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OBJECTIVES: Transplant renal artery stenosis (TRAS) is now recognized as a curable disease with a good prognosis if intervention occurs in the early stage. However, the mid-term outcomes of TRAS when treated by percutaneous transluminal angioplasty with stent placement have yet to be fully elucidated. The purpose of this study was to compare mid-term graft and patient survival of TRAS group with a control group. PATIENTS AND METHODS: Ninety-two patients were diagnosed of TRAS between January 2016 and January 2022 in our center. Fifty-six pairs of recipients with grafts from the same donor were selected as a study group with TRAS and a control group without TRAS, respectively. All donor kidneys were from deceased organ donation rather than living donors. The primary endpoints were graft and patient survival. The secondary outcomes were changes in renal graft function. RESULTS: The mean follow-up time for the TRAS group was 43.6 months, while the mean follow-up time for the control group was 45.3 months. In the TRAS group, the age of patients ranged from 11 to 62 years with 39 males and 17 females. In the control group, the age of patients ranged from 18 to 67 years with 40 males and 16 females. In the TRAS group, there were more patients with diabetic nephropathy as the primary renal disease compared to the control group (5/56 vs 0/56), and the incidence of acute rejection was higher in the TRAS group than in the control group (12/56 vs 3/56). Eight patients in the TRAS group and one patient in the control group experienced graft loss (p = .019). Four patients in the TRAS group and four patients in the control group died with functional renal allograft during the follow-up time (p = .989). The levels of eGFR did not differ significantly between the two groups in the first three years after kidney transplant (p > .05). Patients in the TRAS group had worse graft functionality (eGFR, 44.96 ± 18.9 vs 54.9 ± 19.6 mL/min) in the fourth year when compared with the control group (p = .01). CONCLUSIONS: The graft function deteriorated faster, and graft survival was lower in the TRAS group treated by stent placement when compared with a control group without TRAS over the mid-term.
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Supervivencia de Injerto , Trasplante de Riñón , Obstrucción de la Arteria Renal , Stents , Humanos , Masculino , Femenino , Obstrucción de la Arteria Renal/cirugía , Obstrucción de la Arteria Renal/etiología , Obstrucción de la Arteria Renal/terapia , Obstrucción de la Arteria Renal/mortalidad , Persona de Mediana Edad , Trasplante de Riñón/efectos adversos , Adulto , Estudios Retrospectivos , Anciano , Adulto Joven , Adolescente , Niño , Cadáver , Angioplastia/métodos , Tasa de Filtración GlomerularRESUMEN
BACKGROUND: Clear cell renal cell carcinoma (ccRCC) is the most common form of adult kidney cancer. Ubiquitin-specific protease (USP)44 has been reported to be involved in various cancers. We investigated the function, role and molecular mechanism of USP44 in ccRCC. METHODS: Data obtained from the Cancer Genome Atlas Data Portal and Gene Expression Omnibus database were analyzed to uncover the clinical relevance of USP44 expression and tumor development. USP44 function in the proliferation and migration of tumor cells was assessed by cellular and molecular analyses using ccRCC lines (786-O cells and Caki-1 cells). RESULTS: USP44 showed low expression in ccRCC cancer tissues compared with that in normal tissue. USP44 expression was negatively correlated with tumor stage, tumor grade, and patient survival. USP44 overexpression inhibited the proliferation and migration of 786-O cells and Caki-1 cells significantly. USP44 overexpression also prohibited cell proliferation by upregulating expression of P21, downregulating cyclin-D1 expression, and inhibiting cell migration by downregulating expression of matrix metalloproteinase (MMP)2 and MMP9. USP44 knockdown enhanced the proliferation and migration of 786-O cells and Caki-1 cells. USP44 function in inhibiting the proliferation and migration of 786-O cells and Caki-1 cells was associated with phosphorylation of Jun N-terminal kinase (JNK). CONCLUSION: USP44 may be a marker in predicting ccRCC progression. Inhibition by USP44 of the proliferation and migration of 786-O cells and Caki-1 cells is dependent upon the JNK pathway.
