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Objectives: To assess the risk of chronic kidney disease (CKD) associated with tenofovir disoproxil fumarate (TDF) use by baseline D:A:D CKD risk score. Methods: Adult antiretroviral therapy (ART)‐naïve people living with HIV (PLWH) initiating treatment, with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, were identified in the OPERA cohort. CKD was defined as two or more consecutive eGFR < 60 mL/min/1.73 m2, > 90 days apart. Associations between TDF use, baseline D:A:D CKD risk and incident CKD were assessed with incidence rates (IRs; Poisson regression) and adjusted pooled logistic regression. The impact of pharmacoenhancers on the observed association between TDF and CKD was also evaluated. Results: Of 9802 PLWH included, 6222 initiated TDF and 3580 did not (76% and 79% low D:A:D CKD risk, respectively). Overall, 125 CKD events occurred over 24 382 person‐years of follow‐up. Within strata of D:A:D CKD risk score, IRs were similar across TDF exposure, with high baseline CKD risk associated with highest incidence. Compared with the low‐risk group without TDF, there was no statistical difference in odds of incident CKD in the low‐risk group with TDF (adjusted odds ratio = 0.55, 95% confidence interval: 0.19–1.54). Odds of incident CKD did not differ statistically significantly by pharmacoenhancer exposure, with or without TDF. Conclusions: In this large cohort of ART‐naïve PLWH, incident CKD following ART initiation was infrequent and strongly associated with baseline CKD risk. TDF‐containing regimens did not increase the odds of CKD in those with a low baseline D:A:D CKD risk, the largest group of ART‐naïve PLWH, and may remain a viable treatment option in appropriate settings. [ABSTRACT FROM AUTHOR]

Background The potential for an ultrasound-based screening programme for renal cell carcinoma ( RCC) to improve survival through early detection has been the subject of much debate. The prevalence of ultrasound-detected asymptomatic RCC is an important first step to establishing whether a screening programme may be feasible. Methods A systematic search of MEDLINE and Embase was performed up to March 2016 to identify studies reporting the prevalence of renal masses and RCC. Two populations of patients were chosen: asymptomatic individuals undergoing screening ultrasonography and patients undergoing ultrasonography for abdominal symptoms not related to RCC. A random-effects meta-analysis was performed. Study quality was evaluated using a validated eight-point checklist. Results Sixteen studies (413 551 patients) were included in the final analysis. The pooled prevalence of renal mass was 0·36 (95 per cent c.i. 0·23 to 0·52) per cent and the prevalence of histologically proven RCC was 0·10 (0·06 to 0·15) per cent. The prevalence of RCC was more than double in studies from Europe and North America than in those from Asia: 0·17 (0·09 to 0·27) versus 0·06 (0·03 to 0·09) per cent respectively. Data on 205 screen-detected RCCs showed that 84·4 per cent of tumours were stage T1-T2 N0, 13·7 per cent were T3-T4 N0, and only 2·0 per cent had positive nodes or metastases at diagnosis. Conclusion At least one RCC would be detected per 1000 individuals screened. The majority of tumours identified are early stage ( T1-T2). [ABSTRACT FROM AUTHOR]

Background: The standard open technique for exposure of the upper thoracic spine, T1-T4, usually requires a difficult thoracotomy. From November 1, 1995 to June 30, 1997, eight patients underwent video-assisted thoracoscopic spinal surgery in our institute to treat their upper thoracic spinal lesions endoscopically.Methods: A new approach, the so-called "extended manipulating channel method," was used in this series that allows the combined use of video-assisted thoracoscopy and conventional spinal instruments to enter the chest cavity freely for the procedures. Patients' ages ranged from 44 to 89 years (average, 60 years). Definitive diagnoses included two pyogenic spondylitis and six spinal metastases. Five patients presented initially with myelopathy.Results: There were no deaths or neurologic injuries associated with this technique. The mean surgical time was 3.1 h. The mean duration of chest tube retention was 3.3 days. The mean total blood loss was 1,038 ml, and two patients had a blood loss of more than 2,000 ml owing to bleeding from epidural veins or raw osseous surfaces. Complications included one superficial wound infection and one subcutaneous emphysema that resolved spontaneously. In this series, there was no need of conversion to open thoracotomy for the patients.Conclusions: The thoracoscopy-assisted spinal technique using the extended manipulating channels, usually 2.5-3.5 cm, allows variable instrument angulations for manipulation. The mean surgical time (3.1 h) was considered no longer than for an open technique for the equivalent anterior procedure. Such an approach can achieve less procedure-related trauma and has proved to be a good alternative to other treatment modalities. [ABSTRACT FROM AUTHOR]

Background: The endoscopic treatment of spinal lesions in the thoracolumbar junction (T11-L2) poses a great challenge to the surgeon. From November 1, 1995 to December 31, 1996, we successfully used a combination of video-assisted thoracoscopy and conventional spinal instruments to treat 38 patients with anterior spinal lesions. Twelve of them had lesions in the thoracolumbar junction.Methods: The so-called extended manipulating channel method was used to perform vertebral biopsy, discectomy, decompressive corpectomy, interbody fusions, and/or internal fixations in these patients. The size of the thoracoscopic portals was greater than usual in order to allow conventional spinal instruments and a thoracoscope to enter the chest cavity freely and be manipulated by techniques similar to those used in standard open surgical procedures. In this series, the procedures were performed by using either a three-portal approach (2. 5-3.5 cm) or a modified two-portal technique involving a 5-6 cm larger incision and a small one for introducing the scope.Results: None of the operations resulted in injury to the great vessels, internal organs, or spinal cord. The total time for the operation ranged from 1.5 to 4.5 h (average, 3); and the total blood loss ranged from 50 to 3000 cc (average, 1050). One patient was converted to an open procedure due to severe pleural adhesion. Complications included two instances of transient intercostal neuralgia, one superfical wound infection, and one residual pneumothorax.Conclusions: The video-assisted technique with the extended manipulating channel method presented in this report simplifies thoracoscopic spinal surgery in the thoracolumbar junction and makes it easier. It avoids division of the diaphragm, removal of the rib, and wide spread of the intercostal space, and it allows greater control of intraoperative vessel bleeding. Using this technique, the number of portals required during the procedure can be reduced. In addition, the technique reduces the endoscopic materials required, thus lowering overall cost. It is an effective and promising approach. [ABSTRACT FROM AUTHOR]

