Repositório Institucional - Unifesp :: Navegando por Palavras-chave "transplantation"

Navegando por Palavras-chave "transplantation"

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Contraceptive counseling and use among 197 female kidney transplant recipients
(Lippincott Williams & Wilkins, 2008-09-15) Guazzelli, Cristina A. F.; Torloni, Maria R.; Sanches, Tatila F.; Barbieri, Marcia; Pestana, Jose O. M. A.; Universidade Federal de São Paulo (UNIFESP)
Background. There is growing interest about the quality of life of female transplant recipients, including their sexual and reproductive health. Although menstrual irregularity and infertility are common in women with advanced chronic diseases, most regain their reproductive function shortly after transplantation. Because an unplanned pregnancy soon after transplantation can expose both mother and fetus to considerable risk, it is recommended that these women should receive contraceptive counseling. However, the actual implementation and effectiveness of this recommendation has not been extensively studied.Methods. A total of 197 reproductive age, female, stable kidney graft recipients attending a large Brazilian transplantation clinic were interviewed. They were asked about menstrual pattern, sexual activity, counseling, and their use of contraceptive methods both before and after the transplant.Results. Before transplantation 70.6% reported menstrual irregularity, 91.9% of them were sexually active, 74.1% were counseled to use contraception and 86.3% used some contraceptive method. After the graft, 50.2% had menstrual irregularity, 79.7% were sexually active, 48.7% were advised to use contraceptives and 72.1% were actually using a method. After transplantation, there were 14 pregnancies in 11 women and 92.9% (13/14) of these were unplanned.Conclusions. Although most female kidney transplant recipients were sexually active both before and after transplantation, many were not counseled about the need for contraception and did not use any form of birth control. Health professionals involved in the management of these patients need to include contraceptive counseling as part of their routine care.
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Cutaneous Mycobacterium haemophilum infection in a kidney transplant recipient after acupuncture treatment
(Wiley-Blackwell, 2011-02-01) Castro-Silva, A. N.; Freire, A. O. [UNIFESP]; Grinbaum, R. S.; Elmor de Araujo, M. R.; Abensur, H.; Araujo, M. R. T.; Romao, J. E.; Sampaio, J. L. M.; Noronha, I. L.; Universidade de São Paulo (USP); Hosp Beneficencia Portuguesa São Paulo; Universidade Federal de São Paulo (UNIFESP); Fleury Diagnost
P>Mycobacterium haemophilum is a slow-growing nontuberculous mycobacterium that can cause disease in both immunocompetent and immunocompromised patients. the most common clinical presentations of infection are the appearance of suppurative and ulcerated skin nodules. for the diagnosis, samples collected from suspected cases must be processed under the appropriate conditions, because M. haemophilum requires lower incubation temperatures and iron supplementation in order to grow in culture. in this case report, we describe the occurrence of skin lesions in a kidney transplant recipient, caused by M. haemophilum, associated with acupuncture treatment. the diagnosis was established by direct smear and culture of material aspirated from cutaneous lesions. Species identification was achieved by characterization of the growth requirements and by partial sequencing of the hsp65 gene. the patient was successfully treated with clarithromycin and ciprofloxacin for 12 months. Considering that the number of patients receiving acupuncture treatment is widely increasing, the implications of this potential complication should be recognized, particularly in immunosuppressed patients.
