[Pulmonary artery stenosis after single lung transplantation: a case report and literature review].

Objective: To summarize and analyze the clinical features, treatment, and prognosis of pulmonary artery stenosis post-lung transplantation. Methods: A 62-year-old male patient was admitted to the hospital with a cough and chest tightness of over a year's duration, which had worsened in the last two months, leading to the diagnosis of idiopathic pulmonary fibrosis. The clinical data were observed and reviewed post-left allograft single lung transplantation. Literature searches were conducted using the keywords "lung transplantation" "stenosis, pulmonary artery" and "postoperative complications" in CNKI, Wanfang Medical Network, and PubMed databases up to December 2022. Results: On January 26, 2022, a left allograft single lung transplantation was performed under general anesthesia. Postoperatively, extracorporeal membrane oxygenation and mechanical ventilation were successfully weaned off at 22 hours and 2 days, respectively, with transfer from the intensive care unit 12 days after surgery. PaO2 and PaCO2 were 50 mmHg and 40 mmHg after deoxygenation. Both pulmonary CT angiography and ventilatory-perfusion imaging indicated stenosis of the left pulmonary anastomosis. Balloon dilation and pulmonary artery stenting were performed, with PaO2 and PaCO2 improving to 87 mmHg and 42 mmHg, respectively. The patient was discharged 102 days post-surgery, and was followed up for 1 year, with a good prognosis. Additionally, 36 related articles were retrieved, encompassing 69 cases with a median age of 53 years (38.5-59.0 years). Of these, 27.54% (19/69) were diagnosed with idiopathic pulmonary fibrosis, 46.38% (32/69) underwent single lung transplantation, with the primary clinical symptom being hypoxemia in 71.01% (49/69) cases. Left pulmonary artery anastomotic stenosis was observed in 43.48% (30/69), with 65.22% (45/69) being diagnosed in the late postoperative period. Interventional therapy was performed to 44.93% (31/69), with a mortality rate of 21.74% (15/69). Conclusions: The primary clinical manifestation of post-lung transplantation pulmonary artery stenosis is hypoxemia and can be diagnosed by pulmonary artery CT angiography, transesophageal echocardiography, and pulmonary angiography. Early diagnosis can significantly reduce mortality, and interventional therapy is an effective treatment for severe pulmonary artery stenosis post-lung transplantation.

[Lung transplantation for pulmonary alveolar proteinosis: a case report and literature review].

Objective: To observe the efficacy of lung transplantation for pulmonary alveolar proteinosis (PAP) patients and to improve the understanding of the therapy. Methods: The clinical data of a patient with autoimmune PAP treated with sequential homogenous bilateral lung transplantation were described and the literatures were reviewed. Results: This 55-year-old female patient was diagnosed with autoimmune PAP and had been treated with whole lung lavage for 19 times, but only achieved short-term symptomatic relief after each operation. Inhalation of granulocyte macrophage colony stimulating factor occurred allergic reactions. Lung transplantation was performed on February 15, 2022, and a significant improvement in oxygenation and clinical symptoms were observed. The patient remained stable during follow-up. Conclusion: Treatment with lung transplantation is safe and effective for end-stage patients with PAP in the early phase, but the long-term effect remains to be observed.

Effect of heat stress on the behavioral and physiological patterns of Small-tail Han sheep housed indoors.