Silicon-on-sapphire (SOS) is a member of the silicon-on-insulator (SOI) family which uses a hetero-epitaxial process to generate thin films of semiconductor materials. SOS has become an attractive technology for low-power and radio-frequency integrated circuits. This study tends to apply SOS to thin film solar cell by thin film transfer technique. The nano-scale silicon thin film can be generated on the high quality sapphire substrate to form SOS. SOS is soaked in the special H+-chemical solution at first. The aluminum layer is bonded by thermal annealing treatment and the silicon thin film will transfer to the aluminum layer with cooling slowly due to the thermal stress induced. Through the special H+chemical treatment and the annealing process, the SOS can be transferred to Si/Al layer and sapphire layer successfully. The Si/Al layer can be applied to thin film solar cell or other nano-size devices. The sapphire layer can be recycle for the SOS use. [ABSTRACT FROM AUTHOR]

The generation and homeostasis of bone tissue throughout development and maturity is controlled by the carefully balanced processes of bone formation and resorption. Disruption of this balance can give rise to a broad range of skeletal pathologies. Lethal osteosclerotic bone dysplasia (or, Raine syndrome) is an autosomal recessive disorder characterized by generalized osteosclerosis with periosteal bone formation and a distinctive facial phenotype. Affected individuals survive only days or weeks. We have identified and defined a chromosome 7 uniparental isodisomy and a 7p telomeric microdeletion in an affected subject. The extent of the deleted region at the 7p telomere was established by genotyping microsatellite markers across the telomeric region. The region is delimited by marker D7S2563 and contains five transcriptional units. Sequence analysis of FAM20C, located within the deleted region, in six additional affected subjects revealed four homozygous mutations and two compound heterozygotes. The identified mutations include four nonsynonymous base changes, all affecting evolutionarily conserved residues, and four splice-site changes that are predicted to have a detrimental effect on splicing. FAM20C is a member of the FAM20 family of secreted proteins, and its mouse orthologue (DMP4) has demonstrated calcium-binding properties; we also show by in situ hybridization its expression profile in mineralizing tissues during development. This study defines the causative role of FAM20C in this lethal osteosclerotic disorder and its crucial role in normal bone development. [ABSTRACT FROM AUTHOR]

To compare durability of antiretroviral therapy (ART) regimens among heavily treatment-experienced (HTE) people living with HIV (PLWH) and non-HTE treatment-experienced PLWH in care in the United States. Methods ART-experienced PLWH in care in the OPERA Cohort on 12/31/2016 were identified as HTE (defined as being on a regimen indicative of HTE or experienced >=3 core agent classes prior to current regimen) or non-HTE treatment experienced (not meeting the definition of HTE and on a three-drug regimen of 1 core agent and 2 nucleoside reverse transcriptase inhibitors (NRTIs)). [Extracted from the article]

In this work, we study the microstructural modifications and the electrical properties of Pb(Mn 1/3 Nb 2/3 ) 0.1 Zr 0.52 Ti 0.38 O 3 + 1.5 wt% PbO (PMNZT) ceramics processed using microwave sintering (MS) and conventional sintering (CS) techniques. Dielectric and piezoelectric properties were evaluated via an impedance/gain phase analyzer and the corresponding microstructures were examined using transmission electron microscopy (TEM). The experimental results imply that smaller grain size and less loss of PbO obtained for specimens using MS process. The MS specimens (1200°C-15 min) show the remanent polarization (P r ) of 24.1 μC/cm 2 , coercive field (E c ) of 15.2 kV/cm, dielectric constants (ℇ r ) of 432 and electromechanical coupling coefficient (k p ) of 0.47 , which are superior to CS specimens (1200°C-2 h) with P r = 19.5 μC/cm 2 , E c = 16.1 kV/cm, ℇ r = 395 and k p = 0.45. The results revealed that the MS process shows capability of fabrication of good quality PMNZT ceramics with advantages of lowing process temperature and shorten process time. TEM investigations of MS specimens show that smaller grain size and simpler domain arrangements exist inside the specimens. From the energy aspect, the domain structure in piezoelectric ceramics below the temperature of a ferroelectric structural phase transformation is a result of energy minimization. Homogeneous elastic strain energy is reduced at the expense of domain boundary energy during the phase transformation. Density of domain boundaries, 71° (109°) domains in particular, depends on and increases with the grain size. Base on the above argument, therefore, CS specimens exhibit more complicated domain arrangements because they possess larger grain size than MS specimens do. The microstructural investigations suggest that the electrical property difference is intimately related to different sintering methods since the complicated domain arrangements could hinder domain moving and deteriorate electrical performance. In addition, the microstructural characteristics in both MS and CS specimens will be discussed further in the context. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: A theoretical model is used to examine the mechanics of red blood cell (RBC) motion in nonuniform capillaries. The model includes effects of the endothelial surface layer (ESL), which is a layer of macromolecules adjacent to the endothelium and which impedes plasma flow. METHODS:: The motion of an RBC traversing a capillary with diameter varying sinusoidally between 5.4 μm and 7.4 μm is simulated numerically. The ESL is assumed to be 0.7-μm wide and deformable. Axisymmetric RBC shapes are assumed. Lubrication theory is used to analyze the motion of plasma around the RBC and through the ESL. RESULTS:: In a nonuniform capillary with no ESL, moving RBCs undergo large transient deformations and predicted flow resistance is substantially higher than in a uniform capillary with the same mean diameter. The presence of a deformable ESL reduces the transient fluid shear stresses and deformations experienced by RBCs traversing a nonuniform capillary. With an ESL, the increase in flow resistance resulting from nonuniformity is less than twofold versus three- to fourfold with no ESL in vessel geometries with the same ESL-free luminal region. CONCLUSIONS:: The presence of the ESL reduces the impact of capillary irregularity on flow resistance and may protect RBCs traversing irregular capillaries from damage due to large, rapidly fluctuating external stresses.Microcirculation (2002) 9, 189–196. DOI: 10.1038/sj.mn.7800132 [ABSTRACT FROM AUTHOR]

Discusses the similarity of Helmert method of weight determination and the iterated almost unbiased estimation (IAUE) method. Formulas for the Helmert method; Methods of MINQUE and IAUE.

Presents a study which investigated the effects of blood flow velocity on motion and axisymmetric deformation of red blood cells in a capillary with an endothelial surface layer. Methodology; Results; Discussion.