Acesso aberto (Open Access)
Ectopic development of skeletal muscle induced by subcutaneous transplant of rat satellite cells
(Assoc Bras Divulg Cientifica, 2005-03-01) Fukushima, Mauricio Guendi [UNIFESP]; Furlan, Ingrid; Chiavegatti, Tiago [UNIFESP]; Kiyomoto, Beatriz Hitomi [UNIFESP]; Godinho, Rosely Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The present study analyzes the ectopic development of the rat skeletal muscle originated from transplanted satellite cells. Satellite cells (106 cells) obtained from hindlimb muscles of newborn female 2BAW Wistar rats were injected subcutaneously into the dorsal area of adult male rats. After 3, 7, and 14 days, the transplanted tissues (N = 4-5) were processed for histochemical analysis of peripheral nerves, inactive X-chromosome and acetylcholinesterase. Nicotinic acetylcholine receptors (nAChRs) were also labeled with tetramethylrhodaminelabeled alpha-bungarotoxin. the development of ectopic muscles was successful in 86% of the implantation sites. By day 3, the transplanted cells were organized as multinucleated fibers containing multiple clusters of nAChRs (N = 2-4), resembling those from non-innervated cultured skeletal muscle fibers. After 7 days, the transplanted cells appeared as a highly vascularized tissue formed by bundles of fibers containing peripheral nuclei. the presence of X chromatin body indicated that subcutaneously developed fibers originated from female donor satellite cells. Differently from the extensor digitorum longus muscle of adult male rat (87.9 +/- 1.0 mu m; N = 213), the diameter of ectopic fibers (59.1 mu m; N = 213) did not obey a Gaussian distribution and had a higher coefficient of variation. After 7 and 14 days, the organization of the nAChR clusters was similar to that of clusters from adult innervated extensor digitorum longus muscle. These findings indicate the histocompatibility of rats from 2BAW colony and that satellite cells transplanted into the subcutaneous space of adult animals are able to develop and fuse to form differentiated skeletal muscle fibers.
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Effects of eurocollins solution as aortic flush for the procurement of human pancreas
(Lippincott Williams & Wilkins, 2005-11-15) Gonzalez, A. M.; Filho, GJL; Pestana, JOM; Linhares, M. M.; Silva, MHG; Moura, RMAM; Melaragno, C.; Sa, JR de; Rangel, E. B.; Trivino, T.; Universidade Federal de São Paulo (UNIFESP)
Background. Belzer solution is considered to be the best preservation media used for pancreas transplantation; however, its high cost accounts for approximately 14.5% of all resources allocated by the Brazilian government toward each pancreatic transplant. the objective of the present study was to test a reduction of Belzer solution during pancreas harvest, thereby lowering procedural cost.Methods. the patients received pancreas-kidney transplantations during the period from January 2003 to August 2004. Patients were divided into two groups. Patients assigned to Group A (n =30) received only Belzer solution (2 L through the aorta artery), whereas patients in Group B (n = 16) were perfused first with I L of Eurocollins solution followed by I L of Belzer solution. the two groups were assessed for differences in the following clinical parameters: the need for insulin replacement or antifungal and anticytomegalovirus treatment, pancreatitis, acute cellular rejection, graft vascular thrombosis, fistulas, intra-abdominal collection, graft loss, deaths, pancreatic ischemia time, and average hospitalization time.Results. No statistically significant differences were observed in any of the parameters analyzed (P < 0.05). the use of Eurocollins solution, followed by Belzer solution during pancreas harvesting, did not result in differences in graft survival or functionality, postsurgical complications, or patient survival and hospitalization time, when compared to the use of Belzer solution alone.Conclusions. Perfusion with 1 L of Eurocollins solution followed by I L of Belzer solution during pancreas harvesting seems to be a simple and efficient alternative for reducing the costs of the harvesting process.
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Enteric-coated mycophenolate sodium provides higher mycophenolic acid predose levels compared with mycophenolate mofetil: Implications for therapeutic drug monitoring
(Lippincott Williams & Wilkins, 2007-06-01) Budde, Klemens; Tedesco-Silva, Helio; Pestana, Jose Medina; Glander, Petra; Neumayer, Hans-H.; Felipe, Claudia Rosso; Machado, Paula Pinheiro; Sechaud, Romain; Schmouder, Robert; Charite Univ Med Berlin; Universidade Federal de São Paulo (UNIFESP); Novartis Pharma; Novartis Pharmaceut Corp
The delayed release of mycophenolic acid (MPA) from enteric-coated mycopbenolate sodium (EC-MPS) may lead to different MPA predose (CO) levels compared with mycopbenolate mofetil (MMF). A post hoc analysis was performed on MPA morning predose values assessed in 88 maintenance renal transplant patients from three studies converted from MMF (1000 mg twice a day) to equimolar EC-MPS (720 mg twice a day) or vice versa, both in combination with cyclosporine. the median MPA predose level was approximately 30% higher when patients received EGMPS (2.40 mu g/mL; range, 0.49-39.30 mu g/mL) compared with MMF (1.83 mu g/mL; range, < 0.1-12.80 mu g/mL). Rare cases (3.0%) of high MPA CO levels 15 mu g/mL or greater were observed with EGMPS consistent with a very prolonged release of MPA from this formulation. Both EGMPS and MMF exhibited a poor correlation between MPA CO levels and exposure as assessed by MPA area under the curve. Physicians targeting a certain MPA predose level have to be aware of the higher morning CO levels with EGMPS, whereas the overall MPA exposure is not different to MMF.