This study was conducted to investigate the effects of heat stress on the behavioral and physiological patterns in Small-tail Han sheep housed indoors in summer without climate control. Sixteen adult animals were allocated into two groups of eight animals, based on sex: one group of eight rams and one group of eight ewes. Temperature-humidity index (THI) was used to assess the degree of heat stress. All sheep were subjected to a 10-day pre-experimental period of habituation to the experimental feed and environment. Physiological parameters monitored were respiratory rate (RR), rectal temperature (RT), and heart rate (HR). Blood chemistry parameters were also recorded, including plasma minerals and blood metabolites, from jugular vein blood samples. Behavioral parameters were lying, standing, excreting, drinking, foraging, walking, and ruminating. The research findings showed that there were some significant differences of behavior (standing, P = 0.001; walking, P = 0.049; ruminating, P = 0.010), physiology (RR, P = 0.0001; HR, P = 0.002; RT, P = 0.03;) and plasma minerals and blood metabolites (sodium, P = 0.047; phosphorus, P = 0.002; T4, P = 0.041; cortisol, P = 0.0047; triglyceride, P = 0.009) between ram and ewe and that heat stress also significantly affected (P < 0.05) standing, lying, foraging and drinking behavior, all of the physiological parameters and some of the blood chemistry parameters (chlorides, sodium, phosphorus, total protein, tetraiodothyronine, cholesterol, triglyceride, creatinine, cortisol, and glucose). These results indicate that ewe has better high-temperature tolerance than ram, and heat stress can alter behavioral and physiological patterns in Small-tail Han sheep housed indoors. These changes may allow the sheep to adapt better to the ambient temperature.

Differential expression of Toll-like receptors in goat dominant and nondominant follicles.

The mechanism of dominant follicle selection is unclear because of its physiological complexity. However, some studies have reported that the immune system plays an important role in reproductive physiology. The objective of the current study was to investigate the differential expression of Toll-like receptors (TLRs) in the dominant (DFs) and nondominant follicles (NFs), and to determine the correlation between the expression of TLRs and the related genes, such as WNT4 and FOXL2. In this comparative study, the expression levels of TLRs, WNT4, and FOXL2 genes of DFs and NFs were obtained from three Dazu black goats were estimated using the real-time PCR. Our results showed no significant difference in the expression of seven TLRs (excluding TLR2, TLR5, and TLR8), WNT4, and FOXL2 between the DFs and NFs. In addition, the mRNA expression levels of WNT4 significantly correlated with the relative expression of TLR6 (r = 0.949739, P < 0.01); however, no significant expression of the TLR genes was found to be associated with FOXL2 mRNA expression. Our results support the fact that TLRs are not involved in the process of dominant follicle selection; however, TLR6 might play a role in the development of follicles by interacting with WNT4.

Behavioural and physiological responses of Small Tail Han sheep to predators.

Prey animals modify their behaviour and physiology in the presence of predators. Domestic animals differ from wild animals in having less exposure to wild predators, but whether they still retain an antipredator instinct is frequently unknown. In this study, we used domesticated Small Tail Han sheep as a model prey animal to gauge their response to the presence of predators, in the form of odours from the faeces of lion, tiger, and leopard. The faeces of male sheep and male rabbit (as a heterogeneous non-predator) were used as control. We found that the frequency and time of feeding, exploration, moving, watching, and lying down behaviours were significantly affected by predator odour, and that there was an interaction between odour sources and sex. When exposed to predator odour, sheep reduced their frequency and time of feeding, and increased their exploratory, moving, and watching behaviours. Female sheep showed greater motivation towards frequent and lengthy exploration, moving, watching, and lying down behaviours than male sheep, and less motivation towards feeding and drinking behaviours. Serum cortisol levels were lowest in response to tiger stimuli. These results illustrated that Small Tail Han sheep could recognise predator odour and adjust their behaviour to display antipredator strategies, and displayed some physiological responses, although only changing in serum cortisol could be significantly attributed to the odour of predators.

Central and peripheral blood pressures in relation to plasma advanced glycation end products in a Chinese population.

