Use of outpatient parenteral antimicrobial therapy for transrectal ultrasound-guided prostate biopsy prophylaxis in the setting of community-associated multidrug-resistant Escherichia coli rectal colonization.

OBJECTIVE: To study the use of ertapenem delivered in an outpatient parenteral antimicrobial therapy (OPAT) hospital-based unit setting for targeted transrectal ultrasound-guided prostate biopsy (TRUSPBx) prophylaxis in the setting of multidrug-resistant (MDR) Escherichia coli rectal colonization. E coli is the pathogen most commonly associated with post-TRUSPBx complications, and there is increasing prevalence of community-associated MDR E coli. METHODS: Prospective data analysis of all patients admitted to the OPAT unit for administration of intravenous antibiotics for prophylaxis for TRUSPBx over 18-month period was performed. Patients had identification of MDR E coli in rectal swab cultures and/or intolerance to available oral agents. Microbiologic data and tolerability of administered antibiotics and outcome after TRUSPBx were tabulated. RESULTS: Nine patients (median age 74 years) were referred because of antibiotic-resistant E coli from rectal swabs (all fluoroquinolone resistant, 7 MDR). All patients received ertapenem 1 g intravenously 1 day before TRUSPBx and the day of the procedure before TRUSPBx. None of the patients experienced infectious complications immediately after TRUSPBx or several weeks or months later, and no patient was lost to urologic follow-up. CONCLUSION: Increasing worldwide reports of prostatitis, urinary tract infections, and septicemia after TRUSPBx because of MDR E coli suggest rectal screening before procedure may be useful in decreasing complications. Targeted prophylaxis in these instances is necessary. Although carbapenems are used for treatment, they are not routinely used for prophylaxis. We report successful use of ertapenem delivered in a hospital-based OPAT unit for TRUSPBx prophylaxis.

Role of CD8beta domains in CD8 coreceptor function: importance for MHC I binding, signaling, and positive selection of CD8+ T cells in the thymus.

The contribution of the CD8beta subunit to CD8 coreceptor function is poorly understood. We now demonstrate that the CD8beta extracellular domain increases the avidity of CD8 binding to MHC I, and that the intracellular domain of CD8beta enhances association with two intracellular molecules required for TCR signal transduction, Lck and LAT. By assessing CD8+ T cell differentiation in CD8beta-deficient mice reconstituted with various transgenic CD8beta chimeric molecules, we also demonstrate that the intracellular and extracellular domains of CD8beta can contribute independently to CD8+ T cell development, but that both CD8beta domains together are most efficient. Thus, this study identifies the molecular functions of the CD8beta intracellular and extracellular domains and documents their contributions to CD8+ T cell development.

Association of the adaptor molecule LAT with CD4 and CD8 coreceptors identifies a new coreceptor function in T cell receptor signal transduction.

Linker for activation of T cells (LAT) is an adaptor protein whose tyrosine phosphorylation is critical for transduction of the T cell receptor (TCR) signal. LAT phosphorylation is accomplished by the protein tyrosine kinase ZAP-70, but it is not at all clear how LAT (which is not associated with the TCR) encounters ZAP-70 (which is bound to the TCR). Here we show that LAT associates with surface CD4 and CD8 coreceptors and that its association is promoted by the same coreceptor cysteine motif that mediates Lck binding. In fact, LAT competes with Lck for binding to individual coreceptor molecules but differs from Lck in its preferential association with CD8 rather than CD4 in CD4(+)CD8(+) thymocytes. Importantly, as a consequence of LAT association with surface coreceptors, coengagement of the TCR with surface coreceptors induces LAT phosphorylation and the specific recruitment of downstream signaling mediators to coreceptor-associated LAT molecules. These results point to a new function for CD4 and CD8 coreceptors in TCR signal transduction, namely to promote LAT phosphorylation by ZAP-70 by recruiting LAT to major histocompatibility complex-engaged TCR complexes.

gamma delta T-cells may interfere with a productive immune response in Plasmodium yoelii infections.

Mice lacking alpha beta T-cells or gamma delta T-cells were infected with Plasmodium yoelii 17X NL (non-lethal) and followed for parasitaemia and cytokine production. While the parasitaemia in wild type mice resolved after reaching a peak value of 30 to 50%, it persisted in the -alpha beta T-cell mice until death. However, in the -gamma delta T-cell mice the peak parasitaemia was 12.5% of the levels seen in the wild type and -alpha beta T-cell mice and resolved faster than in the wild type mice. Higher levels of IL-10 and IFN-gamma were consistently found in the wild type and -gamma delta T-cell mice but not in the -alpha beta T-cell mice.

Murine gamma delta T lymphocytes elicited during Plasmodium yoelii infection respond to Plasmodium heat shock proteins.

gamma delta T cells accumulate during Plasmodium infections in both murine and human malarias. The biological role of these cells and the antigens that they recognize are not clearly understood, although recent findings indicate that gamma delta T cells in general influence both innate and antigen-specific adaptive host responses. We examined the accumulation of gamma delta T cells elicited during infection with virulent and avirulent Plasmodium yoelii parasites in relatively susceptible and resistant strains of mice. Our results indicated that in nonlethal malaria infections, gamma delta T cells comprise a larger proportion of splenic T cells than in lethal infections and that only a live infection is capable of inducing an increase in the percentage of gamma delta T cells in vivo. Furthermore, we demonstrate that gamma delta T cells elicited during a P. yoelii infection respond by proliferation in vitro to P. falciparum heat shock proteins (HSPs) of 60 and 70 kDa, suggesting a possible immunological involvement of parasite HSPs in this arm of the cellular immune response during malarial infection in mice.

[Experimental femoral neck fractures in rats after prolonged steroid therapy]. / Doswiadczalne zlamania szyjki kosci udowej szczurów poddanych przewleklemu podawaniu hydrokortyzonu.

The method of the experiment has been presented. It was found, that after 8 weeks of hydrocortisonum hemisuccinatum administration, 20 mg per day in two doses the braking force decreased by 15 per cent. The calculation of the measurements at 150 g of animal body weight proved to be useful.

[Surgical treatment of Smith and Barton type fractures]. / Operacyjne leczenie zlaman typu Smitha i Bartona.

The method and the results of surgical treatment of Smith and Barton fracture of the distal radial epiphysis has been presented in 10 patients. Dislocation of fragments is reduced after exposure of the palmar side of the distal radial bone. Stabilization is secured by a metal plate, which supports the epiphysis and is fixed to the proximal fragment by screws. It prevents from redislocation of fragments and helps to recover full activity of the hand, which was obtained in 8 patients. Delayed reduction or stabilization of fragments by Kirschner wires in 2 persons has failed.