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Epidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantion
(Edizioni Internazionali Srl, 2007-04-01) Cappellano, Paola [UNIFESP]; Viscoli, Claudio; Bruzzi, Paolo; Van Lint, Maria Teresa; Pereira, Carlos Alberto Pires [UNIFESP]; Bacigalupo, Andrea; Univ Genoa; Universidade Federal de São Paulo (UNIFESP)
A total of 315 patients who underwent allogeneic Hematopoietic Stem Cell Transplantation (HSCT) during a 4year period were analysed with the aim of collecting information on bloodstream infections (BSI). Eighty-four patients (27%) developed 112 BSI, with a cumulative risk of 20.6% at 30 days and 27.7% at 180 days. Overall, 127 pathogens were isolated, 95 (75%) gram-positive cocci, 27 (21%) gram-negative rods and 5 (4%) fungi. Enterococcus sp. accounted for 46 of 127 (36%) isolates. In a multivariable analysis only including baseline factors, the type of transplant was the only factor significantly associated with the risk of BSI and the risk was higher for patients receiving transplant from mismatched or unrelated donors.In a case-control study aimed at evaluating the predictive role of additional factors during transplant, the risk appeared to be higher in patients with a positive CMV antigenemia (p=0.03; OR of 4.82; 95% CI, 1.21-19.17), long duration of severe granulocytopenia (p=0.015; OR 7.53; 95% CI, 1.92 - 29.58) and lower platelet count (p<0.001; OR 0.14; 95% CI, 0.05 - 0.40). By day 180 post-transplant, 87 (28%) out of 314 patients had died. The cumulative risk of death was significantly higher among patients with BSI than among other patients.
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The essential role of annexin A1 mimetic peptide in the skin allograft survival
(Wiley-Blackwell, 2016) Teixeira, Rodrigo Antonio Parra [UNIFESP]; Mimura, Kallyne Kioko Oliveira [UNIFESP]; Araujo, Leandro Pires [UNIFESP]; Greco, Karin Vicente; Oliani, Sonia Maria [UNIFESP]
Immunosuppressive drugs have a critical role in inhibiting tissue damage and allograft rejection. Studies have demonstrated the anti-inflammatory effects of the annexin A1 (AnxA1) in the regulation of transmigration and apoptosis of leucocytes. In the present study, an experimental skin allograft model was used to evaluate a potential protective effect of AnxA1 in transplantation survival. Mice were used for the skin allograft model and pharmacological treatments were carried out using either the AnxA1 mimetic peptide Ac2-26, with or without cyclosporine A (CsA), starting 3days before surgery until rejection. Graft survival, skin histopathology, leucocyte transmigration and expression of AnxA1 and AnxA5 post-transplantation were analysed. Pharmacological treatment with Ac2-26 increased skin allograft survival related with inhibition of neutrophil transmigration and induction of apoptosis, thereby reducing the tissue damage compared with control animals. Moreover, AnxA1 and AnxA5 expression increased after Ac2-26 treatment in neutrophils. Interestingly, the combination of Ac2-26 and cyclosporine A showed similar survival of transplants when compared with the cyclosporine A group, which could be attributed to a synergistic effect of both drugs. Investigations in vitro revealed that cyclosporine A inhibited extracellular-signal-regulated kinase (ERK) phosphorylation induced by Ac2-26 in neutrophils. Overall, the results suggest that AnxA1 has an essential role in augmenting the survival of skin allograft, mainly owing to inhibition of neutrophil transmigration and enhancement of apoptosis. This effect may lead to the development of new therapeutic approaches relevant to transplant rejection. Copyright (c) 2013 John Wiley & Sons, Ltd.