We investigated the association of plasma AGE (advanced glycation end product) concentration with central and peripheral blood pressures and central-to-brachial blood pressure amplification in a Chinese population. The study subjects were from a newly established residential area in the suburb of Shanghai. Using the SphygmoCor system, we recorded radial arterial waveforms and derived aortic waveforms by a generalized transfer function and central systolic and pulse pressure by calibration for brachial blood pressure measured with an oscillometric device. The central-to-brachial pressure amplification was expressed as the central-to-brachial systolic blood pressure difference and pulse pressure difference and ratio. Plasma AGE concentration was measured by the enzyme-linked immunosorbent assay method and logarithmically transformed for statistical analysis. The 1051 participants (age, 55.1±13.1 years) included 663 women. After adjustment for sex, age and other confounding factors, plasma AGE concentration was associated with central but not peripheral blood pressures and with some of the pressure amplification indexes. Indeed, each 10-fold increase in plasma AGE concentration was associated with 2.94 mm Hg (P=0.04) higher central systolic blood pressure and 2.39% lower central-to-brachial pulse pressure ratio (P=0.03). In further subgroup analyses, the association was more prominent in the presence of hypercholesterolemia (+8.11 mm Hg, P=0.008) for central systolic blood pressure and in the presence of overweight and obesity (-4.89%, P=0.009), diabetes and prediabetes (-6.26%, P=0.10) or current smoking (-6.68%, P=0.045) for central-to-brachial pulse pressure ratio. In conclusion, plasma AGE concentration is independently associated with central systolic blood pressure and pulse pressure amplification, especially in the presence of several modifiable cardiovascular risk factors.

Pen size and parity effects on maternal behaviour of Small-Tail Han sheep.

The aim of this experiment was to study the effects of pen size and parity on maternal behaviour of twin-bearing Small-Tail Han ewes. A total of 24 ewes were allocated to a 2×2 design (six per pen), with parity (primiparous or multiparous) and pen size (large: 6.0×3.0 m; small: 6.0×1.5 m) as main effects at Linyi University, Shandong Province, China. Behaviour was observed from after parturition until weaning. All ewes were observed for 6 h every 5 days from 0700 to1000 h and from 1400 to 1700 h. Continuous focal animal sampling was used to quantify the duration of maternal behaviours: sucking, grooming and following as well as the frequency of udder accepting, udder refusing and low-pitched bleating. Oestradiol and cortisol concentrations in the faeces (collected in the morning every 5 days) were detected using EIA kits. All lambs were weighed 24 h after parturition and again at weaning at 35 days of age. The small pen size significantly reduced following (P<0.005), grooming (P<0.001) and suckling durations (P<0.05), as well as the frequency of udder refusals (P<0.001). However, there was a significant interaction with ewe parity, with decreased grooming and suckling in the small pen largely seen in the multiparous ewes (P<0.001). Independent of pen size, multiparous ewes accepted more sucking attempts by their lambs (P<0.05) and made more low-pitched bleats than primiparous ewes (P<0.001). Multiparous ewes had higher faecal oestradiol concentrations than primiparous ewes (P<0.001), and ewes in small pens had higher faecal cortisol levels compared with ewes in larger pens (P<0.001). As lambs increased in age, the duration of maternal grooming, following and suckling as well as frequency of udder acceptance and low-pitched bleating all declined, and the frequency of udder refusing increased (P<0.001 for all). Ewe parity, but not pen size, affected lamb weight gain during the period of observation (P<0.001). This is the first study to show that pen size, interacting with parity, can affect the expression of maternal behaviour in sheep during lactation. The study is also the first to report on the maternal behaviour of Chinese native sheep breeds (Small-Tail Han sheep), with implications for the production of sheep in China.

Acute renal failure after immersion in seawater polluted by diesel oil.

Acute renal failure after exposure to toxic doses of hydrocarbon has been uniformly associated with multiorgan failure. We report a case of isolated acute renal failure in a patient after immersion in seawater polluted by diesel oil. The sites of absorption were likely to be skin, gastrointestinal tract, and lung. Investigations showed renal impairment as the only consequence from the exposure. The patient recovered uneventfully and did not require dialysis. This case highlighted the unusual consequence of isolated renal involvement resulting from hydrocarbon toxicity.

