Renal allograft failure resulting from diffuse cortical necrosis.

ABSTRACT: Cortical necrosis of the renal allograft is an extremely rare but serious complication of renal transplantation and can lead to graft failure. Few cases have been reported in the literature to date. We present a rare case of a 28-year-old woman with chronic kidney disease for the past four years who was on biweekly hemodialysis and referred to our tertiary care center for a living-related renal transplant. The patient developed tacrolimus toxicity on the second day post-transplant. The renal biopsy performed on third day after transplant showed ischemic acute tubular injury. C4d and donor-specific antibodies were negative. On day 12 post-transplant, USG Doppler of the renal allograft showed thrombosis of the renal vein, and an open wedge biopsy was performed that showed extensive renal cortical necrosis. A month and half later, the patient developed pus collection anterior to the transplanted kidney and a fistula from the perinephric space up to the skin with persistent pus discharge. Two months later, a graft nephrectomy was performed, and diffuse cortical necrosis of renal allograft with a thick band of exudate on the capsule was diagnosed on histopathology. Ureteral necrosis and thrombosis of both renal artery and renal vein were also seen. In this case, the etiology of graft cortical necrosis is multifactorial and includes acute ischemia, urologic complications, and sepsis. To prevent graft failures, it is critical to differentiate thrombosis caused by surgical complications from hyperacute or acute humoral rejection.

Psychosocial factors, disability and quality of life in chronic shoulder pain patients with central sensitization.

Chronic shoulder pain is a complex and multidimensional phenomenon with multiple causative factors involved in its perpetuation. Alteration of central nervous system processing along with the central sensitization is a predominant feature in chronic pain. Reduction in physical function has an impact on the psychological well-being of an individual. The aim of the study was to compare pain, kinesiophobia, catastrophizing, disability and quality of life in chronic shoulder pain patients with and without central sensitization. Eighty chronic unilateral shoulder pain patients in the age group of 40 to 60 years were recruited. Of them, 38 were chronic shoulder pain with central sensitization and 42 without central sensitization, classified on the basis of central sensitization inventory. Pain catastrophizing was measured using the pain catastrophizing scale, kinesiophobia using Tampa scale of kinesiophobia, disability using Shoulder pain and disability index and quality of life using 36-Item Short Form Health Survey questionnaire was evaluated in both the groups. Increased pain catastrophizing (p=0.000), kinesiophobia (p=0.000) and disability (p=0.000) was observed in centrally sensitized chronic shoulder pain patients. Also, physical component summary (p=0.000) and mental component summary (p=0.000) of SF-36 quality of life were reduced in chronic shoulder pain with central sensitization as compared to without central sensitization. Hence, these components should be included during assessment which will provide a holistic and multimodal approach towards the understanding, planning and management of chronic shoulder pain patients.

Association of periodontitis with pre term low birth weight - A review.

Prematurity is one of the main causes of neonatal morbidity and mortality. The association between periodontitis and premature delivery and low weight at birth has been suggested in many literature. Pregnancy totally depends on physiological immune tolerance of a women. During pregnancy shifts in the microbial composition of the subgingival dental plaque biofilm promotes the formation of more hazardous and destructive microbial community. In women suffering with periodontitis, the infected periodontal tissues may act as source of bacteria and their products can reach to the foetus-placenta unit through circulation. This helps the bacterial agents and their products to activate inflammatory signalling pathways locally and in extra-oral sites, including the placenta-foetal unit, which may not only induce preterm labor but also restrict the intrauterine growth. Number of literature has shown about the effectiveness of providing periodontal treatment in preventing gestational complications by controlling the infection and inflammation in periodontitis patients during pregnancy. In this review we aimed to throw the light on the current data of association between pregnancy and periodontitis, pathogenic mechanisms underlying this association, evidence of this association and effect of providing periodontal treatment as a safety precaution to the mothers.

FZL is primarily localized to the inner chloroplast membrane however influences thylakoid maintenance.

KEY MESSAGE: FZL is primarily localized to the chloroplast inner envelope and not to the thylakoids, but nevertheless affects the maintenance of thylakoid membranes and photosynthetic protein complexes. The fuzzy-onion-like protein (FZL) is a membrane-bound dynamin-like GTPase located in the chloroplast. We have investigated the chloroplast sub-localization of the endogenous FZL protein and found it to be primarily localized to the inner envelope. Moreover, we observed that mature leaves of fzl mutants start to turn pale, especially in the midvein area of the leaves, 11 days after germination. We therefore assessed their photosynthetic performance as well as the accumulation of thylakoid membrane proteins and complexes after the initial appearance of the phenotype. Interestingly, we could observe a significant decrease in amounts of the cytochrome b6f complex in 20-day-old mutants, which was also reflected in an impaired electron transport rate as well as a more oxidized P700 redox state. Analysis of differences in transcriptome datasets obtained before and after onset of the phenotype, revealed large-scale changes in gene expression after the phenotype became visible. In summary, we propose that FZL, despite its localization in the inner chloroplast envelope has an important role in thylakoid maintenance in mature and aging leaves.

Oep23 forms an ion channel in the chloroplast outer envelope.

BACKGROUND: Metabolite, ion and protein translocation into chloroplasts occurs across two membranes, the inner and the outer envelope. Solute and metabolite channels fulfill very important functions in integrating the organelles into the metabolic network of the cell. However so far only a few have been identified. Here we describe the identification and the characterization of the outer envelope protein of 23 kDa, Oep23 from garden pea. RESULTS: Oep23 is found in the entire plant lineage from green algae to flowering plants. It is expressed in all organs and developmental states tested so far. The reconstituted recombinant protein Oep23 from pea forms a high conductance ion channel with a maximal conductance in the fully open state of 466 ± 14pS at a holding potential of +100 mV (in 250 mM KCl). The Oep23 channel is cation selective (PK+ : PCl- = 15 : 1) with a voltage dependent open probability of maximal Vmem = 0 mV. CONCLUSION: The data indicate that the Oep23 activity represents a single channel unit and does not assemble into a multiple pore complex like bacterial type porins or mitochondrial voltage dependent anion channel. Thus, Oep23 represents a new member of ion channels in the outer envelope of chloroplasts involved in solute exchange.