Subclinical rejection in renal transplants is associated with low serum mannose-binding lectin levels

Surveillance biopsies have contributed to the understanding of the natural history of renal allograft lesions. Subclinical rejection, defined as the presence of histological lesions, indistinguishable from acute rejection in stable grafts, is associated with progression of interstitial fibrosis and tubular atrophy. The prevalence of subclinical rejection has decreased as more powerful immunosuppressive treatments have been introduced, suggesting that subclinical rejection represents the degree of control of the alloimmune response. However, non-immune factors such as donor age are also associated with the prevalence of subclinical rejection, suggesting that kidneys from older donors are more susceptible to insult and have a reduced capacity for tissue regeneration. Innate immunity has a crucial role in the modulation of the inflammatory response during infection and tissue damage. Mannose-binding lectin (MBL) is an innate immune protein, the polymorphisms of which are associated with infection, low-grade inflammation, diabetes, and cardiovascular disease. However, the relationship between MBL and disease is complex. For example, low MBL level is associated with higher risk for diabetes, whereas in patients with diabetes, high MBL level is associated with more severe renal damage. In renal transplant patients, low MBL levels are associated with an increased prevalence of infection and diabetes, whereas high MBL levels are associated with shortened graft survival. Although MBL is not clearly associated with prevalence of acute rejection, surveillance biopsy studies have shown that low MBL levels are associated with subclinical rejection in kidney and the heart, suggesting that MBL modulates the injury–repair process of the allograft

Análise do Ruído Magnético de Barkhausen por Meio da Transformada Wavelet Discreta para Detecção de Microestrutura Fragilizante em Aço

Ensaios eletromagnéticos não destrutivos vêm sendo desenvolvidos para acompanhamento de formação de microestruturas deletérias em materiais ferromagnéticos. No presente trabalho, o ruído magnético de Barkhausen (RMB) resultante da interação entre ondas emissoras de 5 Hz, 25 Hz e 50 Hz em um aço inoxidável duplex SAF 2205 é avaliado por meio da Transformada Wavelet Discreta (TWD), uma ferramenta de processamento de sinais que possibilita exibir o comportamento de um sinal em diferentes frequências. O aço inoxidável duplex SAF 2205 é utilizado para o estudo por apresentar, após tratamento térmico, a formação de precipitados finos no interior dos grãos que levam à fragilização do mesmo. No caso do RMB, que é um sinal não-estacionário e possui características de alta frequência, a TWD se torna útil em sua análise, uma vez que a decomposição permite a análise multirresolução, em que é possível obter informações dos sinais em diferentes faixas de frequências. Através de diferentes níveis de resolução, as wavelets são capazes de analisar as componentes de alta frequência de um sinal e gerar informações características mais precisas. A primeira fase dos experimentos foi realizada utilizando-se as Transformadas Wavelets Discretas com a famílias Daubechies de ordem 1 (Db1) e cinco níveis de detalhes. Assim, foi verificado que apenas três níveis de detalhes eram necessários para prosseguir. Após isso, outras famílias foram introduzidas, Db5 e Db10, e percebeu-se que a Daubechies de maior ordem, utilizando um nível de resolução, apresentava um melhor resultado em relação as outras. Concluiu-se neste trabalho que a análise do ruído magnético de Barkhausen utilizando a técnica de processamento de sinais pelo uso da Transformada Wavelet Discreta mostrou-se eficaz na detecção da formação de precipitados nanométricos no interior do material, que levam à fragilização do mesmo. Os resultados obtidos com a utilização de ondas emissoras de 5 Hz e 25 Hz foram satisfatórios, entretanto as ondas de 50 Hz não lograram êxito para estas aplicações

Renal Biopsy in Type 2 Diabetic Patients

The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients

Cultural collocations in written and oral corpora formed by reports of rubber tappers from Acre

Com base nos preceitos teóricos da Fraseologia e da Linguística de Corpus, este artigo visa aextração e análise das colocações culturais presentes no Corpus Escrito da Vila Japiim (CEVIJ) e no Corpus Oral do Acre (COAC), formados por relatos de seringueiros acreanos, homens que se dedicaram ao trabalho nos seringais. Metodologicamente, utilizamos o programa WordSmith Tools. Por meio de suas ferramentas WordList, Keywords e Concord, fizemos o levantamento e análise das palavras-chave de maior frequência com foco em sua significação e carga cultural. Neste procedimento de busca, destacaram-se como base (node) lexias como ‘borracha’ e ‘estrada’. Com base na observação das concordâncias, foi possível selecionar colocações culturais incomuns e únicas como “barões da borracha”, “boom da borracha”,“estrada de porta”, “espigão da estrada” e “soldado da borracha”, que fazem parte das idiossincrasias lexicais do “ciclo da borracha”. Os seringueiros que se deslocaram para a Amazônia no período da segunda guerra mundial foram denominados de “soldados da borracha”, em razão de participarem do esforço concentrado de guerra através da produção de borracha que se destinaria ao abastecimento dos mercados da Europa beligerante.Based on principles of Phraseology and Corpus Linguistics, this paper focuses on the extraction and analysis of the cultural collocations present in the Corpus Escrito da Vila Japiim (CEVIJ) and in the Corpus Oral do Acre (COAC), both corpora were built with the speech of rubber tappers from Acre, workers that acted in the northern rubber plantations of Brazil. Regarding our methodology, we used some tools from the software WordSmith Tools, which were WordList, Keywords and Concord to collate and analyze the keywords with the highest frequency, focusing on their meaning and cultural background. During the search procedure, nodes such as ‘borracha’ (rubber) and ‘estrada’ (road) stood among the others for their concordances, from which the observation we could select uncommon and unique cultural collocations as “barões da borracha”, “boom da borracha”,“estrada de porta”, “espigão daestrada”, and “soldado da borracha” ‒ all part of the “Amazon Rubber Boom” idiosyncrasies.The rubber tappers who moved into the Amazon during the Second World War were denominated “rubber soldiers” due to the role they played in the concentrated war efforts through the rubber production to supply the belligerent European market