Changes of cytokine profiles during peritonitis in patients on continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) has emerged as an important dialysis treatment modality worldwide. One of the major complications is bacterial peritonitis, which may result in subsequent technique failure because of loss of peritoneal clearance or peritoneal fibrosis. Bacterial peritonitis leads to the release of proinflammatory cytokines from resident and infiltrating cells in the peritoneal cavity. We studied 35 patients undergoing CAPD with acute bacterial peritonitis. All patients treated with antibiotics for 2 weeks after the clinical diagnosis of peritonitis had a good recovery. Peritoneal dialysate effluent (PDE) was collected on days 1, 3, 5, 10, 21, and 42 after the start of treatment. Cell populations were monitored by flow cytometry. PDE levels of interleukin-1beta (IL-1), IL-6, transforming growth factor-beta (TGF-beta), and basic fibroblast growth factor (FGF) were measured by enzyme-linked immunosorbent assay. Gene transcription of TGF-beta in macrophages from PDE was measured by quantitative polymerase chain reaction. Bacterial peritonitis was associated with a sharp increase in total cell and neutrophil counts (400-fold) in PDE up to 3 weeks after peritonitis despite clinical remission (P < 0.0001). There was an increased absolute number of macrophages during the first 3 weeks despite the reduced percentage of macrophages among total cells in PDE compared with noninfective PDE. There was a progressive increase in the percentage of mesothelial cells or dead cells in the total cell population in PDE over the entire 6-week period. PDE levels of IL-1, IL-6, TGF-beta, and FGF increased markedly on day 1 before their levels decreased gradually. PDE levels of these cytokines or growth factors were significantly greater than those in noninfective PDE (n = 76) throughout the study period (P < 0.01). Similarly, TGF-beta complementary DNA (cDNA) molecules per macrophage were significantly greater than those of macrophages in noninfective PDE throughout this period (P < 0.01). There was no significant correlation between PDE levels of TGF-beta and TGF-beta cDNA molecules per macrophage, suggesting that peritoneal macrophages are not the only source of TGF-beta in PDE. We conclude there is an active release of proinflammatory cytokines and sclerogenic growth factors through at least 6 weeks despite apparent clinical remission of peritonitis. The peritoneal cytokine networks after peritonitis may potentially affect the physiological properties of the peritoneal membrane.

Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis.

A retrospective study of the prevalence and pattern of tuberculosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) was performed. Thirty-eight cases of tuberculosis were diagnosed among 790 patients (18 men, 20 women; mean age, 58 +/- 12.6 years) between July 1994 and June 2000. The interval between the initiation of CAPD and onset of tuberculosis ranged from 1 to 168 months (median, 22 months). There were 18 cases of pulmonary tuberculosis, 14 cases of tuberculous peritonitis, 5 cases of tuberculous lymphadenitis, and 1 case of tuberculous synovitis. Patients with pulmonary tuberculosis usually presented with fever, constitutional symptoms, and pleural effusion or pulmonary infiltrates on chest radiograph. Abdominal pain and turbid dialysate were the main presenting symptoms in patients with tuberculous peritonitis. Diagnosis was established by positive culture in 20 patients, typical histological characteristics on a tissue biopsy specimen in 10 patients, and response to empirical antituberculous treatment in 8 patients. The duration of symptoms before the diagnosis of tuberculosis and initiation of antituberculous treatment ranged from 7 to 57 days (median, 30 days). Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and ofloxacin for 9 to 15 months. Antituberculous treatment generally was well tolerated. Twenty-seven patients (71%) completed antituberculous treatment. No recurrence of tuberculosis was observed after a mean follow-up of 19.8 months. Eleven patients (29%) died while on antituberculous treatment; none of the deaths appeared to be directly caused by tuberculosis. We conclude that: (1) tuberculosis is prevalent among CAPD patients in our locality; (2) extrapulmonary tuberculosis, particularly tuberculous peritonitis, is common; and (3) a high index of suspicion for tuberculosis among CAPD patients is warranted to ensure early diagnosis and prompt initiation of treatment.