Objective: Simulations of oxygen delivery by a three-dimensional network of microvessels in rat cerebral cortex were used to examine how the distribution of partial pressure of oxygen (PO[SUB2]) in tissue depends on blood flow and oxygen consumption rates. Methods: Network geometry was deduced from previously published scanning electron micrographs of corrosion casts. A nonlinear least-squares method, using images obtained at three different angles, was used to estimate vessel locations. The network consisted of 50 segments in a region 140 μm × 150 μm × 160 μm. A Green's function method was used to predict the PO[SUB2] (distribution. Effects of)varying perfusion and consumption were examined, relative to a control state with consumption 10 cm[SUP3]O[SUB2]/100 g per min and perfusion 160 cm[SUP3]/100 g per min. Results: In the control state, minimum tissue PO[SUB2] was 7 mm Hg. A Krogh-type)model with the same density of vessels, but with uniform spacing, predicted a minimum tissue PO[SUB2] of 23 mm Hg. For perfusion below 60% of control, tissue hypoxia (PO[SUB2] <1 mm Hg) was predicted. When perfusion was reduced by 75%, the resulting hypoxia could be eliminated by a 31% reduction in oxygen consumption rate. Conclusions: The simulations suggest that tissue hypoxia resulting from a severe decrease in brain perfusion, as can occur in stroke, may be avoided by a moderate decrease in oxygen consumption rate. [ABSTRACT FROM AUTHOR]

Background: The literature contains few reports on negative outcomes after thoracoscopic spinal surgery. Methods: From November 1995 to February 1998, 90 patients underwent minimally invasive spinal surgery by thoracoscopic assistance as treatment for their anterior spinal lesions. The diagnoses included 41 spinal metastases, 13 cases of scoliosis, 12 burst fractures, 10 cases of tuberculous spondylitis, 8 cases of pyogenic spondylitis, 2 thoracic disc herniations, 2 cases of ankylosing spondylitis with discitis, 1 osteoporotic compression fracture, and 1 case of thoracolumbar kyphosis. The procedures included biopsy only (3 patients); thoracic discectomy (3 patients); multilevel anterior releases, discectomy, and fusion (14 patients); corpectomy for decompression (6 patients); corpectomy and interbody fusion (32) patients; and internal instrumentation (28 patients). Results: A total of 30 complications were noted in 22 patients (24.4%). Two fatal complications occurred, resulting from massive blood transfusion in one case and postoperative pneumonia in another. Other nonfatal complications included four cases of transient intercostal neuralgia, three superficial wound infections, three cases of pharyngeal pain, two cases of lung atelectasis, two cases of residual pneumothorax, two cases of subcutaneous emphysema, one inadvertent pericardial penetration due to adhesion, one chylothorax that resolved after conservative management, one vertebral screw malposition, and one graft dislodgement that needed late revision surgery. Three patients required ventilatory support for longer than 72 hours. Five patients with spinal metastases had an estimated intraoperative blood loss of more than 2,000 ml. No injury to the internal organs or spinal cord was observed. There were four conversions to open procedures due to two cases of severe pleural adhesions and two poorly tolerated one-lung ventilation. At the latest follow-up, nine patients had died as a result of cancer dissemination. Conclusions: (a) Well-selected patients and attention to details are essential to optimizing surgical results. (b) A refined technique for less invasive tumor surgery has been developed. (c) Surgeons had better experience with the standard anterior spinal approach and showed no hesitation in converting to an open procedure when necessary. A procedure failure does not mean a treatment failure. [ABSTRACT FROM AUTHOR]

Presents information on a study which proposed a design case using a structural analysis program to reduce the complexity in finding the natural shape of tensioned fabric roofs. Development of fiber-reinforced glass fabric; Application of deformation theory for tensioned fabric membranes; Conclusions.

Analyzes the effects of glycocalyx on hematocrit and resistance to blood flow in capillaries by using a theoretical model. Effects of red blood cell shape and deformability on blood flow; Confinement of red blood cell in narrower channels of the capillaries in the presence of glycocalyx; Increase of flow resistance in the presence of a very dilute, endothelium-bound macromolecular matrix.

Focuses on a model for red blood cell motion in glycocalyx-lined capillaries. Biological structure of the interior surfaces of capillaries; Representation of the glycocalyx; Assumption made regarding the axisymmetric red blood cell shapes.

Focuses on the diffusive exchange between arterioles and capillaries in the skeletal muscle. Convective and diffusive oxygen transport; Oxygen saturation of capillary blood; Participation of arterial blood in the metabolic regulation of blood flow.

Examines the motion of red blood cells in capillaries with variable cross-sections. Continual deformation when traversing microvessels; effects of cell membrane shear viscosity and elasticity; Use of lubrication theory to describe the flow of surrounding plasma.

We examined ionoregulatory traits of four cichlid species from South America, oscars (Astronotus ocellatus), Tapajos cichlids (Geophagus sp.), Macmaster's dwarf cichlids (Apistogramma macmasteri), and keyhole cichlids (Cleithracara maronii), all inhabitants of ion-poor waters. K m values for Na+ transport in fish held in 100 μmol L−1 Na+ water ranged from 49 to 143 μmol L−1, and J max values spanned 450 to 1205 nmol g−1 h−1. After one month in 1000 μmol L−1 Na+ water, kinetic parameters for Na+ uptake in three of the four species acclimated, but only oscars displayed the "typical" pattern of higher K m and lower J max values. Low pH water inhibited Na+ uptake (J in Na) in all, and stimulated Na+ efflux (J out Na) 2.5 to 3.5-fold in three of the four species. Oscars alone had had a measurable J in Na at pH 3.5 and no stimulation of J out Na. We measured J in Na in oscars and keyhole cichlids during exposure to 100 μmol L−1 Ethoxzolemide (EZ), an inhibitor of carbonic anhydrase, and 1 mmol L−1 NH 4 Cl (HEA). EZ inhibited J in Na by about 50% and HEA reduced J in Na by 80–90%. These results suggest that Na+ uptake involves H+ extrusion. Acute exposure to 1 μmol L−1 CuSO 4 and 60 nmol L−1 AgNO 3 inhibited J in Na in both species by 30–85%. Exposure of oscars to 5-fold higher concentrations of both metals did not further inhibit J in Na, but it did stimulate J out Na 50–150%. The response to metals of both species are similar to other species that have been examined. Unlabelled Image • Kinetics of Na+ transport in 4 South American cichlids in low Na+ water show a range of K m and J max values, but usually low rates of Na+ uptake.. • Kinetics of Na+ transport in 3 of 4 cichlids held in high Na+ water acclimated, but only one showed "typical" pattern of higher K m /lower J max. • Na+ uptake of two species were inhibited by ethoxzolamide and HEA, suggesting that Na+ transport involves H+ extrusion. • Exposure to copper and silver inhibited Na+ transport, indicating that they have similar sensitivity as other species to these metals. [ABSTRACT FROM AUTHOR]