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Biomarcadores de Tumor/genética , Carcinoma de Células Renales/patología , Regulación hacia Abajo , Neoplasias Renales/patología , Ubiquitina Tiolesterasa/genética , Carcinoma de Células Renales/genética , Carcinoma de Células Renales/metabolismo , Línea Celular Tumoral , Movimiento Celular , Proliferación Celular , Progresión de la Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Neoplasias Renales/genética , Neoplasias Renales/metabolismo , Sistema de Señalización de MAP Quinasas , Masculino , Clasificación del Tumor , Análisis de Supervivencia , Ubiquitina Tiolesterasa/metabolismoRESUMEN
Hepatic ischemia-reperfusion (I/R) injury is an important risk factor resulting in liver failure during liver surgery. However, there is still lack of effective therapeutic methods to treat hepatic I/R injury. DUSP12 is a member of the dual specific phosphatase (DUSP) family. Some DUSPs have been identified as being involved in the regulation of hepatic I/R injury. However, the role of DUSP12 during hepatic I/R injury is still unclear. In the present study, we observed a significant decrease in DUSP12 expression in a hepatic I/R injury mouse model in vivo and in hypoxia/reoxygenation (H/R) model in vitro. Using hepatocyte-specific DUSP12 knockout mice and DUSP12 transgenic mice, we demonstrated that DUSP12 apparently relieved I/R-induced liver injury. Moreover, DUSP12 inhibited hepatic inflammatory responses and alleviated apoptosis both in vitro and in vivo. Furthermore, we demonstrated that JNK and p38 activity, but not ERK1/2, was increased in the DUSP12-deficient mice and decreased in the DUSP12 transgenic mice under I/R condition. ASK1 was required for DUSP12 function in hepatic I/R injury and inhibition of ASK1 prevented inflammation and apoptosis in DUSP12-deficient hepatocytes and mice. In conclusion, DUSP12 protects against hepatic I/R injury and related inflammation and apoptosis. This regulatory role of DUSP12 is primarily through ASK1-JNK/p38 signaling pathway. Taken together, DUSP12 could be a potential therapeutic target for hepatic I/R injury.
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Fosfatasas de Especificidad Dual/metabolismo , Sistema de Señalización de MAP Quinasas , Daño por Reperfusión/patología , Animales , Apoptosis , Células Cultivadas , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Regulación hacia Abajo , Fosfatasas de Especificidad Dual/deficiencia , Hepatocitos/metabolismo , Hepatocitos/patología , Inflamación/metabolismo , Inflamación/patología , Hígado/irrigación sanguínea , Hígado/patología , MAP Quinasa Quinasa Quinasa 5/metabolismo , Ratones NoqueadosRESUMEN
Ubiquitin-specific peptidase 4 (USP4) protein is a type of deubiquitination enzyme that is correlated with many important biological processes. However, the function of USP4 in hepatic ischaemia/reperfusion (I/R) injury remains unknown. The aim of the present study was to explore the role of USP4 in hepatic I/R injury. USP4 gene knockout mice and primary hepatocytes were used to construct hepatic I/R models. The effect of USP4 on hepatic I/R injury was examined via pathological and molecular analyses. Our results indicated that USP4 was significantly up-regulated in liver of mice subjected to hepatic I/R injury. USP4 knockout mice exhibited exacerbated hepatic I/R injury, as evidenced by enhanced liver inflammation via the nuclear factor κB (NF-κB) signalling pathway and increased hepatocyte apoptosis. Additionally, USP4 overexpression inhibited hepatocyte inflammation and apoptosis on hepatic I/R stimulation. Mechanistically, our study demonstrates that USP4 deficiency exerts its detrimental effects on hepatic I/R injury by inducing activation of the transforming growth factor ß-activated kinase 1 (TAK1)/JNK signalling pathways. TAK1 was required for USP4 function in hepatic I/R injury as TAK1 inhibition abolished USP4 function in vitro In conclusion, our study demonstrates that USP4 deficiency plays a detrimental role in hepatic I/R injury by promoting activation of the TAK1/JNK signalling pathways. Modulation of this axis may be a novel strategy to alleviate the pathological process of hepatic I/R injury.