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The essential role of annexin A1 mimetic peptide in the skin allograft survival
(Wiley-Blackwell, 2016) Teixeira, Rodrigo Antonio Parra [UNIFESP]; Mimura, Kallyne Kioko Oliveira [UNIFESP]; Araujo, Leandro Pires [UNIFESP]; Greco, Karin Vicente; Oliani, Sonia Maria [UNIFESP]
Immunosuppressive drugs have a critical role in inhibiting tissue damage and allograft rejection. Studies have demonstrated the anti-inflammatory effects of the annexin A1 (AnxA1) in the regulation of transmigration and apoptosis of leucocytes. In the present study, an experimental skin allograft model was used to evaluate a potential protective effect of AnxA1 in transplantation survival. Mice were used for the skin allograft model and pharmacological treatments were carried out using either the AnxA1 mimetic peptide Ac2-26, with or without cyclosporine A (CsA), starting 3days before surgery until rejection. Graft survival, skin histopathology, leucocyte transmigration and expression of AnxA1 and AnxA5 post-transplantation were analysed. Pharmacological treatment with Ac2-26 increased skin allograft survival related with inhibition of neutrophil transmigration and induction of apoptosis, thereby reducing the tissue damage compared with control animals. Moreover, AnxA1 and AnxA5 expression increased after Ac2-26 treatment in neutrophils. Interestingly, the combination of Ac2-26 and cyclosporine A showed similar survival of transplants when compared with the cyclosporine A group, which could be attributed to a synergistic effect of both drugs. Investigations in vitro revealed that cyclosporine A inhibited extracellular-signal-regulated kinase (ERK) phosphorylation induced by Ac2-26 in neutrophils. Overall, the results suggest that AnxA1 has an essential role in augmenting the survival of skin allograft, mainly owing to inhibition of neutrophil transmigration and enhancement of apoptosis. This effect may lead to the development of new therapeutic approaches relevant to transplant rejection. Copyright (c) 2013 John Wiley & Sons, Ltd.
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Heme oxygenase-1 (HO-1), a protective gene that prevents chronic graft dysfunction
(Elsevier B.V., 2005-02-15) Camara, NOS; Soares, M. P.; Gulbenkian Inst Sci; Universidade Federal de São Paulo (UNIFESP)
Heme oxygenase-1 (HO-1) is a stress-responsive enzyme that acts during inflammatory reactions as the rate-limiting step in the catabolism of heme, yielding equimolar amounts of iron (Fe), biliverdin, and the gas carbon monoxide (CO) [1]. Expression of HO-1 regulates inflammatory and immune responses, such as those involved in the rejection of transplanted organs. We will discuss here accumulating evidence supporting the notion that expression of HO-1 in a transplanted organ can prevent its rejection. We will argue that the protective effects exerted by HO-1 are mediated to a large extent by the end products that it generates via the catabolism of heme. Better knowledge of how to enhance these protective effects is likely to help create new therapeutic strategies to improve the outcome of transplanted organs. (C) 2004 Elsevier Inc. All rights reserved.