Transient luminous events in the atmosphere, such as lighting-induced sprites and upwardly discharging blue jets, were discovered recently in the region between thunderclouds and the ionosphere. In the conventional picture, the main components of Earth's global electric circuit include thunderstorms, the conducting ionosphere, the downward fair-weather currents and the conducting Earth. Thunderstorms serve as one of the generators that drive current upward from cloud tops to the ionosphere, where the electric potential is hundreds of kilovolts higher than Earth's surface. It has not been clear, however, whether all the important components of the global circuit have even been identified. Here we report observations of five gigantic jets that establish a direct link between a thundercloud (altitude ~16?km) and the ionosphere at 90?km elevation. Extremely-low-frequency radio waves in four events were detected, while no cloud-to-ground lightning was observed to trigger these events. Our result indicates that the extremely-low-frequency waves were generated by negative cloud-to-ionosphere discharges, which would reduce the electrical potential between ionosphere and ground. Therefore, the conventional picture of the global electric circuit needs to be modified to include the contributions of gigantic jets and possibly sprites. [ABSTRACT FROM AUTHOR]

Describes a new method of gene transfer into transgenic chickens in the absence of replicating retroviruses.

We have investigated the effect of postgrowth thermal annealing on the electron emission from InAs quantum dots (QDs) containing a misfit-related defect state induced by strain relaxation. Additional carrier depletion in the GaAs bottom layer near the QD, caused by the defect state, can effectively suppress electron tunneling from the QD, leading to the observation of a thermal emission from the QD electron ground state to the GaAs conduction band with a large emission energy of 213 meV, in contrast to defect-free nonrelaxed QDs in which an emission of 58 meV from the QD electron ground state to first excited state is observed. The emission energy is reduced to 193 meV and to 164 meV after annealing at 650 and 700 °C for 1 min, respectively. This emission energy reduction is correlated with the photoluminescence blueshift which is attributed to the interdiffusion of atoms across the QD interface. The electron emission from the QD first excited and ground states is found to be a thermal emission at high temperatures and a tunneling emission at low temperatures. The tunneling energy barrier is found to be comparable to the thermal emission energy, supporting a thermal emission to the GaAs conduction band. This study illustrates a significant effect of a defect state on the electron-emission process in the QDs, suggesting the possibility of modifying the electron emission time of the QDs by purposely introducing a deep defect state. [ABSTRACT FROM AUTHOR]

The article describes the case of iatrogenic esophageal foreign body in a 74-year-old man who underwent routine Maloney esophageal bougienation and accidentally swallowed the dilator. Topics discussed include the results of chest radiography and esophagoscopy, the use of an endoscopic extractor to remove the device, and the use of Bougie dilatation for inoperable patients with the motility disorders of the esophagus.

The article discusses the effect of vapor chamber in an injection molding process on part tensile strength. An experimental setup was conducted on tensile test parts and multiholed plates which were test-molded utilizing the vapor chamber-based rapid heating and cooling system that was manufactured by Taiwan Microloops Corp. The study uses two different mold designs and a mold with one gate. Results show that the system can minimize the depth of the V-notch as much as 24 times.

The need for corporations to expand or functionally alter their existing multi-story buildings increases because of rapid changes in the competitive environment. However, limited by building structures and the availability of space, when planning cross-level material handling, effective article transfer equipment integration becomes an important issue. The complexity and difficulty is far greater than that for traditional article transfer operations on a single-level floor area. Therefore, based on the concept of personal computers being able to replace IBM mainframes in the market, this paper proposed a smaller and more mobile multi-level device for article transfers that has the capacity to integrate other plant equipment to replace the conventional conveying device. This paper will make suggestions for cross-level article transfer device applications for use in different environments and industries. The structure of this facility is simple and its modularized design allows flexible expansion to accommodate corporate growth. This is a well-planed system that can serve as a reference for corporations intending to implement multi-level article transfer systems. [ABSTRACT FROM AUTHOR]

Abstract: Ventricular assist devices (VAD) have benefited patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experience of HTx in the presence of device-related infection (DRI) including driveline exit site with pocket infections. From May 1996 to April 2003, mechanical circulatory support with the HeartMate VAD was performed in eight patients, and with the Thoratec VAD in seven patients. Although 151 patients underwent HTx during that period, only 8 of the 15 patients had suitable donors and underwent orthotopic HTx. Six of the eight patients developed DRI. Their ages ranged from 18 to 59 years (mean = 36 ± 14 years). The duration of VAD support ranged from 8 to 287 days (mean = 125 ± 117 days). The general condition and cardiac function improved gradually under VAD support. At the time of HTx, all six male patients were suffering from DRI. The causative microorganisms were Acinetobacter baumannii (n = 3) methicillin-resistant Staphylococcus aureus (n = 2), and Enterococcus faecium (n = 1). All patients underwent successful HTx, and were discharged in good condition. It is concluded that under the coverage of appropriate antibiotics, HTx can be successfully performed for the patients for VAD support with DRI. It is important to prevent the spread of infection during HTx. Adequate debridement and drainage of the infected materials prevents postoperative wound infections. [Copyright &y& Elsevier]