Majocchi's granuloma and posttransplant lymphoproliferative disease in a renal transplant recipient.

Renal transplant recipients are predisposed to infection and malignancy because of underlying long-term immunosuppressive therapy. In this case report, a renal transplant patient with coexisting Trichophyton rubrum granuloma (Majocchi's granuloma) and posttransplant lymphoproliferative disease (PTLD) is presented, showing the undesirable effects of heavy immunosuppression. Majocchi's granuloma was probably associated with PTLD as a reflection of overimmunosuppression.

Electrophysiology and glucose transport of human peritoneal mesothelial cells: implications for peritoneal dialysis.

OBJECTIVE: To elucidate ionic and glucose transport across human peritoneal mesothelium, we utilized an Ussing chamber setup and studied the electrophysiological characteristics and tissue permeabilities of human peritoneal mesothelial cells (HPMC) to L- and D-glucose. METHODS: Human mesothelial cells were grown on polyester filters (snapwell; Costar, Cambridge, MA, U.S.A.) that, upon confluence, were fitted into Ussing chambers. Transmesothelial resistance and resting potential were determined using electrophysiological techniques. Radiolabeled glucose was added to one side of the chamber and the permeabilities determined by serial sampling in the receptive compartment. RESULTS: The transmesothelial potential and resistance were 0.54 +/- 0.07 mV (apical positive) and 20.4 +/- 3.2 ohms x cm2 respectively (mean +/- SEM, n = 36). The course of overall transfer of D- and L-glucose was examined using L-glucose as a positive diffusion-plus-leak marker. The permeabilities of HPMC to D-glucose were 3.00 +/- 0.26 cm/sec (apical-to-basolateral) and 3.25 +/- 0.27 cm/sec (basolateral-to-apical) [n = 6 experiments, p = not significant (NS)], which were not different from those of L-glucose: 3.00 +/- 0.30 cm/sec (apical-to-basolateral) and 2.71 +/- 0.24 (basolateral-to-apical) (n = 6 experiments, p = NS). CONCLUSIONS: The transepithelial resistance of HPMC is low and the ionic gradient, although it exists, is small and inconsequential. Passive paracellular flow accounts for the majority of transmesothelial glucose transport. The existence of a large paracellular shunt precludes the mesothelial membrane as a clinically relevant osmotic barrier.

A retrospective survey of attitudes toward acceptance of peritoneal dialysis in Chinese end-stage renal failure patients in Hong Kong--from a cultural point of view.

OBJECTIVE: We undertook to study the attitudes toward dialysis of patients approaching end-stage renal failure and to analyze those attitudes from a cultural perspective. SETTING: The study was performed in the pre-dialysis clinic of a tertiary referral renal center. PATIENTS: All patients of Chinese ethnic origin seen in the pre-dialysis clinic from 1995 to 2000 for assessment of dialysis therapy were included. METHOD: We performed a retrospective analysis of patient records with regard to attitudes of the patients toward dialysis, reasons for those attitudes, and factors that could lead to a subsequent change in attitude. RESULTS: We assessed 462 patients over the 6-year period. Their mean age was 65.5 +/- 13.3 years, and 43.9% of the patients had diabetes. Peritoneal dialysis (PD) was offered to 74% of the patients, and hemodialysis (HD) to 3.9%. Among the patients offered PD, only 44% accepted dialysis. After counselling, 54% of the patients who originally declined PD ultimately accepted it. The major reasons for refusing PD were the ideas of "having lived long enough" and "lack of family support." Most other reasons could be overcome by counselling. Only a minority of patients demanded hemodialysis. CONCLUSIONS: Declining an offer of dialysis was common. Counselling helped patients to accept PD. Certain cultural elements that hindered acceptance of dialysis were involved in the ideas of "having lived long enough" and "lack of family support." Those cultural elements should be tackled more specifically during counselling.

