Pretransplantation seroreactivity in kidney donors and recipients as a predictive factor for posttransplant BKPyV-DNAemia.

BK polyomavirus (BKPyV) often reactivates after kidney transplantation, causing BKPyV-associated nephropathy (BKPyVAN) in 1%-10% of cases with a potential detrimental effect on allograft survival. Kidney transplant recipients are regularly screened for BKPyV DNA in plasma. As this strategy may not always reduce the risk of BKPyVAN, other predictive markers are needed. To evaluate the role of pretransplant BKPyV-specific antibody, 210 kidney transplant recipients and 130 donors were screened for BKPyV DNA and BKPyV-specific antibodies. We found that the donor BKPyV immunoglobulin G (IgG) seroprevalence and antibody level were strongly associated with BKPyV-DNAemia and BKPyVAN, although multivariant analysis found the presence of anti-BKPyV-specific antibodies as a predictive factor only for BKPyV-DNAemia. The pretransplant recipient status had no effect on posttransplant BKPyV-DNAemia and BKVAN. BKPyV IgG levels remained stable in BKPyV-negative recipients during 1-year follow-up, while a considerable increase was observed in BKPyV-positive patients. The presence of anti-BKPyV-specific antibodies in kidney allograft donors is a good and reliable predictive marker for posttransplant BKPyV replication with relevance to risk stratification in transplant recipients.

Analysis of Factors Affecting Employment Status of Kidney Transplant Recipients in Selected European Union Member States.

Despite an increasing quality of life after renal transplantation, the number of recipients undertaking paid professional work remains relatively low. Employment after kidney transplantation became a new important marker of clinically significant health recovery. Furthermore, for social and economic reasons, returning to work and participation in social life may be considered as an objective parameter that demonstrate the effectiveness of transplantation. The objectives of the following study were to evaluate the factors that determine resuming paid work after renal transplantation, to assess a patient's decision about returning to professional activity by comparative analysis of renal transplant recipients from Poland, Czech Republic and Germany, and to identify groups of patients exposed to professional exclusion in those EU countries. Five hundred renal transplant recipients from three EU countries were included into the study. The two main research methods used in the study were the SF-36 questionnaire, constructed and validated to assess the quality of life after kidney transplantation and a questionnaire constructed for the purposes of this study. Multifactorial analysis identified several risk factors associated with professional exclusions after kidney transplantation, namely young or advanced age, female gender, lack of education, place of residence in rural areas, long period of illness, and lack of occupational activity before transplantation. Despite the high standards of social care and rehabilitation support, patients in Germany failed to take up professional activity after kidney transplantation in more cases than those in Poland and Czech Republic. Surprisingly, the objective function of the kidney (creatinine level) and the multidimensional assessment of quality of life (SF-36 survey) did not have a significant association with the employment status after renal transplantation.

Dynamics and size of cross-linking-induced lipid nanodomains in model membranes.

Changes of membrane organization upon cross-linking of its components trigger cell signaling response to various exogenous factors. Cross-linking of raft gangliosides GM1 with cholera toxin (CTxB) was shown to cause microscopic phase separation in model membranes, and the CTxB-GM1 complexes forming a minimal lipid raft unit are the subject of ongoing cell membrane research. Yet, those subdiffraction sized rafts have never been described in terms of size and dynamics. By means of two-color z-scan fluorescence correlation spectroscopy, we show that the nanosized domains are formed in model membranes at lower sphingomyelin (Sph) content than needed for the large-scale phase separation and that the CTxB-GM1 complexes are confined in the domains poorly stabilized with Sph. Förster resonance energy transfer together with Monte Carlo modeling of the donor decay response reveal the domain radius of ~8 nm, which increases at higher Sph content. We observed two types of domains behaving differently, which suggests a dual role of the cross-linker: first, local transient condensation of the GM1 molecules compensating for a lack of Sph and second, coalescence of existing nanodomains ending in large-scale phase separation.

[The disease caused by Clostridium difficile in geriatric patients]. / Onemocnení vyvolané Clostridium difficile u geriatrických nemocných.

BACKGROUND: The disease caused by the bacterium Clostridium difficile/Clostridium difficile associated disease/diarrhoea (CDAD) is becoming a serious problem especially in geriatric patients, who are now relatively often treated by broad-spectrum antibiotics. The goal of our study was to evaluate the occurrence of the risk factors and to evaluate the complex of relations and coherence which lead to the CDAD disease in a selected group of seniors treated at our institution. MATERIAL AND METHODS: The retrospective study evaluated a group of 67 patients with diagnosed CDAD, who were hospitalized at the clinic of internal medicine, geriatrics and practical medicine, Faculty of Medicine and Faculty Hospital in Brno from January 2007 till October 2010. In the study 46 women (68.7%) and 21 men (31.3%) were included of the average age 78.8 +/- 10.3 years (56 till 96 years). The decisive moment in the diagnosis of CDAD was the discovery of enterotoxines A and B in faeces of the patients. RESULTS: The mean time of hospitalization of the patients suffering from CDAD was significantly higher (p = 0.01) in comparison with the control patients (24.63 +/- 16.34 vs. 11.5 +/- 10.7 days). Polymorbidity was also high in those patients. On average, each patient was ill with 11.3 diseases. The most frequent diseases were: high blood pressure (76.1% of the patients), ischemic heart disease 68.7% and the third most frequent diagnosis was the cerebrovascular disease 50.7%. We found that only 13 patients (19.4%) did not take the antibiotics at all, further 54 patients (80.6%) used one or more antibiotics. From the cohort of 67 patients 12 died (17.9%), the section was done in 7 patients, and colitis pseudomembranosa was proved in 3 of them. In 8 cases relapse of the colitis was proved. CONCLUSIONS: The infection of the clostridium is a very serious disease which increases the morbidity and mortality in geriatric patients. Besides the demands on the diagnostics and therapy, it influences also the duration of the hospitalization.

[Monitoring the occurrence of fungi in the air and environment at the Hemato-Oncology Clinic of the Faculty Hospital in Brno-Bohunice]. / Sledování výskytu mikroskopických hub v ovzdusí v prostredí Interní hematoonkologické kliniky Fakultní nemocnice Brno-Bohunice.

OBJECTIVE: The air can be one of the ways of transmission of fungal infections in hospital environment. This is why we examined the occurence of fungi in the air of units where patients with hemato-oncology disorders, naturally predisposed to fungal infections, are hospitalized. MATERIALS AND METHODS: We performed the search at four sampling sites with different grade of reverse isolation. (unit for allogeneis transplantation, unit for autologous transplantation, intensive care unit and standard three-bed room. Air samples were collected by a special instrument for aeroscopic sampling (Biotest RCS Plus) during two consecutive periods in 2002, in summer (June - July) and in fall (November - December). and compared with each other. RESULTS: Forty-four samples of air were collected, which yielded 147 fungal isolates, representing 41 genera. The growth of fungi was recorded in 34 samples of air (77.3 %), 10 samples were free of fungi. Yeasts were not taken into consideration in this study. The isolates belonged mostly to the genera Cladosporium (33,9 %), Penicillium (23,9 %), Aspergillus (12,8 %), Acremonium (5,6 %) and Alternaria (5,6 %), the other genera represented 18,2 % altogether. CONCLUSION: Increasing occurence of fungi was found at the unit for autologous transplantation and in the standard room. The results led to reconsideration of the daily regime and of environmental factors in both units and relevant preventive measures were proposed.