Objectives: The aim of the study was to assess the validity of an easy‐to‐calculate chronic kidney disease (CKD) risk score developed by the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) group in a longitudinal observational study of people living with HIV (PLWH) in the USA. Methods: PLWH (2002–2016) without prior exposure to potentially nephrotoxic antiretroviral agents and with at least three estimated glomerular filtration rate (eGFR) test results were identified in the Observational Pharmaco‐Epidemiology Research and Analysis (OPERA®) cohort. Three samples were drawn independently using the same eligibility criteria but each using a different eGFR equation, specifically the Cockcroft–Gault (C‐G), Modification of Diet in Renal Disease (MDRD) or Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) eGFR estimation method. Full and short D:A:D risk scores were applied. CKD was defined as a confirmed decrease in eGFR to < 60 mL/min/1.73 m2 (stages 3–5). Poisson models estimated the association between CKD incidence and a one‐point increase in the continuous risk score. The incidence rate ratio (IRR), adjusted IRR (aIRR), and Harrell's discrimination statistic were used to assess validity. Results: There were 19 444, 22 727 and 22 748 PLWH in the OPERA C‐G, CKD‐EPI and MDRD samples, respectively. The median (minimum–maximum) follow‐up duration was 6.1 (0.3–9.1) years in the D:A:D cohort and ranged from 3.2 to 3.5 (0.2–15.5) years in the OPERA validation samples. The observation time for the majority of PLWH in the D:A:D cohort began prior to 2006, in stark contrast to the OPERA validation samples, where the majority of PLWH were observed after 2011. The CKD incidence ranged from 7.3 per 1000 person‐years [95% confidence interval (CI) 6.8, 7.9 per 1000 person‐years] in OPERA C‐G to 11.0 (95% CI 10.4, 11.6 per 1000 person‐years) in OPERA MDRD. In OPERA samples, IRRs by risk group and adjusted IRRs (full risk score) were similar to those in the D:A:D derivation cohort (adjusted IRR 1.3; 95% CI 1.3, 1.3). Harrell's c‐statistic ranged from 0.87 to 0.92 in the OPERA samples, comparable to that in the derivation cohort (0.92). Results for short scores were similar. Conclusions: The findings support the validity of the D:A:D risk scoring method for assessing CKD (stages 3–5) probability in an exclusively USA‐based sample regardless of eGFR method. [ABSTRACT FROM AUTHOR]

No direct observational evidence of sprite‐produced active radicals has been presented owing to the difficulty of observing a small event area in the nighttime mesosphere, whereas sprite chemical models have indicated that sprite discharge locally affects the atmospheric composition. We present the first observational evidence of a HO 2 production above sprite‐producing thunderstorms from the coincidence of temporal‐spatial observations of HO 2 spectra, sprite events, and thunderstorms by two space instruments, a submillimeter‐wave limb spectrometer and ultraviolet/visible Imager and a ground‐based very low frequency radiation lightning detection network. A total of three areas was identified with enhanced HO 2 levels of approximately 10 25 molecules. A chemical sprite model indicates an increase in HO 2 in the considered altitude region; however, the predicted production due to a single sprite event is smaller than the observed enhancement. Our observational results suggest that sprites potentially contribute 1% of nighttime background HO 2 generation at altitudes of 75–80 km globally. Plain Language Summary: HO 2 radical, a key atmospheric oxidant in the mechanisms that influence the atmospheric composition of our planet, has been predicted to be generated by lightning‐induced upper atmospheric discharge, called sprites, from water vapor. However, there has been no observational evidence of sprite‐producing active radicals due to the difficulty in specific observations that identify these radical productions by sprite, caused by factors such as a very small molecular abundance and narrow event area in the upper atmosphere. For the first time, we present observational evidence of a rise in HO 2 amount above sprite‐producing thunderstorms by using a unique method that combined observations between HO 2 detection by a super‐high‐sensitive space spectrometer, sprite emission detection using a satellite imager and ground‐based lightning detection using expand radio frequency receivers. The amount of HO 2 generated in the sprite event area can be approximated to be 40–190 times greater than the background values. Sprite chemical model simulations reproduced HO 2 enhancement by sprite events. These pieces of evidence suggest that sprites potentially contribute about 1% increase of background level of global HO 2 generation during nighttime at altitudes of 75–80 km, which can contribute to a change in the Earth's atmospheric composition. Key Points: Clear HO 2 enhancements above sprite‐producing thunderstorms were identified by coincidence of space and ground‐based observationsEnhanced HO 2 amounts in a sprite event area were estimated to be 10 25 moleculesSprites potentially contribute about 1% of nighttime background HO 2 generations at 75–80 km globally [ABSTRACT FROM AUTHOR]

Precise regulation of transcription in gene expression is critical for all aspects of normal organism form, fitness, and function and even minor alterations in the level, location, and timing of gene expression can result in phenotypic variation within and between species including evolutionary innovations and human disease states. Eukaryotic transcription is regulated by a complex interplay of multiple factors working both at a physical and molecular levels influencing this process. In Saccharomyces cerevisiae , the TF with the greatest number of putative regulatory targets is the essential gene Repressor Activator Protein 1 (RAP1). While much is known about the roles of Rap1 in gene regulation and numerous cellular processes, the response of Rap1 target genes to systematic titration of RAP1 expression level remains unknown. To fill this knowledge gap, we used a strain with a tetracycline-titratable promoter replacing wild-type regulatory sequences of RAP1 to systematically reduce the expression level of RAP1 and followed this with RNA sequencing (RNA-seq) to measure genome-wide gene expression responses. Previous research indicated that Rap1 plays a significant regulatory role in particular groups of genes including telomere-proximal genes, homothallic mating (HM) loci, glycolytic genes, DNA repair genes, and ribosomal protein genes; therefore, we focused our analyses on these groups and downstream targets to determine how they respond to reductions in RAP1 expression level. Overall, despite being known as both an activator and as a repressor of its target genes, we found that Rap1 acts as an activator for more target genes than as a repressor. Additionally, we found that Rap1 functions as an activator of ribosomal protein genes and a repressor for HM loci genes consistent with predictions from the literature. Unexpectedly, we found that Rap1 functions as a repressor of glycolytic enzyme genes contrary to prior reports of it having the opposite effect. We also compared the expression of RAP1 to five different genes related to DNA repair pathway and found that decreasing RAP1 downregulated four of those five genes. Finally, we found no effect of RAP1 depletion on telomere-proximal genes despite its functioning to silence telomeric repeat-containing RNAs. Together our results enrich our understanding of this important transcriptional regulator. • Yeast RAP1 acts predominantly as an activator of gene expression • RAP1 functions as an activator of ribosomal protein genes and RNR genes • RAP1 functions as a repressor of glycolysis genes and the homothallic mating loci • We did not find a consistent role of RAP1 in regulating telomere-proximal genes [ABSTRACT FROM AUTHOR]