Long-term renal allograft recipients from South-east Asia in the pre-cyclosporin era.

The clinical outcome of long-term renal allograft recipients in the Chinese population has not been reported previously. We analysed patients from the pre-cyclosporin era who had grafts that functioned for > 10 years. Forty-five patients (31 men, 14 women; mean age 30, follow-up duration 13.3 years), representing a 10-year graft survival of 53%, were included. Thirty-six patients (80%) received living-related allografts and 9 (20%) received cadaveric or living-unrelated renal transplantation. The mean serum creatinine at last follow-up was 1.36 mg/dl (range, 0.83-4.08). Major posttransplantation complications included: hypertension in 25 (56%), infection in 16 (36%), acute rejection in 15 (33%), lipid disorder in 13 (29%), liver disease in 7 (16%), osteonecrosis in 5 (11%), malignancy in 4 (9%), coronary artery disease in 3 (7%), and diabetes mellitus in 3 (7%). Five grafts were lost: 3 to chronic rejection, and 2 to patients with stable function who died of non-renal causes. Proteinuria correlated strongly with graft function and survival, and marginally with hypertension. In hepatitis B carriers, serum alpha-feto protein is useful in the early detection of hepatocellular carcinoma. We conclude that while patients in the pre-cyclosporin era can survive with excellent graft function beyond the first decade, the risk of complications leading to significant morbidity still remains even when patients are receiving minimal doses of immunosuppression in the second decade.

Simultaneous removal and reinsertion of Tenckhoff catheters for the treatment of refractory exit-site infection.

Exit-site infection (ESI) refractory to medical therapy is an important complication of continuous ambulatory peritoneal dialysis (CAPD). Between July 1994 and June 1998, 28 patients in our hospital underwent simultaneous removal and reinsertion of Tenckhoff catheters for the treatment of refractory ESI. The ESI was caused by Pseudomonas aeruginosa in 22 patients (78%), methicillin-resistant Staphylococcus aureus in 5 patients (18%), and diphtheroid bacilli in 1 patient (4%). The patients had received antibiotic treatment for a mean duration of 11.6 +/- 5.8 weeks (range: 3-28 weeks) before their operations. During each operation, the old Tenckhoff catheter was removed and a new catheter was inserted in the opposite side of the abdomen. CAPD was resumed after two weeks of intermittent peritoneal dialysis. All patients received intravenous antibiotic cover for seven days after the operation. Early post-operative complications were uncommon. At one year after the operation, 22 patients (78%) were free of ESI. Six patients (22%) had a recurrence of ESI 21.3 +/- 6 weeks (range: 16-32 weeks) after their operation. All new infections were treated successfully with antibiotics. Seven patients (25%) had one episode of peritonitis each, all of which resolved with intraperitoneal antibiotic treatment. We conclude that simultaneous removal and reinsertion of Tenckhoff catheters is a safe and effective method for the treatment of refractory ESI. The procedure alleviates the need for temporary hemodialysis and allows an early return to CAPD.

Percutaneous transluminal angioplasty for stenosis of arteriovenous fistulae: a review of local experience.

The stenosis and subsequent thrombosis of the arteriovenous fistulae may lead to a loss of vascular access sites; this a major problem in chronic haemodialysis patients. Percutaneous transluminal angioplasty has been a popular way of correcting such lesions in recent years. We have reviewed patients who underwent this operation from 1993 to 1996 at the Queen Mary Hospital. Among 11 patients who were documented as having arteriovenous fistula stenosis, 60% of lesions were in the anastomotic area while 40% were in the venous limb. All patients had abnormal dialysis blood line pressures corresponding to the actual site of stenosis. The initial success rate of percutaneous transluminal angioplasty in treating the stenotic lesions was 73%. This method is thus a promising form of semi-invasive treatment for symptomatic arteriovenous fistula stenosis.