A Systematic Search for Molecular Outflows Toward Candidate Low-Luminosity Protostars and Very Low Luminosity Objects

We present a systematic single-dish search for molecular outflows toward a sample of 9 candidate low-luminosity protostars and 30 candidate Very Low Luminosity Objects (VeLLOs; L_int < 0.1 L_sun). The sources are identified using data from the Spitzer Space Telescope catalogued by Dunham et al. toward nearby (D < 400 pc) star forming regions. Each object was observed in 12CO and 13CO J = 2-1 simultaneously using the sideband separating ALMA Band-6 prototype receiver on the Heinrich Hertz Telescope at 30 arcsecond resolution. Using 5-point grid maps we identify five new potential outflow candidates and make on-the-fly maps of the regions surrounding sources in the dense cores B59, L1148, L1228, and L1165. Of these new outflow candidates, only the map of B59 shows a candidate blue outflow lobe associated with a source in our survey. We also present larger and more sensitive maps of the previously detected L673-7 and the L1251-A IRS4 outflows and analyze their properties in comparison to other outflows from VeLLOs. The accretion luminosities derived from the outflow properties of the VeLLOs with detected CO outflows are higher than the observed internal luminosity of the protostars, indicating that these sources likely had higher accretion rates in the past. The known L1251-A IRS3 outflow is detected but not remapped. We do not detect clear, unconfused signatures of red and blue molecular wings toward the other 31 sources in the survey indicating that large-scale, distinct outflows are rare toward this sample of candidate protostars. Several potential outflows are confused with kinematic structure in the surrounding core and cloud. Interferometric imaging is needed to disentangle large-scale molecular cloud kinematics from these potentially weak protostellar outflows.Comment: 42 pages, 19 figures, Accepted for publication in the Astronomical Journa

The fate of renal allografts treated with OKT3 for steroid-resistant rejection

OBJETIVO: Avaliar o efeito do anticorpo monoclonal anti-CD3 (OKT3), utilizado para tratamento de rejeição aguda córtico-resistente em pacientes transplantados renais, em relação à função do rim transplantado e à sobrevida do enxerto e do paciente a longo prazo. PACIENTES E MÉTODOS: Foram estudados 231 pacientes transplantados renais de doador vivo e cadavérico, tendo como imunossupressão de base prednisona, azatioprina e ciclosporina. O diagnóstico de rejeição aguda baseou-se em critérios clínicos e laboratoriais. Sessenta e três (27,2%) pacientes não apresentaram rejeição aguda, 135 (58,4%) tiveram rejeição córtico-sensível e 33 (14,2%) receberam OKT3 para rejeição córtico-resistente. Foram avaliados dados demográficos, função do enxerto, sobrevida do enxerto e do paciente até o quinto ano de transplante, bem como as causas de perda do rim transplantado e de óbito. RESULTADOS: O tempo de anastomose vascular e a prevalência de necrose tubular aguda foram significativamente maiores nos pacientes que receberam OKT3. A média da creatinina sérica do grupo OKT3 não diferiu do grupo com rejeição córtico-sensível. A sobrevida do enxerto no primeiro ano foi significativamente pior no grupo tratado com OKT3 em relação ao pacientes sem rejeição (P = 0,001) e com rejeição córticoresponsiva (P = 0,04), mas a sobrevida ao final do seguimento não diferiu. Nos transplantes cadavéricos, a diferença ocorreu apenas entre o grupo OKT3 e os pacientes sem rejeição. A sobrevida do paciente em 5 anos foi semelhante entre os 3 grupos. Não houve diferença nas causas de perda do enxerto, mas a proporção de óbitos associados à infecção foi maior nos pacientes que utilizaram OKT3. CONCLUSÕES: O uso de OKT3 como terapia de resgate não esteve associado a uma pior função ou pior sobrevida do enxerto renal em 5 anos, mas no primeiro ano a sobrevida do enxerto foi significativamente menor nos pacientes tratados com OKT3. O emprego de uma imunossupressão mais potente não se refletiu em maior mortalidade até o 5º ano do transplante, mas o grupo que utilizou OKT3 apresentou uma maior incidência de óbitos associados à infecção.OBJECTIVE: To evaluate the long-term effects of the monoclonal antibody anti-CD3 (OKT3), used to treat steroid-resistant acute renal allograft rejection, on allograft function and long-term allograft and patient survival. MATERIALS AND METHODS: We studied 231 kidney transplants from living and cadaver donors and with prednisone, azathioprine and cyclosporin used for baseline immunosuppression. Diagnosis of acute rejection was based on clinical and laboratory criteria. Sixty-three (27.2%) patients did not present acute rejection, 135 (58.4%) presented steroid-sensitive rejection, and 33 (14.2%) received OKT3 as a rescue therapy for steroid-resistant rejection. We evaluated demographic data, serum creatinine, and allograft and patient survival up to the 5th posttransplant year, as well as causes of graft loss and patient death. RESULTS: Vascular anastomosis time and prevalence of acute tubular necrosis were significantly higher in OKT3-treated patients. Average serum creatinine was not different between steroid-sensitive and steroid-resistant patients. Graft survival in the first year was poorer in the OKT3 group as compared to the non-rejection (P = 0.001) and steroidsensitive rejection (P = 0.04) groups; there was no difference, however, in the survival up to the 5th posttransplant year. In transplants from cadaver donors, graft survival was statistically different only between OKT3 and non-rejection patients. Patient survival did not differ between the 3 groups up to the end of the follow-up. There were no differences in causes of graft loss, but the proportion of deaths associated with infection was greater in patients treated with OKT3. CONCLUSIONS: OKT3 used for rescue therapy in steroid-resistant acute rejection was not associated with poorer renal graft function or survival over the 5-year follow-up period. However, graft survival in the first year was significantly poorer in patients that needed OKT3. The use of a more potent immunosuppression did not result in higher mortality rates up to the 5th year of posttransplant, but OKT3-treated recipients presented a higher incidence of deaths related to infection