Organ transplant recipients have diminished humoral immune responses to COVID-19 vaccination than the general population. The current study have reported the risk factors about the antibody response after vaccination. Data from several studies show that to use of mycophenolate mofetil (MMF) as a major factor associated with poor antibody response after COVID-19 vaccination. But little is known at heart transplant recipients(HTXs) and in Asian race. We performed a single-center, prospective observational cohort study of 59 HTXs from National Taiwan University Hospital, Taiwan, was conducted between Jun 1, 2021 and July 31, 2022. We identified the response of antibody titers after vaccination and there were stratified into two categories: with MMF; without MMF. Anti‐spike IgG (S‐IgG) antibody was determined at a specified time point, which is 30 days after each dose of vaccine, and a S‐IgG value of 0.8 U/mL or higher was considered positive (Roche Diagnostics). We enrolled 59 patients (age: 53±13 years;86 % were men) with a negative SARS-CoV-2 anti-nucleocapsid antibody test. 21 patients received an immunosuppressive regimen with MMF, Among these patients, 21 received an immunosuppressive regimen with MMF (36%) throughout the study period. The time period of vaccine administration between the first and the second dose ranged from 28 to 135 days. The time period between the second and the third dose ranged from 34 to 182 days For those recipient, tacrolimus blood levels is 2.6 to 12.1 ng/mL, MMF is given in dose of 250 to 3000 mg QD, the everolimus(EVR) blood level is 1.6 to 5 ng/mL before the first vaccination. The antibody response positive of HTXs on a MMF-containing immunosuppressive regimen were 13% after first vaccination, whereas the response on the no-MMF regimen was significantly higher at 50% (P = 0.002). And the antibody response titer of an MMF-containing group is were significantly lower than no MMF-containing group (P = 0.019 and P = 0.002) after 1 and 2 vaccinations. An immunosuppressive regimen with MMF (no/with EVR) is hampered the antibody response after COVID-19 2 vaccinations and no significantly after COVID-19 3 vaccinations(p=0.101). The result will not affected by the type of vaccination. This finding should be investigated in larger cohorts, including transplant recipients of all races. [ABSTRACT FROM AUTHOR]

TiO2 compact layers are used in dye-sensitized solar cells (DSSCs) to prevent charge recombination between the electrolyte and the transparent conductive substrate (indium tin oxide, ITO; fluorine-doped tin oxide, FTO). Thin TiO2 compact layers are deposited onto ITO/glass by means of radio frequency (rf) magnetron sputtering, using deposition parameters that ensure greater photocatalytic activity and increased DSSC conversion efficiency. The photoinduced decomposition of methylene blue (MB) and the photoinduced hydrophilicity of the TiO2 thin films are also investigated. The photocatalytic performance characteristics for the deposition of TiO2 films are improved by using the Grey-Taguchi method. The average transmittance in the visible region exceeds 85% for all samples. The XRD patterns of the TiO2 films, for sol-gel with spin coating of porous TiO2/TiO2 compact/ITO/glass, show a good crystalline structure. In contrast, without the TiO2 compact layer (only porous TiO2), the peak intensity of the anatase (101) plane in the XRD patterns for the TiO2 film has a lower value, which demonstrates inferior crystalline quality. With a TiO2 compact layer to prevent charge recombination, a higher short-circuit current density is obtained. The DSSC with the FTO/glass and Pt counter electrode demonstrates the energy conversion efficiency increased. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To investigate the effect of an early postoperative outpatient cardiac rehabilitation program to health-related quality of life among heart transplantation recipients (HTR) and patients with coronary artery bypass graft (CABG) surgery. Methods: The study included 45 clinically stable HTR (age: 47 ± 14 years; 36 men, 9 women) and 34 patients with CABG (age: 57.2 ± 12.5 years; 27 men, 7 women). HTR started rehabilitation 70 ± 33 days after transplantation; patients with CABG started training 36 ± 18 days after surgery. Patients participated in a 12-week supervised exercise training program three times per week. Each training session comprised 10 minutes of warm-up, 25 to 30 minutes of cycling or treadmill walking, and 10 minutes of cooldown. The exercise intensity was set at 50% to 80% of peak oxygen uptake (V̇O2peak) according to the patient''s condition. The health-related quality of life of subjects was evaluated by the Medical Outcomes Trust 36-item health survey (SF-36) at baseline and upon the completion of rehabilitation. Results: At baseline, the HTR group showed lower V̇O2peak than the CABG group, but the health-related quality of life was similar between the two groups. After training, both groups exhibited an increase of 3.6 mL·kg−1 ·min−1 in V̇O2peak and improvement of physical component in health-related quality of life. The HTR group showed a significant increase of SF-36 scores in physical functioning (59.7 ± 18.9 to 77.0 ± 14.0), physical role (21.1 ± 34.1 to 38.3 ± 37.9), bodily pain (57.4 ± 24.3 to 73.6 ± 21.5), social functioning (63.6 ± 23.4 to 72.8 ± 22.1), emotional role (59.2 ± 43.7 to 76.3 ± 37.4), and mental health (67.1 ± 17.9 to 73.4 ± 14.6). The CABG group only exhibited increased scores in physical functioning (60.0 ± 22.9 to 73.4 ± 18.0), physical role (19.1 ± 24.9 to 27.9 ± 38.3), bodily pain (57.1 ± 20.0 to 70.3 ± 16.1), and social functioning (54.0 ± 21.3 to 69.9 ± 21.1). Conclusions: Early postoperative cardiac rehabilitation significantly improved physical capacity and quality of life among heart transplant recipients and patients with CABG. Additionally, HTR showed greater improvement in health-related quality of life than patients with CABG regardless of lower physical capacity. [Copyright &y& Elsevier]

An abstract of the study "Association of Amino-Terminal Propeptide of Type III Procollagen and Aute Myocardial Rejection in Male patients Receiving Heart Transplantation," by Y. Lin and colleagues is presented.

