to be different in many respects from cellular carnosinase. For example, the serum isozyme hydrolyzed homocarnosine, whereas the cellular carnosinase did not. The apparent molecular weight of serum carnosinase was 160 000, while that of the cellular isozyme was 90 000. Although it has been reported that serum contains two molecular forms of carnosinase, only one form was detected using several electrophoretic methods and two ion exchange chromatography procedures. The concentration of serum carnosinase varied greatly between individuals. Little or no enzyme was detected in children below 10 months in age. Thereafter, the average concentration of carnosinase increased gradually to reach the adult range at age 13-15.

Disruption of multicellular organization in the cellular slime molds by cyclic AMP

Addition of cyclic AMP causes disorder in the multicellular stage of a number of species of cellular slime molds. In those which produce fruits with cellular stalks, the addition of cyclic AMP stimulates prestalk cells to differentiate into mature stalk cells. Prespore cells do not differentiate into spores under the influence of cyclic AMP, most degenerate and seem to die. I hypothesize that the normal course of differentiation from vegetative cells is one leading to spores, but that cyclic AMP can divert this course to one leading to the stalk cell. Dibutyryl cyclic AMP, cyclic GMP and cyclic AMP disrupt slugs of Polysphondylium pallidum, while species of Dictyostelium are disrupted by only cyclic AMP. The multicellular stage of P. violaceum is unaffected by high concentrations of exogenous cyclic nucleotides. Cell organization of Acytostelium ellipticum, a species with an acellular stalk, was disrupted by cyclic AMP, but no stalk cells were formed; only spores.

Germination and mitochondrial damage in spores of Dictyostelium discoideum following supraoptimal heating

Spores of Dictyostelium discoideum may be quantitatively activated with a heat treatment of 45 degrees C for 30 min. Heat activation at either higher temperatures of for longer duration at 45 degrees C resulted in damaged spores. The spores showed an increased postactivation lag time at 23 degrees C and an increased inability to respond to deactivation with 0.2 M sucrose. As the severity of supraoptimal heating increased, a greater percentage of the spores appeared to contain phase dark lesions and to lose viability. Oxygen uptake began to decrease during and after the appearance of the lesions. Using electron microscopy, the phase dark lesions were found to be mitochondria with disrupted cristae.

Scanning electron microscopy of spore germination in Dictyostelium discoideum

The ellipsoidal dormant spores of Dictyostelium dicoideum prepared by freeze-drying had a uniform, compact appearance with fine wrinkles or ridges on the surface. Swollen spores were uneven in appearance, without fine wrinkles but with a seemingly expanded surface covering. The surfaces of the postgermination spore husks appeared unaltered except for a single straight exit slit along the longitudinal plane.

Therapy of acute myelocytic leukemia. Daunomycin contrasted with a combination of cytosine arabinoside and 6-thioguanine

Twenty-three patients with acute myelocytic leukemia (aml) were treated with daunomycin and the results contrasted to those obtained in a subsequent group of 18 patients treated with cytosine arabinoside (ara-c) and 6-thioguanine (tg). The complete remission (cr) rate with daunomycin was 17 percent (mean duration 10.6 months) and the partial remission (pr) rate 26 percent (mean duration 44 days). Corresponding figures in the ara-c and tg group were: cr rate 44 percent (mean duration 5.8 months) and pr rate 17 percent (mean duration 48 days). There were 12 deaths resulting from daunomycin-induced pancytopenia and in ten of the patients who died persistent leukemia infiltrate was found in antemortem marrow specimens or at autopsy. This contrasts with death of six patients from ara-c and tg-induced pancytopenia, in four of whom residual leukemic infiltrate was not evident. Daunomycin alone is deemed not suitable for induction of remission in aml. The results obtained with ara-c and tg are encouraging and may be improved if the number of infectious deaths associated with drug-induced pancytopenia can be reduced.

Hemorrhagic ascites: an unusual complication of multiple myeloma

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