Electrochemical biosensor for aerobic acetate detection

There is an increasing demand on alternatives methods to animal testing. Numerous health parameters have been already studied using in vitro devices able to mimic the essential functions of the organs, being the real-time monitoring and response to stimuli their main limitations. Regarding the health of the gut, the short chain fatty acids, and particularly acetate, have emerged as key biomarkers to evaluate gut healthiness and disease development, although the number of acetate biosensors is still very low. This article presents a microbial biosensor based on fully biocompatible materials which is able to detect acetate in aerobic conditions in the range between 11 and 50 mM, and without compromising the viability and function of either bacteria (>90% viability) or mammalian cells (>80% viability). The detection mechanism is based on the metabolism of acetate by Escherichia coli bacteria immobilized on the transducer surface. Ferricyanide is used as a redox mediator to transfer electrons from the acetate metabolism in the bacterial cells to the transducer. High bacterial concentrations are immobilized in the transducer surface (109 cfu mL-1) by electrodeposition of conductive alginate hydrogels doped with reduced graphene oxide. The results show successful outcomes to exploit bacteria as a biosensing tool, based on the use of inkjet printed transducers, biocompatible materials and cell entrapment technologies.

Eco-toxicity assessment of industrial by-product-based alkali-activated binders using the sea urchin embryogenesis bioassay

New cement-based materials such as alkali-activated binders (AABs) or geopolymers allow the incorporation of waste or industrial by-products in their formulation, resulting an interesting valorization technique. Therefore, it is essential to inquire about the potential environmental and health impacts throughout their life cycle. In the European context, a minimum aquatic toxicity tests battery has been recommended for construction products, but their potential biological effects on marine ecosystems have not been considered. In this study, three industrial by-products, PAVAL® (PV) aluminum oxide, weathered bottom ash (WBA) resulting from incinerator bottom ash and glass cullet recycling waste (CSP), were evaluated as precursors in the AAB formulation from an environmental point of view. To determine the potential effects on marine environment caused by the leaching of contaminants from these materials into seawater, the leaching test EN-12457-2 and an ecotoxicity test using the model organism sea urchin Paracentrotus lividus were conducted. The percentage of abnormal larval development was selected as endpoint of the toxicity test. Based on the results obtained from the toxicity tests, AABs have less damaging impact (EC₅₀ values: 49.2%-51.9%) on the marine environment in general than raw materials. The results highlight the need to stablish a specific battery of toxicity tests for the environmental assessment of construction products on marine ecosystem.

First multivisceral transplantation in Mitchell-Riley/Martinez-Frias syndrome

BACKGROUND

MRS/MFS is a rare multisystem disorder with a poor prognosis. The high mortality rate of this syndrome is related to the severity of the associated gastrointestinal, pancreatic, and hepatobiliary conditions, as most of them are not amenable to conventional medical and surgical treatments.

METHODS

We report the case of a Romani girl with all the key clinical features of MRS/MFS, and a review of cases reported in the literature. Our patient is a newborn from consanguineous parents who presented duodenal atresia, hypoplastic pancreas, gallbladder agenesis, and neonatal diabetes. Given the clinical suspicion of MRS/MFS, a genetic analysis was performed which revealed the presence of a homozygous variant in the RFX6 gene. During the course of the disease, the patient presented intractable secretory diarrhea and severe intestinal failure.

RESULTS

At 2 years of age, she underwent MVT of the stomach, duodenum, small intestine, colon, liver, and pancreas. There were no surgical complications. Histologic evaluation of the small bowel showed extensive patches of gastric heterotopia. After more than 10 years of follow-up, she had presented with normal gastrointestinal, hepatic, and pancreatic function. She has one of the longest survival periods in the literature.

CONCLUSIONS

Our experience suggests that multivisceral transplantation may be a promising option in select cases of MRS/MFS.