Abstract: Background: Arformoterol is a single-isomer (R,R-formoterol) nebulized long-acting β 2-agonist approved for use in patients with chronic obstructive pulmonary disease (COPD). Exposure (plasma concentrations of (R,R)-formoterol) and forced expiratory volume in 1s (FEV1) were compared for 15μg nebulized arformoterol and 12 and 24μg racemic formoterol (containing 6 and 12μg (R,R)-formoterol, respectively) delivered by dry powder inhaler (DPI). Methods: An open-label, randomized, three-way crossover study in 39 subjects with COPD (FEV1 1.4L, 44.4% predicted). Twice-daily treatments included nebulized arformoterol (15μg) and racemic formoterol DPI (12 and 24μg) for 14 days. Plasma concentrations of (R,R)- and (S,S)-formoterol were determined on days 1 and 14 of each treatment period. Airway function efficacy endpoints included the percent change in trough FEV1 from baseline on day 14 of each treatment period. Results: At steady state, exposure to (R,R)-formoterol was similar following nebulized 15μg arformoterol (C max: 6.5pg/mL; AUC(0−τ): 56.5pgh/mL) and 12μg racemic formoterol DPI (C max: 6.2pg/mL; AUC(0− τ ): 46.3pgh/mL). The geometric mean ratios between these two treatments (90% confidence intervals) for C max and AUC(0− τ ) were 0.91 (0.76, 1.09) and 1.16 (1.00, 1.35), respectively. Treatment with 24μg racemic formoterol DPI resulted in dose proportionally higher (R,R)-formoterol: C max (10.8pg/mL) and AUC(0− τ ) (83.6pgh/mL). Detectable (S,S)-formoterol was consistently measured only after treatment with racemic formoterol. The mean percent increase in trough FEV1 was 19.1% in the arformoterol group, and 16.0% and 18.2% in the 12 and 24μg racemic formoterol groups, respectively. Changes in (R,R)-formoterol concentrations over time paralleled changes in FEV1. Conclusions: In this study, plasma exposure to (R,R)-formoterol was similar for nebulized 15μg arformoterol and 12μg racemic formoterol DPI, and 40% lower than 24μg racemic formoterol DPI. There was no evidence of chiral interconversion following treatment with arformoterol. Finally, temporal changes in airway function in all treatment groups corresponded to changes in (R,R)-formoterol plasma concentrations. [Copyright &y& Elsevier]

Background and objective: The study of biodistribution and in situ pharmacokinetics is a challenging, but sometimes very important, aspect of premarketing characterization of drugs. We aimed to develop a non-invasive fluorine magnetic resonance (MR) spectroscopic method for the absolute quantitation of a mono-fluorinated compound and of its metabolites in the heart and liver of healthy subjects for this purpose. Method: We used fluorine MR spectroscopy (MRS) at 4 T (Tesla) and external standardization in an open label multiple-dose study. Twenty-three healthy adult subjects were enrolled in the study. The surface coil localized fluorine MR spectrum was monitored in the heart and liver at baseline and after oral administration of multiple doses of tecastemizole. Steady-state measurements were made at set time points that depended upon dose, and washout measurements were made only on subjects in which in vivo fluorine signal was observed. Results and discussion: At 4 T, under the given experimental conditions, the method had a lower limit of quantitation (LLOQ) of about 2·6 μ m and a limit of detection (LOD) of about 0·3 μ m for solution state samples (linewidth approximately 15 Hz). The measurement reproducibility was 6·4% using a 50 μ m phantom. The effect of MR operator and spectral analyst on the calculated calibration curve slope was small, with inter-rater correlation coefficients of 0·999 and 0·998 respectively. MR signal from fluorine-containing tecastemizole-related moieties was observed in situ only at day 8 in the liver of three of five subjects dosed at 270 mg/day. The average in situ concentration was estimated to be 58 ± 22 μ m , with an average test–retest reproducibility of 216%. Extrapolating the in vitro results to human measurements, with an approximate linewidth of 250 Hz, predicts in situ LOD and LLOQ values of approximately 6 and 44 μ m respectively. However, the human study had a fluorine MRS LOD of approximately 20 μ m . The decrease in sensitivity and the increase in variability of the in vivo, in situ measurements compared with the validation study most likely arose from coil placement and incomplete rephasing of the MR signal by the respiratory phase compensation method. Conclusion: The measured concentrations were the lowest ever recorded for a multi-dose exogenous mono-fluorinated compound in the human liver using a validated fluorine MR quantitation method. The proposed non-invasive MR method for studying the biodistribution and in situ pharmacokinetics of mono-fluorinated compounds in the liver and heart should have broader application to the development of non-invasive biomarkers. [ABSTRACT FROM AUTHOR]

An 81-year-old woman came to our clinic (Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan) with multiple erythematous, indurated papules over the left side of her face. Two years earlier, the patient had a skin biopsy done at a similar anatomical area with the histopathological diagnosis of Bowen's disease. After reviewing surgical specimens and confirming no systemic involvement, clear cell eccrine porocarcinoma with extensive cutaneous metastasis has been diagnosed. In addition, the peripheral blood lymphocyte function of the patient was evaluated. The expression of interleukin-2 receptors on lymphocytes after stimulation is abnormal compared with the age-matched normal control and a patient with cutaneous squamous cell carcinoma. This clinical manifestation of eccrine porocarcinoma is exceptional, and lymphocyte dysfunction in this patient has probably contributed to extensive cutaneous metastasis. [ABSTRACT FROM AUTHOR]

Presents several abstracts of papers and posters discussed at the 2001 Annual Conference of the Society for Reproductive and Infant Psychology. 'Early Infant Distress and the Caregiving Context in a Danish Sample,' by Marissa Alvarez; 'Families of the Reproductive Revolution: Parenting and Child Development,' by Susan Golombok.

Abstract: Objective: The objective of this study was to report our experience of treating acute humoral rejection with plasmapheresis in heart transplant (HT) recipients. Patients and Methods: From May 1996 to December 2005, 238 HTs were performed using therapy with cyclosporine or tacrolimus, azathioprine or mycophenolate mofetil, and prednisolone as well as induction treatment with rabbit anti-human thymocyte globulin. Endomyocardial biopsy for rejection surveillance was performed weekly for the first month, monthly for 3 months, yearly after the first year, and whenever rejection was suspected. Immunofluorescence studies with IgG, IgM, C3, C4, C1q, and HLA-DR were performed routinely on the first month biopsy. After a 2-year trial, immunofluorescence studies were not performed routinely, because no significant findings were observed; thus they were performed only when clinical deterioration, unstable hemodynamic status, or suspicion of rejection occurred on routine echocardiographic examinations. Plasmapheresis with fresh frozen plasma exchanging twice the blood volume of the patients was performed for 5 days. Rescue immunosuppression with methylprednisolone (1 g/d) was delivered for 3 days and the immunosuppressants changed, but no intravenous immunoglobulin was prescribed. Results: Twelve patients suffered biopsy-proven acute humoral rejection at 3 days to 32 months after HT (mean, 9.4 months). Immunofluorescence studies showed positive HLA-DR in 7 patients; IgG in 4 patients; IgM in 1 patient; C3 in 4 patients; C4 in 1 patient; and C1q in 1 patient. One patient who was 3 months after HT showed only C1q positive but was treated with extracorporeal membrane oxygenation and intra-aortic balloon pumping support and died 1-month after plasmapheresis. Another patient who deteriorated on the 3rd postoperative day and died 3 days after plasmapheresis was considered to have vascular rejection by interstitial edema, vacuolated endothelial cells and no pathognomonic clinical features, although there was no positive immunofluorescence result. All other subjects were discharged from the hospital, although 3 required mechanical support during plasmapheresis. Hypotension with hypocalcemia was frequently noted during plasmapheresis. The 1-year survival rate was 75% ± 11%, and 5-year survival rate, 51% ± 15%. Conclusion: Plasmapheresis with concurrent rescue immunosuppression was an effective treatment for acute humoral rejection in HT even with unstable hemodynamics. [Copyright &y& Elsevier]