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How Delayed Graft Function Impacts Exposure to Mycophenolic Acid in Patients After Renal Transplantation
(Lippincott Williams & Wilkins, 2011-04-01) van Gelder, Teun; Silva, Helio Tedesco [UNIFESP]; Fijter, Hans de; Budde, Klemens; Kuypers, Dirk; Mamelok, Richard D.; Armstrong, Victor W.; Oellerich, Michael; Erasmus MC; Universidade Federal de São Paulo (UNIFESP); Leiden Univ; Charite; Leuven Univ; Mamelok Consulting; Univ Gottingen
Introduction: Mycophenolic acid (MPA) plasma concentrations are highly variable on standard-dose mycophenolate mofetil therapy. At creatinine clearances below 25 mL/min, MPA clearance increases as a result of a higher nonprotein-bound fraction. Patients with delayed graft function (DGF) after renal transplantation are exposed to low total MPA concentrations, when risk of rejection is highest. This study investigated the influence of DGF on MPA exposure and on clinical outcome.Methods: Adult renal transplantation patients treated with mycophenolate mofetil, corticosteroids, and either microemulsified cyclosporine (n = 459) or tacrolimus (n = 371) participated in a randomized controlled trial (the Fixed-Dose Concentration-Controlled [FDCC] Study). Abbreviated MPA areas under the curve (AUCs) were obtained on Day 3, Day 10, Week 4, and Month 3, to calculate MPA AUC((0-12)). Free MPA AUC values were available for a subgroup of patients (n = 269).Results: the overall incidence of DGF was 187 of 830 (23%) and did not differ between cyclosporine-treated (24%) and tacrolimus-(21%) treated patients. the incidence of biopsy-proven acute rejection at 12 months was significantly higher in patients with DGF (13.8% versus 21.4%). Patients with DGF had significantly lower dose-corrected MPA AUC on Day 3 and Day 10. Free MPA fraction and dose-corrected free MPA AUC were significantly higher in patients with DGF, from Day 3 until Month 3. the total number of patients with at least one opportunistic infection was significantly higher in patients with DGF (33.2%) compared with patients without DGF (25.8%) (P = 0.048). Patients with DGF developing opportunistic infections did not have higher total MPA AUC nor higher free MPA AUC compared with those without opportunistic infections.Conclusion: Patients with DGF have significantly lower dose-corrected MPA AUC in the first month after renal transplantation, presumably as a result of enhanced MPA clearance on account of the elevated MPA free fraction. Because patients with DGF have a higher rate of acute rejection and lower MPA exposure, higher dosing of mycophenolate mofetil in such patients may improve outcome. However, the already increased incidence of opportunistic infections in patients with DGF is a concern.
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Immune function, as assessed by the ImmuKnow (R) assay, correlates with clinical outcomes in transplant recipients
(Nature Publishing Group, 2007-04-01) Pacheco-Silva, Alvaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Israelita Albert Einstein
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Leflunomide and malononitrilamides
(Lippincott-raven Publ, 1997-05-01) Silva, H. T.; Morris, R. E.; STANFORD UNIV; Universidade Federal de São Paulo (UNIFESP)
Leflunomide is a new immunomodulatory drug that is effective in experimental models of autoimmune diseases and in allo or xenotransplantation. in a phase II clinical trial, leflunomide showed high tolerability and efficacy in patients with advanced rheumatoid arthritis. the immunomodulatory activity of leflunomide is attributed to its primary metabolite A77 1726, which is a malonon-itrilamide. the in vitro and in vivo mechanisms of action of this class of compounds are not defined completely. Several malononitrilamide analogues and A77 1726 inhibit T- and B-cell proliferation, suppress immunoglobulin production, and interfere with cell adhesion. Although no central molecular mechanism of action has been proposed to explain all the effects of the malononitrilamides, the inhibition of de novo pyrimidine biosynthesis and of cytokine- and growth factor receptor-associated tyrosine kinase activity are leading hypotheses for the effects of A77 1726 on T- and B-cell proliferation and function. Leflunomide is effective when administered in daily dosages of 10 mg and 25 mg to patients with active rheumatoid arthritis. the improved efficacy of a 25 mg dose is associated with a higher incidence of adverse effects (gastrointestinal symptoms, weight loss, allergic reactions, skin rash, and reversible alopecia). Because of the long plasma half-life of A77 1726 (11 to 16 days), loading doses are necessary to achieve steady state concentrations. Phase III randomized, placebo-controlled trials that use daily dosages of 10 mg or 20 mg are under way in the United States and Europe to confirm and extend the results of the phase II study.Malononitrilamide analogues of A77 1726 are being evaluated for immunosuppressive efficacy in preclinical models of transplantation. If these analogues show efficacies and therapeutic indexes that are similar to leflunomide in these models and that have shorter half-lives than A77 1726 II phase I trials, the preclinical and phase I data will be used to select the analogues for phase II trials in organ transplant recipients.