Nutritional and antioxidant changes in lentils and quinoa through fungal solid-state fermentation with Pleurotus ostreatus

Solid-state fermentation (SSF) may be a suitable bioprocess to produce protein-vegetal ingredients with increased nutritional and functional value. This study assessed changes in phenol content, antinutrient content, biomass production and protein production resulting from the metabolic activity of Pleurotus ostreatus, an edible fungus, in lentils and quinoa over 14 days of SSF. The impact of particle size on these parameters was also assessed because the process was conducted in both seeds and flours. Fungus biomass increased during fermentation, reaching 30.0 ± 1.4 mg/g dry basis and 32 ± 3 mg/g dry basis in lentil grain and flour and 52.01 ± 1.08 mg/g dry basis and 45 ± 2 mg/g dry basis in quinoa seeds and flour after 14 days of SSF. Total protein content also increased by 20% to 25% during fermentation, in all cases except lentil flour. However, the soluble protein fraction remained constant. Regarding phytic acid, SSF had a positive impact, with a progressive decrease being higher in flours than in seeds. Regarding antioxidant properties, autoclaving of the substrates promoted the release of polyphenols, together with antioxidant activity (ABTS, DPPH and FRAP), in all substrates. However, these parameters drastically decreased as fermentation progressed. These results provide scientific knowledge for producing lentil- or quinoa-based ingredients with low antinutrient content enriched with protein fungal biomass.

Environmental potential assessment of MSWI bottom ash-based alkali-activated binders

Alkali-activated binders (AABs) stand out as a sustainable alternative to ordinary Portland cement (OPC) as they can be formulated using by-products or waste as raw materials. However, the presence of hazardous compounds in residues can lead to an increase in AABs' toxicity due to the highly alkaline media. Therefore, it is extremely important to evaluate their environmental risks to validate their use as building materials. This study environmentally assessed AABs prepared with two different fractions (0-30 mm and 8-30 mm) of weathered bottom ash (AA-WBA) from WtE plants. The potential leachate toxicity of AA-WBA was assessed using granular and monolithic leaching tests that simulated end-of-life and service life scenarios, respectively. Furthermore, an acute toxicity test with crustacean Daphnia magna as model organisms was conducted to determine the relationship between the leachate metal(loid) concentrations and the ecotoxicity of AA-WBA. The results showed higher metal(loid) concentrations in AA-WBA specimens prepared with the 0-30 mm fraction of WBA. The service life scenario revealed multiple metal(loid)-release mechanisms. The 48 h EC₅₀ value (close to 10%; moderate toxicity) indicated that the use of the coarse fraction of WBA increased the immobilisation of the metal(loid)s. Finally, the correlation between the concentrations of some of the metal(loid)s and toxicity was demonstrated.

Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients

Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm³) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO₂/FiO₂ ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.

The potential of fermentation on nutritional and technological improvement of cereal and legume flours: A review

Nowadays there is an increasing demand for vegetable protein sources as an alternative to that of animal origin, not only for its greater environmental sustainability but also for its relationship with lower risk of suffering cardiovascular diseases. Legumes, cereals and seeds are seen as a good proteinaceous source providing as well dietetic fiber and phytochemicals with antioxidant properties. However, their digestibility and bioavailability are limited by the presence of anti-nutritional factors (ANFs) but susceptible of being improved by soaking, cooking or fermentation. The objective of this work is to review the solid-state and submerged fermentation effect on nutritional and functional properties of legumes, cereals and seeds. The microorganisms involved (bacteria, fungus and yeasts) are able to produce enzymes that degrade ANFs giving rise to more digestible flours with a more interesting nutritional, sensorial and technological profile. Solid-state fermentation is more commonly used for its higher efficiency, accepting agro-industrial residues as substrates and its lower volume of effluents. Fermented legumes had their technological properties enhanced while an increment in antioxidant properties was characteristic of cereals. The present review highlights fermentation of cereals and legumes mainly as a key process that at industrial scale could generate new products with enhanced nutritional and technological properties.

Regular monitoring of cytomegalovirus-specific cell-mediated immunity in intermediate-risk kidney transplant recipients: predictive value of the immediate post-transplant assessment

OBJECTIVE

Previous studies on monitoring of post-transplant cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) are limited by single-centre designs and disparate risk categories. We aimed to assess the clinical value of a regular monitoring strategy in a large multicentre cohort of intermediate-risk kidney transplant (KT) recipients.

METHODS

We recruited 124 CMV-seropositive KT recipients with no T-cell-depleting induction pre-emptively managed at four Spanish institutions. CMV-specific interferon-γ-producing CD4⁺ and CD8⁺ T cells were counted through the first post-transplant year by intracellular cytokine staining after stimulation with pp65 and immediate early-1 peptides (mean of six measurements per patient). The primary outcome was the occurrence of any CMV event (asymptomatic infection and/or disease). Optimal cut-off values for CMV-specific T cells were calculated at baseline and day 15.

