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Purpose of Review: Urinary tract infection (UTI) is the most common infection in kidney transplant recipients (KTRs). Several elements increase the risk of UTI and/or modify its clinical presentation among KTRs (e.g. immunosuppressive therapy, kidney allograft denervation, and use of urinary catheters). Also, KTRs may have UTIs because of difficult-to-identify and/or difficult-to-treat organisms. We provide an overview of the current knowledge regarding bacterial UTIs in KTRs, with a focus on recent findings., Recent Findings: There is accumulating evidence from clinical trials that screening for and treating asymptomatic bacteriuria is not beneficial in most KTRs (i.e. those who are ≥1-2 months posttransplant and do not have a urinary catheter). These patients have a point-prevalence of asymptomatic bacteriuria of only 3% and treating asymptomatic bacteriuria probably does not improve their outcomes. There is no clinical trial evidence to guide the management of symptomatic UTI in KTRs. Several important clinical questions remain unanswered, especially regarding the management of posttransplant pyelonephritis and the prevention of UTI in KTRs., Summary: Despite its frequency and associated morbidity, UTI after kidney transplantation is an understudied infection. In an era of increasing antimicrobial resistance and limited resources, further research is needed to ensure optimal use of antimicrobials in KTRs with UTI.

Objective: In this study, the effect of short-term exposure to welding fumes emitted by different welding techniques on workers was investigated., Methods: In a 3-fold crossover study, six welders used three different welding techniques for 3 hours. Before and after welding, blood and urine samples were collected to perform biomonitoring of metals. Breath condensate was collected to assess inflammatory reactions, and lung function measurements were performed., Results: Welding led to a significant increase of chromium and nickel in blood and urine and of nitrate and nitrite in exhaled breath condensate. These increases were higher for manual metal arc welding with alloyed material (MAW-a). Several lung function parameters decreased after welding. This decrease was significantly higher after MAW-a., Conclusions: In respect to biological effects, MAW-a seems to be more important than other welding techniques.

Objective: To determine the incidence and mortality rates and predictors of death in myasthenia gravis (MG) and MG crisis in a large US cohort., Methods: Our cohort was identified from the Nationwide Inpatient Sample database for the years 2000 through 2005 using ICD-9-CM codes. MG crisis was identified by the principal diagnosis code or by the presence of respiratory failure. The incidence of MG was stratified by age, ethnicity, and gender. Multivariate logistic regression analysis was used to identify predictors of mortality in MG. For trend analyses of immune intervention, we used the Cochrane-Armitage test., Results: After data cleansing, 5,502 patients with MG were included. In women, the incidence of admission was two to three times higher during the first 5 decades. In men, the incidence of admission was higher during the sixth, seventh, and eighth decades. The annual incidence rate of MG was higher in black women (0.01 per 1,000 persons/year) compared to white women and white and black men (0.009, 0.008, and 0.007 per 1,000 persons/year). The overall in-hospital mortality rate was 2.2%, being higher in MG crisis (4.47%). Older age and respiratory failure were the predictors of death, with adjusted odds ratios of 9.28 (95% confidence interval [CI], 3.31, 26.0) and 3.58 (95% CI, 2.01, 6.38). The trend of i.v. immunoglobulin utilization has increased compared to plasma exchange and thymectomy (p < 0.0001)., Conclusion: Myasthenia gravis (MG) is still a disease of young women and old men, as reflected by the hospital admission rates. In-hospital mortality of MG is low. Hospital utilization of i.v. immunoglobulin has significantly increased compared to plasma exchange and thymectomy.

In myasthenia gravis and Lambert-Eaton myasthenic syndrome, antibodies against ion channels are clearly related to pathogenesis; however, in the inflammatory myopathies, a link to disease causation is not as evident, except as a marker of autoimmunity. Autoantibody testing in patients with neuromuscular junction and skeletal muscle disorders is useful in diagnosis and, in some diseases, prognosis. This review briefly summarizes methods of autoantibody testing and then proceeds to a clinician-friendly guide to autoantibody testing of neuromuscular junction disorders, hyperexcitability syndromes, and inflammatory muscle diseases.

A large number of autoantibodies with reactivity to glycoconjugate components of peripheral nerve have been described in the last two decades. Serum autoantibodies to gangliosides and glycoproteins have received the most attention and have been implicated in a variety of sensory and motor neuropathy syndromes. Commercial laboratories market panels of autoantibodies and heavily promote them to clinicians as an important step in the evaluation of neuropathies of unclear etiology. Certainly, detection of these autoantibodies raises the possibility that peripheral nerve disturbance is immune-mediated and that immunosuppressive therapy may be effective treatment. However, most of these autoantibodies do not define a specific clinical syndrome, and patients with and without the antibody may present with an identical neuropathy pattern. Furthermore, a pathogenic role remains to be proven for essentially all of the autoantibodies. In this review, we summarize the peripheral nerve syndromes associated with autoantibodies and present a rational approach to autoantibody testing in routine practice.

In extraocular muscle (EOM), expression of the gamma-subunit, which is associated with the fetal-type acetylcholine receptor (AChR), may offer a differential target for immune-mediated damage and could explain the preponderance of ocular manifestations caused by myasthenia gravis (MG). Using Poly(A)+ RNA hybridization, we investigated expression of the gamma-subunit in bovine levator palpebrae superioris (LP), a muscle also differentially involved by MG. There were no transcripts of the gamma-subunit of the AChR, but the epsilon-subunit, associated with the adult-type AChR, was present. The results indicate that the susceptibility of LP to MG is not mediated by gamma-subunit expression and suggest that multiterminal fibers in EOM may be the site of gamma-subunit expression.

In a retrospective study, 155 women who had epidural analgesia only for pain relief during labor and delivery were matched by age, parity, and race with 155 women who had either pudendal or local analgesia for delivery. Infant birth weights were similar in the two groups. The frequency of low forceps, vacuum extraction, and midforceps delivery in the epidural group was significantly higher than in the control group (P less than .05). Women having epidural analgesia who delivered their infants in an occiput anterior position also had a significantly higher frequency of instrumental delivery. Thus, epidural analgesia increased the frequency of instrumental delivery, an increase that was not a consequence of larger infants or fetal malposition.