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Minor Salivary Gland Transplantation for Severe Dry Eyes
(Lippincott Williams & Wilkins, 2017) Wakamatsu, Tais Hitomi [UNIFESP]; Pires Ponce Sant'Anna, Ana Estela Besteti [UNIFESP]; Cristovam, Priscila Cardoso [UNIFESP]; Ferreira Alves, Venancio Avancini; Wakamatsu, Alda [UNIFESP]; Pereira Gomes, Jose Alvaro [UNIFESP]
Dry eye is a multifactorial disease comprising a wide spectrum of ocular surface alterations and symptoms of discomfort. In most patients with aqueous-deficient dry eye, pharmaceutical tear substitutes are used to control symptoms and prevent ocular surface damage. However, in severe dry eye conditions caused by cicatricial disorders, such as Stevens-Johnson syndrome and ocular cicatricial mucous membrane pemphigoid, noninvasive treatments are insufficient, and patients are at risk of developing complications that can lead to blindness. The use of salivary glands as a source of lubrication to treat severe cases of dry eye has been proposed by different authors. The first reports proposed parotid or submandibular gland duct transplantation into the conjunctival fornix. However, complications limited the functional outcomes. Minor salivary gland autotransplantation together with labial mucosa has been used as a complex graft to the conjunctival fornix in severe dry eye with a good outcome. Our group demonstrated significant improvements in best-corrected visual acuity, Schirmer I test score, corneal transparency, and neovascularization after using this technique. A symptoms questionnaire applied to these patients revealed improvements in foreign body sensation, photophobia, and pain. Similar to tears, saliva has a complex final composition comprising electrolytes, immunoglobulins, proteins, enzymes, and mucins. We demonstrated the viability of minor salivary glands transplanted into the fornix of patients with dry eye by performing immunohistochemistry on graft biopsies with antibodies against lactoferrin, lysozyme, MUC1, and MUC16. The findings revealed the presence of functional salivary gland units, indicating local production of proteins, enzymes, and mucins.
Acesso aberto (Open Access)
Monocyte transplantation for neural and cardiovascular ischemia repair
(Wiley-Blackwell, 2010-03-01) Sanberg, Paul R.; Park, Dong-Hyuk; Kuzmin-Nichols, Nicole; Cruz, Eduardo; Hossne, Nelson Americo [UNIFESP]; Buffolo, Enio [UNIFESP]; Willing, Alison E.; Univ S Florida; Saneron CCEL Therapeut INC; Polo Biotecnol Rio Janeiro; Universidade Federal de São Paulo (UNIFESP)
Neovascularization is an integral process of inflammatory reactions and subsequent repair cascades in tissue injury. Monocytes/macrophages play a key role in the inflammatory process including angiogenesis as well as the defence mechanisms by exerting microbicidal and immunomodulatory activity. Current studies have demonstrated that recruited monocytes/macrophages aid in regulating angiogenesis in ischemic tissue, tumours and chronic inflammation. in terms of neovascularization followed by tissue regeneration, monocytes/macrophages should be highly attractive for cell-based therapy compared to any other stem cells due to their considerable advantages: non-oncogenic, non-teratogenic, multiple secretary functions including pro-angiogenic and growth factors, straightforward cell harvesting procedure and non-existent ethical controversy. in addition to adult origins such as bone marrow or peripheral blood, umbilical cord blood (UCB) can be a potential source for autologous or allogeneic monocytes/macrophages. Especially, UCB monocytes should be considered as the first candidate owing to their feasibility, low immune rejection and multiple characteristic advantages such as their anti-inflammatory properties by virtue of their unique immune and inflammatory immaturity, and their proangiogenic ability. in this review, we present general characteristics and potential of monocytes/macrophages for cell-based therapy, especially focusing on neovascularization and UCB-derived monocytes.
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Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population
(Wiley-Blackwell, 2015-04-01) Camargo, L. F. A. [UNIFESP]; Marra, A. R. [UNIFESP]; Pignatari, A. C. C. [UNIFESP]; Sukiennik, T.; Behar, P. P. P.; Medeiros, E. A. S. [UNIFESP]; Ribeiro, J.; Girao, E.; Correa, L.; Guerra, C.; Brites, C.; Pereira, C. A. P.; Carneiro, I.; Reis, M.; Souza, M. A.; Barata, C. U.; Edmond, M. B.; Brazilian SCOPE Study Grp; Hosp Israelita Albert Einstein; Universidade Federal de São Paulo (UNIFESP); Hosp 9 Julho; Santa Casa Porto Alegre; Hosp Conceicao; Hosp Base; Hosp Walter Cantidio; Hosp Rim & Hipertensao; Hosp Diadema; Hosp Espanhol; Inst Oncol Pediat IOP GRAAC; Hosp Coracao; Hosp UNIMED; Hosp Clin Goiania; Univ Fed Triangulo Mineiro; Virginia Commonwealth Univ
BackgroundThe incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described.MethodsThis is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population.ResultsThe prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients.ConclusionAntimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.