RESULTS

Twelve-month cumulative incidence of CMV infection and/or disease was 47.6%. Patients with pre-transplant CMV-specific CD8⁺ T-cell count <1.0 cells/μL had greater risk of CMV events (adjusted hazard ratio (aHR) 2.84; p 0.054). When the CMI assessment was performed in the immediate post-transplant period (day 15), the presence of <2.0 CD8⁺ T cells/μL (aHR 2.18; p 0.034) or <1.0 CD4⁺ T cells/μL (aHR 2.43; p 0.016) also predicted the subsequent development of a CMV event. In addition, lower counts of CMV-specific CD4⁺ (but not CD8⁺) T cells at days 60 and 180 were associated with a higher incidence of late-onset events.

CONCLUSIONS

Monitoring for CMV-specific CMI in intermediate-risk KT recipients must be regular to reflect dynamic changes in overall immunosuppression and individual susceptibility. The early assessment at post-transplant day 15 remains particularly informative.

Factors associated with implementation of the 5A's smoking cessation model

Background

Several health organizations have adopted the 5A’s brief intervention model (Ask, Advise, Assess, Assist, Arrange), based on evidence-based guidelines for smoking cessation. We examine individual, cognitive, behavioral, and organizational factors associated with the 5A’s performance among clinical healthcare workers in Catalonia. We also investigate how these factors interact and potentially predict the implementation of each component of the 5A’s.

Methods

A cross-sectional survey was conducted among clinical health workers enrolled in an online smoking cessation training course (n = 580). The survey included questions about individual characteristics as well as cognitive, behavioral, and organizational factors previously identified in research. We assessed self-reported performance of the 5A’s, assessed on a scale from 0 to 10, and used Multivariate regression to examine factors associated with its performance.

Results

The performance means (standard deviation) were moderate for the first 3A’s [Ask: 6.4 (3.1); Advise: 7.1 (2.7); Assess: 6.3 (2.8)] and low for the last 2A’s [Assist: 4.4 (2.9); Arrange: 3.2 (3.3)]. We observed a high correlation between Assist and Arrange (r = 0.704, p < 0.001). Having positive experiences and feeling competent were positively associated with performing the 5A’s model and having organizational support with Assist and Arrange. Personal tobacco use among healthcare workers was negatively associated with Advice and Arrange.

Conclusions

Our study found that clinical healthcare workers do not perform the 5A’s completely. The main barriers identified suggest the need of training and making available practical guidelines in healthcare services. Organizational support is essential for moving towards the implementation of Assist and Arrange.

Electronic supplementary material

The online version of this article (10.1186/s12971-017-0146-7) contains supplementary material, which is available to authorized users.

Influence of drying process and particle size of persimmon fibre on its physicochemical, antioxidant, hydration and emulsifying properties

Persimmon, given its current surplus production, could be an alternative source for the extraction of certain interesting ingredients for the food industry and human health, such as fibre. Thus, the aim of this study was to analyse the influence of hot air and freeze-drying, as well as the particle size of fibre extracted from persimmon peels or pulp on their physicochemical, antioxidant, hydration and emulsifying properties, compared to commercial fibres (from peach, lemon, orange and apple). The results showed that both freeze-dried persimmon pulp and freeze-dried peel had better hydration properties and oil holding capacity than other fibres analysed, although the swelling capacity was higher for lemon fibre. Freeze-dried persimmon peel fibre showed higher values of emulsion stability than commercial fibres. Finally, the antioxidant activity of the smallest sized persimmon peel fibre obtained by freeze-drying was higher than that for lemon, orange and peach fibre.

Dietary acrylamide: What happens during digestion

Acrylamide is a well-known potentially carcinogen compound formed during thermal processing as an intermediate of Maillard reactions. Three objectives were addressed: the impact of gastric digestion on acrylamide content of French Fries, chips, chicken nuggets, onions rings, breakfast cereals, biscuits, crackers, instant coffee and coffee substitute; the acrylamide content evolution during gastrointestinal digestion of French fries and chips; and the effectiveness of blanching and air-frying on acrylamide mitigation after gastrointestinal digestion. A significant increase (p-value <0.05) in acrylamide content was observed for most of the products after gastric digestion (maximum registered for sweet biscuits, from 30±8 to 150±48µg/kg). However, at the end of the intestinal stage, acrylamide values were statistically similar (p-value=0.132) for French fries and lower than the initial values (before digestion) in potato chips (p-value=0.027). Finally, the low acrylamide content found in blanched and air-fried samples, remained still lower than for deep fried samples even after gastrointestinal digestion.

Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.