Abstract: This study determined cyclosporine Neoral (CsA) pharmacokinetics and the accuracy of a limited sampling strategy to predict the 12-hour CsA area-under-the-curve (AUC) to provide a practical method for more accurate therapeutic drug monitor of CsA among de novo Chinese heart transplant recipients treated with an everolimus-CsA immunosuppressive regimen. Methods: Blood samples were collected at 0, 0.5, 1, 2, 3, 4, 6, 8, 10, and 12 hours after oral administration of CsA in six de novo heart recipients receiving a CsA, everolimus, and methylprenisolone immunosuppressive regimen after rabbit antithymoglobulin sequential immuno-induction. We analyzed the pharmacokinetics of the first dose (PK-1) and steady state dose (PK-2) at 1 month after transplantation. The accuracy of a single-point sampling method to predict the AUC was generated by linear regression analyses. Results: The tmax and dose-normalized Cmax of PK-1 and PK-2 were similar. The correlations in single-point blood levels of PK-1 to predict the AUC0–∞ were much lower than the corresponding sampling times in PK-2. In PK-2 study, C4 had the best correlation (r 2 = 0.913, P = .003) to predict AUC0–12. In addition, the trough concentrations, C0 (r 2 = 0.875, P = .006) and C12 (r 2 = 0.783, P = .02) also showed good correlations. C2 had insufficient correlation to predict AUC0–∞ in PK-1 or AUC0–12 in the PK-2 study. In conclusion, the absorption of CsA was similar during PK-1 and PK-2. At steady dose, C4 had the best single-point correlation to predict AUC0–12. Trough blood levels may be more practical in clinical use to monitor CsA. [Copyright &y& Elsevier]

Abstract: Objective: This study sought to determine the influence of everolimus on cyclosporine Neoral (CsA) pharmacokinetics over the first 6 months after heart transplantation in Chinese recipients. Methods: Six de novo cardiac recipients receiving a CsA-everolimus-based immunosuppressive regimen after rabbit antithymoglobulin sequential immuno-induction were compared with six age-matched recipients receiving a CsA-azathioprine-based regimen. We compared CsA 12-hour area-under-curve (AUC) of the first dose (PK-1) and steady state dose (PK-S) at 1 month after transplantation. The CsA trough concentrations (Cmin) were compared over the first 6 months after transplantation. Results: There was no significant difference between the two groups in age, gender, and body weight. With respect to dose-normalized CsA AUC0–∞ of PK-1 and dose-normalized CsA AUC0–12 of PK-S, the difference between the everolimus- and the azathioprine-based regimens was not significant. The dose-normalized CsA trough concentrations (Cmin/dose) were significantly lower in the everolimus-based group than in the azathioprine-based group during the first 5 months after heart transplantation, but the difference was not significant at posttransplantation month 6. Conclusions: When CsA pharmacokinetic profiles were considered, the CsA dose requirement was not lower in Chinese patients receiving everolimus than that in patients receiving azathioprine. The results differed from reports from Western countries. [Copyright &y& Elsevier]

Abstract: From May 1994 to September 2003, 177 hearts were procured for heart transplantation (HTx) from donors ranging in age from 1 year 2 months to 66 years 5 months (mean = 30 years). All donors and recipients received serologic tests for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs), and hepatitis C virus antibody (anti-HCV). Thirty-two donors were HBsAg-positive and another four were anti-HCV-positive. Two HBsAg-positive donors were transplanted to patients with no previous evidence of hepatitis. After HTx, one received hepatitis B immunoglobulin prophylaxis and no hepatitis was noted during a 5 years follow-up. The other seroconverted at 4 months after HTx, requiring lamivudine treatment. Another four HBsAg-positive donors were transplanted to HBsAg-positive recipients. All four recipients had hepatitis flare-ups requiring lamivudine treatment. The other 26 HBsAg-positive donors were transplanted to anti-HBs–positive recipients. None suffered from hepatitis. Among the four patients receiving anti-HCV–positive hearts, seroconversion was noted in one recipient at 26 months. This patient never had clinical hepatitis before he died of allograft rejection at 3 years after HTx. The other three recipients remain anti-HCV negative during follow-up of 80, 50, and 46 months. It was concluded the hepatitis B- or C-positive donors could be used as heart donors for status 1 patients. Donors with positive HBsAg may be transplanted to anti-HBs–positive recipients with no HBV infection. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to clarify the various clinical presentations, incidence, and complications associated with tuberculosis (TB), as well as patient survival in heart transplantation (HTx) recipients. A retrospective review of 177 case records of HTx recipients from May 1989 to April 2003 were evaluated for their clinical course, diagnostic procedures, treatment, and survival. TB was diagnosed by culture. TB was proven in five (2.8%) patients. There were three pulmonary lesions and two extrapulmonary lesions. TB was diagnosed at 3.5 to 85 months after HTx. Pulmonary lesions were detected by cultures of sputum, bronchoalveolar lavage, or pleural effusion. For extrapulmonay lesions, one subject had neck lymphadenopathy shown by biopsy and culture to be TB; another suffered from swelling of the finger joints which upon culture of the aspirate proved to be TB. Treatment consisted of isoniazid (INH), rifampin (RIF), ethambutol, pyrazinamide, streptomycin (STR), ciprofloxacin (Ciproxin), and levofloxacin (Cravit). During the use of RIF, the daily dosage of cyclosporine (CsA) or tacrolimus was increased to maintain appropriate levels. Because of severe hepatotoxicity and interference with CsA, RIF was withdrawn and STR given in the last three patients. In addition, ciprofloxacin was given in the patient with miliary TB. Levofloxacin was given to the other two patients. All patients survived the TB infection under treatment with at least three drugs. There were five clinical presentations of TB in our HTx recipients. Because of the high incidence of hepatitis and severe drug interaction with CsA or tacrolimus on RIF treatment, avoiding the use of RIF but treatment with at least three drugs is recommended. [Copyright &y& Elsevier]