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Papel da oxigenação hiperbárica na expressão gênica do estresse oxidativo e defesa antioxidante na isquemia e reperfusão hepática em camundongos
(Universidade Federal de São Paulo (UNIFESP), 2016-12-21) Chaves, Jose Carlos [UNIFESP]; Fagundes, Djalma Jose [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective: to evaluate the role of hyperbaric oxygen in the gene expression related to oxidative stress and the antioxidant response on the liver of isogenic mice submitted to ischemia and reperfusion. Methods: Thirty mice (C57BL / 6) underwent anesthesia, laparotomy and at 60 minute intervals of ischemia and 60 minutes of hepatic reperfusion. Three groups were treated with hyperbaric oxygen (GHBO) during different periods: during ischemia (GHBO+I), during reperfusion (GHBO+R) and during ischemia and reperfusion (GHBO+IR). Six animals submitted to IR did not receive HBO (GIR). Six other animals were not submitted to I/R or HBO (GC). Real-time Chain Polymerase Reaction (RT-qPCR) evaluated gene expression. From the 84 analyzable genes were traced by relevance the genes encoding the SOD1 and SOD2 isoforms of the superoxide dismutase and glutathione peroxidase GPX1 and GPX4. Results: the gene expression were; SOD1 => GIR (+10.23), HBO/I (+16.63), HBO/R (+11.577,21), HBO / IR (+35.38); SOD2 => GIR (+5.39), HBO / I (+10.49), HBO / R (+4.266,98), HBO / IR (+16.85); GPX1 => GIR (+7.81), HBO / I (+10.94), HBO / R (+23,888.03), HBO / IR (+25.81); GPX4 => GIR (+4.87), HBO/I (+2.87), HBO/R (+26,782.44), HBO/IR (+9.35). Conclusions: hyperbaric oxygen promoted increased expression of the genes that encode oxidative stress and antioxidant defense, with the most favorable result when applied during ischemia and the deleterious result when applied during reperfusion.
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Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant
(Wiley-Blackwell, 2016) Matos, Ana Cristina; Câmara, Niels Olsen Saraiva [UNIFESP]; Requiao-Moura, Lucio R.; Tonato, Eduardo J.; Filiponi, Thiago C.; Souza-Durao, Marcelino, Jr.; Malheiros, Denise M.; Fregonesi, Mauricio; Borrelli, Milton; Pacheco-Silva, Alvaro [UNIFESP]
Aim: The role of post-reperfusion biopsy findings as a predictor of early and long-term graft function and survival is still a target of research. Methods: We analyzed data from 136 post-reperfusion biopsies performed in deceased donor renal transplanted patients from November 2008 to May 2012. We analyzed the presence of acute tubular necrosis (ATN), arteriolar hyalinosis (AH), intimal thickness (IT), interstitial fibrosis (IF) and glomerulosclerosis (GS). We also analyzed the impact of donor features on the following outcomes: delayed graft function (DGF) and chronic allograft dysfunction defined as eGFR < 60mL/min at 1 year. Results: The mean donor age was 41 years, 26% of whom were extended criteria donors (ECD), 33% had hypertension and 50% had cerebral vascular accident (CVA) as the cause of death. ATN was present in 87% of these biopsies, AH in 31%, IF in 21%, IT in 27% and GS in 32%. DGF occurred in 80% and chronic allograft dysfunction was present in 53%. AHwas the only histological finding associated with DGF and chronic allograft dysfunction at 1 year. Patients with AH had a lower eGFR at 1 year than patients without it (49.8 mL/min x 64.5 mL/min, P= 0.02). In the multivariate analysis, risk variables for development of chronic graft dysfunction were male sex (odds ratio [OR] = 3.159 [CI: 1.22-8.16]
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Proceedings of the Tumor Board of the School of Medicine, University of São Paulo, Brazil - Megatherapy in the treatment of high-risk relapsed Wilms tumor
(Wiley-Blackwell, 2004-08-01) Valera, E. T.; Cristofani, L.; Scrideli, C. A.; Duarte, R. J.; Odone, V; Tone, L. G.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
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Randomized Trial Comparing Amniotic Membrane Transplantation with Lamellar Corneal Graft for the Treatment of Corneal Thinning