The fate of renal allografts treated with OKT3 for steroid-resistant rejection

RESULTADOS: O tempo de anastomose vascular e a prevalência de necrose tubular aguda foram significativamente maiores nos pacientes que receberam OKT3. A média da creatinina sérica do grupo OKT3 não diferiu do grupo com rejeição córtico-sensível. A sobrevida do enxerto no primeiro ano foi significativamente pior no grupo tratado com OKT3 em relação ao pacientes sem rejeição (P = 0,001) e com rejeição córticoresponsiva (P = 0,04), mas a sobrevida ao final do seguimento não diferiu. Nos transplantes cadavéricos, a diferença ocorreu apenas entre o grupo OKT3 e os pacientes sem rejeição. A sobrevida do paciente em 5 anos foi semelhante entre os 3 grupos. Não houve diferença nas causas de perda do enxerto, mas a proporção de óbitos associados à infecção foi maior nos pacientes que utilizaram OKT3. CONCLUSÕES: O uso de OKT3 como terapia de resgate não esteve associado a uma pior função ou pior sobrevida do enxerto renal em 5 anos, mas no primeiro ano a sobrevida do enxerto foi significativamente menor nos pacientes tratados com OKT3. O emprego de uma imunossupressão mais potente não se refletiu em maior mortalidade até o 5º ano do transplante, mas o grupo que utilizou OKT3 apresentou uma maior incidência de óbitos associados à infecção.OBJECTIVE: To evaluate the long-term effects of the monoclonal antibody anti-CD3 (OKT3), used to treat steroid-resistant acute renal allograft rejection, on allograft function and long-term allograft and patient survival. MATERIALS AND METHODS: We studied 231 kidney transplants from living and cadaver donors and with prednisone, azathioprine and cyclosporin used for baseline immunosuppression. Diagnosis of acute rejection was based on clinical and laboratory criteria. Sixty-three (27.2%) patients did not present acute rejection, 135 (58.4%) presented steroid-sensitive rejection, and 33 (14.2%) received OKT3 as a rescue therapy for steroid-resistant rejection. We evaluated demographic data, serum creatinine, and allograft and patient survival up to the 5th posttransplant year, as well as causes of graft loss and patient death. RESULTS: Vascular anastomosis time and prevalence of acute tubular necrosis were significantly higher in OKT3-treated patients. Average serum creatinine was not different between steroid-sensitive and steroid-resistant patients. Graft survival in the first year was poorer in the OKT3 group as compared to the non-rejection (P = 0.001) and steroidsensitive rejection (P = 0.04) groups; there was no difference, however, in the survival up to the 5th posttransplant year. In transplants from cadaver donors, graft survival was statistically different only between OKT3 and non-rejection patients. Patient survival did not differ between the 3 groups up to the end of the follow-up. There were no differences in causes of graft loss, but the proportion of deaths associated with infection was greater in patients treated with OKT3. CONCLUSIONS: OKT3 used for rescue therapy in steroid-resistant acute rejection was not associated with poorer renal graft function or survival over the 5-year follow-up period. However, graft survival in the first year was significantly poorer in patients that needed OKT3. The use of a more potent immunosuppression did not result in higher mortality rates up to the 5th year of posttransplant, but OKT3-treated recipients presented a higher incidence of deaths related to infection

Estudo de permanência prolongada de pacientes internados nas especialidades clínicas do Hospital de Clínicas de Porto Alegre

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Estudo de permanência prolongada de pacientes internados nas especialidades clínicas do Hospital de Clínicas de Porto Alegre

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Estudo da permanência prolongada de pacientes internados nas especialidades pediátricas no Hospital de Clínicas de Porto Alegre

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