Should Asymptomatic Bacteriuria Be Systematically Treated in Kidney Transplant Recipients? Results From a Randomized Controlled Trial

The indication for antimicrobial treatment of asymptomatic bacteriuria (AB) after kidney transplantation (KT) remains controversial. Between January 2011 and December 2013, 112 KT recipients that developed one episode or more of AB beyond the second month after transplantation were included in this open-label trial. Participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of AB occurring ≤24 mo after transplantation [53 patients]) or control group (no antimicrobial therapy [59 patients]). Systematic screening for AB was performed similarly in both groups. The primary outcome was the occurrence of acute pyelonephritis at 24-mo follow-up. Secondary outcomes included lower urinary tract infection, acute rejection, Clostridium difficile infection, colonization or infection by multidrug-resistant bacteria, graft function and all-cause mortality. There were no differences in the primary outcome in the intention-to-treat population (7.5% [4 of 53] in the treatment group vs. 8.4% [5 of 59] in the control group; odds ratio [OR] 0.88, 95% confidence interval [CI] 0.22-3.47) or the per-protocol population (3.8% [1 of 26] in the treatment group vs. 8.0% [4 of 50] in the control group; OR 0.46, 95% CI 0.05-4.34). Moreover, we found no differences in any of the secondary outcomes. In conclusion, systematic screening and treatment of AB beyond the second month after transplantation provided no apparent benefit among KT recipients (NCT02373085).

Some advances in osmotic dehydration of fruit/Algunos avances en deshidratación osmótica de frutas

There are many works in the field of osmotic dehydration of fruit where kinetic studies using a macroscopic approach are reported. However, very few studies have been developed from a microscopic point of view, taking into account the compartment structure of the cellular tissue and the complex cell to cell transport phenomena. The latter could allow a better understanding of the process and therefore a more accurate model, but in many cases it is not possible to establish an adequate bridge between microscopic models and practical applications. The analysis of the concentration profiles during mass transfer phenomena in structured foods, being a macroscopic approach, is a very useful tool to clarify the mass transfer mechanisms as well as to calculate the corresponding kinetics. In this paper the concentration profiles of water and solutes, developed throughout the fruit osmotic dehydration, are discussed as a function of the temperature and sample thickness for apple. The profile development is modeled in terms of a new mathematical model, which could avoid some of the restraints of the Fickian equations, usually utilized in this kind of modeling. Another aspect involved in this work is the equilibrium status of the fruit in the osmotic process. Equilibrium data are required to evaluate the true driving force of the mass transfer process. Nevertheless, a lack of studies in this area was detected. The results of extensive work on the behavior of samples until equilibrium is reached in osmotic treatments are also discussed.

Note. Vacuum impregnation of banana (Musa acuminata cv. giant cavendish) / Nota. Impregnación a vacío de banana (Musa acuminata cv. giant cavendish

Vacuum impregnation of banana was analysed by a hydrodynamic mechanism to determine effec tive porosity ( ∈e). In the initial experiments, the influence of the ripening degree and cut was deter mined without taking into account sample deformations caused by the pressure gradients; in these cases ∈ e decreased as maturity progressed. Important structural changes were observed 2-4 days after the bananas were purchased from the local market, probably due to the climacteric charac teristic of the product. Other experiments were carried out to analyse the coupling of the hydro dynamic mechanism (HDM) with deformation-relaxation phenomena (DRP) by varying the time of treatment; ε e values determined by this procedure were approximately 10.1% and significant deformation values in the vacuum step (γ e = 3.6%) were observed. The height/diameter ratio also seemed to influence the behaviour of the product to the HDM-DRP action. The most impregnated samples were the ones with a height half that of the banana diameter.

Note: Moisture Sorption Isotherms and Isosteric Heat of Red Bell Pepper (var. Lamuyo)

Sorption isotherms of red pepper (var. Lamuyo) were determined at three temperatures (10, 20 and 30°C) in a range of water activity from 0.10 to 0.96. BET, GAB, Halsey, Herderson, Caurie, Smith, Oswin and Iglesias—Chirife equations were tested for modelling the sorption isotherms. The statistical evaluation of fit quality of the preceding models showed good results using the BET, GAB, Halsey and Iglesias—Chirife models on experimental sorption data. The BET and GAB models showed monolayer moisture contents from 0.07 to 0.10 g water/g (d.b.); however, they did not show direct dependence on temperature. The Clausius—Clapeyron equation satisfactorily determined the sorption isosteric heats, which were found to increase as the moisture content decreased; the desorption heat (74.2kJ/mol) was higher than that of adsorption heat (36.9kJ/mol). The preceding experimental data showed a good quality fit when evaluated with the Tsami equation.

Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options

BACKGROUND

Antibiotic resistance is an emerging phenomenon in kidney transplantation (KT).

METHODS

We compared species distribution and antimicrobial susceptibility patterns in 1052 isolates from urine cultures obtained in 2 different cohorts of kidney transplant recipients in a single center (Cohort A: 189 patients undergoing KT between January 2002 and December 2004 [336 isolates]; Cohort B: 115 patients undergoing KT between January 2011 and December 2013 [716 isolates]).

RESULTS

Asymptomatic bacteriuria accounted for most of the isolates (86.9% in Cohort A and 92.3% in Cohort B). Klebsiella pneumoniae (9.5% vs. 15.6%), Pseudomonas aeruginosa (1.8% vs. 7.9%), and Enterobacter cloacae (0.6% vs. 3.1%) were significantly more common in Cohort B. The isolation of K. pneumoniae in Cohort B was associated with the occurrence of acute pyelonephritis (9.8% of all K. pneumoniae isolates vs. 2.8% of the remaining uropathogens; P = 0.001). Non-susceptibility rates among Enterobacteriaceae in Cohort B were higher for every class of antibiotics (P ≤ 0.003) with the exception of fosfomycin. Compared to Cohort A, significant increases were seen in isolates from Cohort B for multidrug-resistant (MDR) (43.9% vs. 67.8%, respectively; P = 0.001), extended-spectrum beta-lactamase (ESBL)-producing (6.6% vs. 26.1%; P = 0.001), and carbapenemase-producing Enterobacteriaceae strains (0.0% vs. 5.0%; P = 0.001). Such differences were mostly attributable to K. pneumoniae (as 54.5% and 13.4% of isolates in Cohort B were ESBL-producing and carbapenemase-producing, respectively). MDR isolates were responsible for 69.1% of episodes of symptomatic urinary tract infection in Cohort B.

CONCLUSION

The increase in resistance rates among Enterobacteriaceae uropathogens is significant and may have an effect on KT programs.

Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study

Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.

Using mixture design of experiments to assess the environmental impact of clay-based structural ceramics containing foundry wastes

This work describes the leaching behavior of potentially hazardous metals from three different clay-based industrial ceramic products (wall bricks, roof tiles, and face bricks) containing foundry sand dust and Waelz slag as alternative raw materials. For each product, ten mixtures were defined by mixture design of experiments and the leaching of As, Ba, Cd, Cr, Cu, Mo, Ni, Pb, and Zn was evaluated in pressed specimens fired simulating the three industrial ceramic processes. The results showed that, despite the chemical, mineralogical and processing differences, only chrome and molybdenum were not fully immobilized during ceramic processing. Their leaching was modeled as polynomial equations, functions of the raw materials contents, and plotted as response surfaces. This brought to evidence that Cr and Mo leaching from the fired products is not only dependent on the corresponding contents and the basicity of the initial mixtures, but is also clearly related with the mineralogical composition of the fired products, namely the amount of the glassy phase, which depends on both the major oxides contents and the firing temperature.

Everolimus-based immunosuppression therapy for BK virus nephropathy

BACKGROUND

Mammalian target of rapamycin inhibitors (mTOR-i) have been proposed as possible immunosuppressants of choice in BK virus nephropathy (BKN) because of their antiviral capacity. On this basis, in 2007, our Service proposed a conversion to everolimus (EVE)-based therapy from calcineurin inhibitors with an anti-calcineurin-free therapy protocol in those patients diagnosed of BKN.

METHODS

A prospective, single-center case series study was performed. Fifteen cases of BKN were diagnosed from 2007 to the end of 2010. According to our protocol, immunosuppressant treatment was modified in 9 of these patients with suspension of mycophenolate and conversion from tacrolimus to EVE.

RESULTS

The renal function achieved by our patients after the transplantation was excellent. Mean serum creatinine (sCr) achieved was 1.16 ± 0.2 mg/dL. Evolution of the renal function after BKN diagnosis and conversion to mTOR-i was positive in all the patients. sCr on diagnosis was 1.85 ± 0.22 mg/dL, sCr at the point in time of conversion to EVE was 2 ± 0.21 mg/dL, and final sCr of the follow-up was 1.6 ± 0.39 mg/dL (P = .05). BK viremia became negative in 5 of our patients and decreased more than 95% in the remaining 4. None of the patients had an acute rejection episode after the change of immunosuppressant.

