Effects of mTOR inhibitor–related proteinuria on progression of cardiac allograft vasculopathy and outcomes among heart transplant recipients

We have previously described the use of sirolimus (SRL) as primary immunosuppression following heart transplantation (HT). The advantages of this approach include attenuation of cardiac allograft vasculopathy (CAV), improvement in glomerular filtration rate (GFR), and reduced malignancy. However, in some patients SRL may cause significant proteinuria. We sought to investigate the prognostic value of proteinuria after conversion to SRL. CAV progression and adverse clinical events were studied. CAV progression was assessed by measuring the Δ change in plaque volume (PV) and plaque index (PI) per year using coronary intravascular ultrasound. Proteinuria was defined as Δ urine protein ≥300 mg/24 h at 1 year after conversion to SRL. Overall, 137 patients were analyzed (26% with proteinuria). Patients with proteinuria had significantly lower GFR (P = .005) but similar GFR during follow-up. Delta PV (P < .001) and Δ PI (P = .001) were significantly higher among patients with proteinuria after adjustment for baseline characteristics. Multivariate Cox regression analysis showed higher all-cause mortality (hazard ratio 3.8; P = .01) with proteinuria but similar risk of CAV-related events (P = .61). Our results indicate that proteinuria is a marker of baseline renal dysfunction, and that HT recipients who develop proteinuria after conversion to SRL have less attenuation of CAV progression and higher mortality risk.     

Findings from an outbreak of carbapenem-resistant <Emphasis Type="Italic">Klebsiella pneumoniae</Emphasis> emphasize the role of antibiotic treatment for cross transmission

Purpose

In January 2015, we noticed by rectal swab analyses that seven of 23 patients at an early rehabilitation ward had been colonized with carbapenem-resistant Klebsiella pneumoniae (CKP). Here, we describe risk factors for CKP acquisition.

Methods

In the present study, the outbreak is described and risk factors for CKP acquisition are examined, e.g., antibiotic treatment. Microbiological analyses including corresponding results were examined to study when colonization with CKP occurred and whether patients had suffered from diarrhea. To examine whether spread of bacteria was clonal, multi-locus sequence typing as well as Xbal macrorestriction and pulsed-field gel electrophoresis was performed. The presence of carbapenmase was examined by PCR analysis. Through univariate analysis of risk factors in the small study sample, the role of antibiotic consumption, isolation procedures, patient’s age, gender, and Barthel index on colonization was elucidated.

Results

Clonal spread of the novel sequence type (ST)2255 was identified. Additionally, one patient was colonized with Escherichia coli and Serratia marcescens, both resistant to carbapenems, while a further patient carried another carbapenem-resistant E. coli strain. In all isolates, carbapenemase gene bla _OXA-48 was found to be located on a conjugative plasmid (60 kb), suggesting in vivo transmission from CKP to E. coli and S. marcescens. Univariate tests indicated that antibiotic treatment was the only risk factor showing a significant association with being colonized by CKP. In addition, the likelihood of diarrhea appeared to be higher in this group. Antibiotic treatment was associated with CKP colonization, whereas patients´ age, gender, Barthel index at admission, and residence with a CKP-colonized roommate were not. Diarrhea also seemed to support to distribution of CKP.

Conclusions

In this small outbreak, antibiotic treatment seemed to be the predominant risk factor for monoclonal transmission of bla _OXA-48 positive CKP.

     

The PCBP1 gene encoding poly(rc) binding protein i is recurrently mutated in Burkitt lymphoma

The genetic hallmark of Burkitt lymphoma is the translocation t(8;14)(q24;q32), or one of its light chain variants, resulting in IG‐MYC juxtaposition. However, these translocations alone are insufficient to drive lymphomagenesis, which requires additional genetic changes for malignant transformation. Recent studies of Burkitt lymphoma using next generation sequencing approaches have identified various recurrently mutated genes including ID3, TCF3, CCND3, and TP53. Here, by using similar approaches, we show that PCBP1 is a recurrently mutated gene in Burkitt lymphoma. By whole‐genome sequencing, we identified somatic mutations in PCBP1 in 3/17 (18%) Burkitt lymphomas. We confirmed the recurrence of PCBP1 mutations by Sanger sequencing in an independent validation cohort, finding mutations in 3/28 (11%) Burkitt lymphomas and in 6/16 (38%) Burkitt lymphoma cell lines. PCBP1 is an intron‐less gene encoding the 356 amino acid poly(rC) binding protein 1, which contains three K‐Homology (KH) domains and two nuclear localization signals. The mutations predominantly (10/12, 83%) affect the KH III domain, either by complete domain loss or amino acid changes. Thus, these changes are predicted to alter the various functions of PCBP1, including nuclear trafficking and pre‐mRNA splicing. Remarkably, all six primary Burkitt lymphomas with a PCBP1 mutation expressed MUM1/IRF4, which is otherwise detected in around 20–40% of Burkitt lymphomas. We conclude that PCBP1 mutations are recurrent in Burkitt lymphomas and might contribute, in cooperation with other mutations, to its pathogenesis. © 2015 Wiley Periodicals, Inc.     

Pain-diminishing effects of Kinesio® taping after median sternotomy

Background: Postoperative pain and severe side effects of opioid analgesics present a clinical challenge after cardio-thoracic surgery. In this study, the impact of Kinesio® taping on postoperative morbidity after median sternotomy was observed. Methods: Thirty-nine patients (mean age 66 ± 9 years, CI: 63.28; 68.98) who underwent median sternotomy between 09/2014 and 11/2014 participated in this prospective randomized controlled trial. Patients were assigned into a treatment on a non-treatment group. Patients in the treatment group were taped after leaving the intensive care unit. We assessed, pain, consumption of pain medication, the subjective estimation of patients’ ability to breathe, radiologic and microbial abnormalities as well as adverse effects resulting from the tape use daily until discharge. To determine the patients’ satisfaction a discharge questionnaire was offered after completion of data. Results: Patients who were treated with tape report significantly less pain (2.14 ± 0.5, CI: 1.1; 3.13) than patients from the control group (4.16 ± 0.6, CI: 2.92; 5.41, p = 0.01). The need for opioid pain medication, as assessed by total analgesic consumption per patient, was significantly less in the treatment group (1.2 ml ± 0.4 ml, CI: 0.40 ml; 2.01 ml) versus (3.1 ml ± 0.5 ml, CI: 2.0 ml; 4.2 ml, p = 0.01). The subjective estimation of patients’ ability to breathe was significantly better (p < 0.001) and the satisfaction was higher in the Kinesio® tape group compared to the control group. Taped patients had a mean hospitalization of 10 ± 1 day (CI: 8.74 days; 11.78 days) untapped patients stayed for 11 ± 1 days (CI: 9.17 days; 11.83 days). Adverse effects from the tape treatment were not observed. Conclusions: Kinesio® taping after median sternotomy is a low-risk, non-pharmacologic, cost effective, and promising method for improving patients’ breathing conditions, reducing postoperative pain, pain medication consumption, and thus, potential adverse effects of analgesics.     

Marker Based In-vitro Antioxidant Potential,Microscopy and Validated High Performance Thin Layer Chromatographic Method for Saffron

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - In vitro antioxidant potential of methanolic extract of saffron and crocetin was assessed along with...