The gene family encoding a trypomastigote-specific protein restricted to the part of the flagellum in contact with the cell body of the trypomastigote form of Trypanosoma cruzi has been isolated, characterized, and expressed in a baculovirus expression system. The gene family contains three tandemly repeated members that have 97 to 100% sequence identity. The predicted protein encoded by the gene family has both significant amino acid sequence identity and other physical and biological features in common with the TolA proteins of Escherichia coli and Pseudomonas aeruginosa. Based on these similarities, we have designated this gene family tolT. Immunization of mice with recombinant TolT generates a population of CD4+ T lymphocytes that recognize T. cruzi-infected macrophages, resulting in the production of gamma interferon (IFN-γ), which leads to NO production and a 50 to 60% reduction in parasite numbers compared to that seen with infected macrophages incubated with naive T cells. This population of T cells also produces both IFN-γ and interleukin 2 (IL-2) but not IL-4 or IL-5 when incubated with spleen cells stimulated with TolT antigen, indicating that they are of the T-helper 1 type. T cells from mice chronically infected with T. cruzi also produce significant levels of IFN-γ when cocultured with macrophages and either TolT protein or paraflagellar rod protein, indicating that both of these flagellar proteins produce positive T-cell responses in mice chronically infected with T. cruzi.

BACKGROUND Risk‐adjusted benchmarking could be useful to compare blood utilization between hospitals or individual groups, such as physicians, while accounting for differences in patient complexity. The aim of this study was to analyze the association of red blood cell (RBC) use and diagnosis‐related group (DRG) weights across all inpatient hospital stays to determine the suitability of using DRGs for between‐hospital risk‐adjusted benchmarking. Specific hierarchical organizational units (surgical vs. nonsurgical patients, departments, and physicians) were also evaluated. STUDY DESIGN AND METHODS We studied blood use among all adult inpatients, and within organizational units, over 4 years (May 2014 to March 2018) at an academic center. Number of RBCs transfused, all patient refined (APR)‐DRGs, and other variables were captured over entire hospital stays. We used multilevel generalized linear modeling (zero‐inflated negative binomial) to study the relationship between RBC utilization and APR‐DRG. RESULTS A total of 97,955 hospital stays were evaluated and the median APR‐DRG weight was 1.2. The association of RBCs transfused and APR‐DRG weight was statistically significant at all hierarchical levels (incidence rate ratio = 1.22; p < 0.001). The impact of APR‐DRG on blood use, measured by the incidence rate ratio, demonstrated an association at the all‐patient and surgical levels, at several department and physician levels, but not at the medical patient level. The relationship between RBCs transfused and APR‐DRG varied across organizational units. CONCLUSION Number of RBCs transfused was associated with APR‐DRG weight at multiple hierarchical levels and could be used for risk‐adjusted benchmarking in those contexts. The relationship between RBC use and APR‐DRG varied across organizational units.

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