Low pre-transplant levels of mannosebinding lectin are associated with viral infections and mortality after haematopoietic allogeneic stem cell transplantation

Background: Mannose-binding lectin (MBL) is a key component of innate immunity. Low serum MBL levels, related to promoter polymorphism and structural variants, have been associated with an increased risk of infection. The aim of this work was to analyse the incidence and severity of infections and mortality in relation to the MBL2 genotype and MBL levels in patients underwent allogeneic haematopoietic stem cell transplantation (Allo-HSCT). Results: This was a prospective cohort study of 72 consecutive patients underwent Allo-HSCT between January 2007 and June 2009 in a tertiary referral centre. Three periods were considered in the patients? follow-up: the early period (0?30 days after Allo-HSCT), the intermediate period (30?100 days after Allo-HSCT) and the late period (> 100 days after Allo-HSCT). A commercial line probe assay for MBL2 genotyping and an ELISA Kit were used to measure MBL levels. A total of 220 episodes of infection were collected in the 72 patients. No association between donor or recipient MBL2 genotype and infection was found. The first episode of infection presented earlier in patients with pre-transplant MBL levels of < 1000 ng/ml (median 6d vs 8d, p = 0.036). MBL levels < 1000 ng/ml in the pre-transplant period (risk ratio (RR) 2.48, 95% CI 1.00?6.13), neutropenic period (0?30 days, RR 3.28, 95% CI 1.53?7.06) and intermediate period (30?100 days, RR 2.37, 95% CI 1.15?4.90) were associated with increased risk of virus infection. No association with bacterial or fungal disease was found. Mortality was associated with pre-transplant MBL levels < 1000 ng/ml (hazard ratio 5.55, 95% CI 1.17?26.30, p = 0.03) but not with MBL2 genotype. Conclusions: Patients who underwent Allo-HSCT with low pre-transplant MBL levels presented the first episode of infection earlier and had an increased risk of viral infections and mortality in the first 6 months post-transplant. Thus, pre-transplant MBL levels would be important in predicting susceptibility to viral infections and mortality and might be considered a biomarker to be included in the pre-transplantation risk assessment.This work was supported by grants from the Fondo de Investigaciones Sanitarias (Ministry of Health of Spain) PI04/0492 to MC Fariñas and Instituto de Investigación Sanitaria Valdecilla (IDIVAL) API 06/01. The content of the paper is solely the responsibility of the authors and does not necessarily represent the official views. The funding body was not involved in the design of the study, collection or analysis of the data, interpretation of the data, or in the writing of the manuscript

Risk factors for non-diabetic renal disease in diabetic patients

Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 6 12.8 years, creatinine was 2.8 6 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n ¼ 329) of patients had DN, 49.6% (n ¼ 413) NDRD and 10.8% (n ¼ 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n ¼ 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) ¼ 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR ¼ 1.51, 95% CI: 1.03–2.21, P ¼ 0.033) and absence of diabetic retinopathy (DR) (OR ¼ 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P ¼ 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P ¼ 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P ¼ 0.002), higher creatinine (P ¼ 0.01) and DN (P ¼ 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis

Surveillance biopsies in children post-kidney transplant

Surveillance biopsies are increasingly used in the post-transplant monitoring of pediatric renal allograft recipients. The main justification for this procedure is to diagnose early and presumably modifiable acute and chronic renal allograft injury. Pediatric recipients are theoretically at increased risk for subclinical renal allograft injury due to their relatively large adult-sized kidneys and their higher degree of immunological responsiveness. The safety profile of this procedure has been well investigated. Patient morbidity is low, with macroscopic hematuria being the most common adverse event. No patient deaths have been attributed to this procedure. Longitudinal surveillance biopsy studies have revealed a substantial burden of subclinical immunological and non-immunological injury, including acute cellular rejection, interstitial fibrosis and tubular atrophy, microvascular lesions and transplant glomerulopathy. The main impediment to the implementation of surveillance biopsies as the standard of care is the lack of demonstrable benefit of early histological detection on long-term outcome. The considerable debate surrounding this issue highlights the need for multicenter, prospective, and randomized studies