(Lippincott Williams & Wilkins, 2016) Farias, Charles Costa de [UNIFESP]; Allemann, Norma [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]
Purpose: There are few studies comparing different surgical procedures for the treatment of corneal thinning. Lamellar corneal transplantation (LCT) has been reported to be efficient, but its results can be jeopardized by allograft rejection, opacification, or high astigmatism. Amniotic membrane transplantation (AMT) has been considered a good alternative, but it is not as resistant as LCT and the tissue can be reabsorbed after surgery. Methods: A prospective, randomized, interventional, and comparative study of consecutive patients with corneal thinning over 6 months was performed. Ophthalmological examination was performed before transplant surgery and then repeated 1, 7, 15, 30, 90, and 180 days after surgery and ultrasound biomicroscopy was performed before and then 30, 90, and 180 days after surgery to assess corneal thinning. Results: Herpes simplex infection was the main cause of corneal thinning (9 eyes), followed by surgery (cataract, glaucoma, 5 cases), rheumatoid arthritis (1), chemical burn (1), perforating trauma (1), previous band keratopathy treatment (1), and Stevens-Johnson syndrome (1). Although all patients showed significant increase in final thickness in the area of thinning, it was higher in those submitted to LCT at 180 days postoperatively. Regardless of the surgical technique, all patients showed epithelialization. Patients undergoing AMT showed an 89% decrease in neovascularization. Final corrected distance visual acuity was better in patients submitted to AMT. Conclusions: LCT proved to be the best option for treating corneal thinning. AMT represents an alternative that allows good visual recovery but does not restore corneal thickness as efficiently as LCT.
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Randomized Trial Comparing Multilayer Amniotic Membrane Transplantation With Scleral and Corneal Grafts for the Treatment of Scleral Thinning After Pterygium Surgery Associated With Beta Therapy
(Lippincott Williams & Wilkins, 2014-11-01) Farias, Charles Costa de [UNIFESP]; Sterlenich, Telma [UNIFESP]; Sousa, Luciene Barbosa de [UNIFESP]; Vieira, Luiz Antonio [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: The aim of this study was to compare the use of multilayer amniotic membrane transplantation (AMT) with lamellar corneal transplantation (LCT) and lamellar scleral transplantation (LST) for the treatment of scleral thinning after pterygium surgery associated with beta therapy.Methods: Twenty-six eyes from 26 different patients with scleral thinning as a consequence of beta therapy after pterygium surgery were evaluated at the Federal University of Sao Paulo, Brazil. Ophthalmologic examination and ultrasound biomicroscopy were performed to assess scleral thinning before the transplant surgery and then repeated at 30, 90, and 180 days after surgery. An increase in scleral thickness, epithelialization of the ocular surface, and preservation of the ocular globe were the main outcome measures.Results: Irrespective of the surgical technique used (AMT, LCT, or LST), no clinical or statistical changes in corrected distance visual acuity were found in any of the patients during this study. The median preoperative scleral thickness was similar in all 3 groups: AMT = 0.45 mm, LST = 0.48 mm, and LCT = 0.52 mm (P = 0.257); however, 6 months after surgery, the median thickness in the AMT group (0.19) was significantly less than that of the LCT group (0.57) (P = 0.27) or the LST group (0.76) (P = 0.19). Epithelialization occurred in all the patients.Conclusions: LCT was the best option for the structural treatment of scleral thinning, followed by LST with a conjunctival flap. A high rate of reabsorption was found with AMT, which was the least effective of the 3 therapeutic options and should not be used for this condition.

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