CONCLUSIONS

Conversion to mTOR-i-based therapy could provide an added benefit in BKN and could be an effective strategy for the decrease of the viremia and increase of graft survival in selected patients.

Characterisation of the sintering behaviour of Waelz slag from electric arc furnace (EAF) dust recycling for use in the clay ceramics industry

Waelz slag is an industrial by-product from the recovery of electric arc furnace (EAF) dust which is mainly sent to landfills. Despite the different chemical and mineralogical compositions of Waelz slag compared to traditional clays, previous experiments have demonstrated its potential use as a clay substitute in ceramic processes. Indeed, clayey products containing Waelz slag could improve mechanical and environmental performance, fixing most of the metallic species and moreover decreasing the release of some potential pollutants during firing. However, a deeper understanding of the complex phase transformations during its thermal treatment and the connection of this behaviour with the end properties is desirable in order to explain the role that is played by the Waelz slag and its potential contribution to the ceramic process. For this purpose, in the present study, the chemical, mineralogical, thermal and environmental behaviour of both (i) unfired powdered samples, and (ii) pressed specimen of Waelz slag fired up to different temperatures within the typical range of clay based ceramic production, has been studied. The effect of the heating temperature on the end properties of the fired samples has been assessed. In general, an increase of the firing temperature promotes sintering and densification of the products and decreases the open porosity and water absorption which also contributes to the fixation of heavy metals. On the contrary, an increase in the leaching of Pb, Cr and Mo from the fired specimens is observed. This can be attributed to the creation of Fe and Ca molybdates and chromates that are weakly retained in the alkali matrix. On the other side, at temperature above 950 °C a weight gain related to the emission of evolved gases is observed. In conclusion, the firing temperature of the ceramic process is a key parameter that affects not only the technical properties but also strongly affects the leaching behaviour and the process emissions.

[Ocular paraneoplastic syndrome: cancer-associated retinopathy]

CASE REPORT

We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed.

DISCUSSION

Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour.

Serum iron parameters in the early post-transplant period and infection risk in kidney transplant recipients

BACKGROUND

The impact of iron metabolism on the risk of infectious complications has been demonstrated in various immunosuppressed populations. However, no previous studies have assessed this potential association in kidney transplant (KT) recipients.

METHODS

We prospectively analyzed 228 patients undergoing KT at our institution from November 2008 to February 2011. Serum iron parameters (iron level, ferritin, total iron-binding capacity, unsaturated iron-binding capacity, transferrin, and transferrin saturation) were assessed within the first 2 weeks after transplantation (median interval, 3 days; interquartile [Q1 -Q3 ] range, 1-6 days), and before the occurrence of the first infectious episode (median interval, 26 days; Q1 -Q3 range, 11-76 days). Primary outcome was the occurrence of any episode of infection during the first year. Multivariate-adjusted hazard ratios (aHRs) were estimated by Cox regression models.

RESULTS

Patients with ferritin level ≥ 500 ng/mL had higher incidence rates (per 1000 transplant-days) of overall infection (P = 0.017), bacterial infection (P = 0.002), and bloodstream infection (P = 0.011) during the first post-transplant year. One-year infection-free survival rate was lower in these recipients (26% vs. 41%; P = 0.004). On multivariate analysis, after adjusting for potential confounders, ferritin emerged as an independent predictor of overall infection (aHR [per unitary increment], 1.001; P = 0.006), and bacterial infection (aHR [per unitary increment], 1.001; P = 0.020).

CONCLUSION

Monitoring of serum iron parameters in the early post-transplant period may be useful in predicting the occurrence of infection in KT recipients, although further studies should be carried out to confirm this preliminary finding.

Extensive hypermetabolic pattern of brown adipose tissue activation on 18F-FDG PET/CT in a patient diagnosed of catecholamine-secreting para-vesical paraganglioma

The widespread use of (18)F-FDG PET-CT scanning in oncological patients has allowed to demonstrate the existence of metabolically active brown fat, also called brown adipose tissue (BAT), in adult humans, and specifying its anatomical distribution in vivo. As physiological determinants to BAT (18)F-FDG uptake has been identified gender, age, temperature, and body mass index. We have observed extensive activation of the BAT, including the mesenteric region, in a patient with a catecholamine-secreting para-vesical paranganglioma. The extensive BAT activation could be secondary to adrenergic stimulation due to excess of circulating norepinephrine concentration.