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Hígado/irrigación sanguínea , Hígado/enzimología , Quinasas Quinasa Quinasa PAM/metabolismo , Daño por Reperfusión/enzimología , Proteasas Ubiquitina-Específicas/deficiencia , Animales , Apoptosis , Modelos Animales de Enfermedad , Células HEK293 , Humanos , Mediadores de Inflamación/metabolismo , Proteínas Quinasas JNK Activadas por Mitógenos/metabolismo , Hígado/patología , Quinasas Quinasa Quinasa PAM/genética , Masculino , Ratones Noqueados , FN-kappa B/metabolismo , Daño por Reperfusión/genética , Daño por Reperfusión/patología , Transducción de Señal , Proteasas Ubiquitina-Específicas/genéticaRESUMEN
Prior studies indicate that trait emotional intelligence (EI) is associated negatively with loneliness. However, the mechanisms underlying the relationship are not clear. This study assessed whether both self-esteem and social support mediated the associations between trait EI and loneliness. 469 Chinese undergraduate participants whose age ranged from 18 to 23 years (208 women) were asked to complete four self-report questionnaires, including the Wong Law Emotional Intelligence Scale, the Social and Emotional Loneliness Scale, the Rosenberg Self-esteem Scale, and the Multi-Dimensional Scale of Perceived Social Support. Analyses indicated that self-esteem and social support fully mediated the associations between trait EI and loneliness. Effect contrasts indicated that the specific indirect effect through social support was significantly greater than that through self-esteem. Moreover, a multiple-group analysis indicated that no path differed significantly by sex. These results suggest that social support is more important than self-esteem in the association between trait EI and loneliness. Furthermore, both sexes appear to share the same mechanism underlying this association.
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Carácter , Inteligencia Emocional , Soledad/psicología , Autoimagen , Apoyo Social , Estudiantes/psicología , Adolescente , China , Femenino , Humanos , Masculino , Modelos Psicológicos , Estadística como Asunto , Adulto JovenRESUMEN
During liver ischemia-reperfusion injury, existing mechanisms involved oxidative stress, calcium overload, and the activation of inflammatory responses involve mitochondrial injury. Mitochondrial autophagy, a process that maintains the normal physiological activity of mitochondria, promotes cellular metabolism, improves cellular function, and facilitates organelle renewal. Mitochondrial autophagy is involved in oxidative stress and apoptosis, of which the PINK1-Parkin pathway is a major regulatory pathway, and the deletion of PINK1 and Parkin increases mitochondrial damage, reactive oxygen species production, and inflammatory response, playing an important role in mitochondrial quality regulation. In addition, proper mitochondrial permeability translational cycle regulation can help maintain mitochondrial stability and mitigate hepatocyte death during ischemia-reperfusion injury. This mechanism is also closely related to oxidative stress, calcium overload, and the aforementioned autophagy pathway, all of which leads to the augmentation of the mitochondrial membrane permeability transition pore opening and cause apoptosis. Moreover, the release of mitochondrial DNA (mtDNA) due to oxidative stress further aggravates mitochondrial function impairment. Mitochondrial fission and fusion are non-negligible processes required to maintain the dynamic renewal of mitochondria and are essential to the dynamic stability of these organelles. The Bcl-2 protein family also plays an important regulatory role in the mitochondrial apoptosis signaling pathway. A series of complex mechanisms work together to cause hepatic ischemia-reperfusion injury (HIRI). This article reviews the role of mitochondria in HIRI, hoping to provide new therapeutic clues for alleviating HIRI in clinical practice.
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BACKGROUND: This study aimed to develop a simple predictive model for early identification of the risk of adverse outcomes in kidney transplant-associated Pneumocystis carinii pneumonia (PCP) patients. METHODS: This study encompassed 103 patients diagnosed with PCP, who received treatment at our hospital between 2018 and 2023. Among these participants, 20 were categorized as suffering from severe PCP, and, regrettably, 13 among them succumbed. Through the application of machine learning techniques and multivariate logistic regression analysis, two pivotal variables were discerned and subsequently integrated into a nomogram. The efficacy of the model was assessed via receiver operating characteristic (ROC) curves and calibration curves. Additionally, decision curve analysis (DCA) and a clinical impact curve (CIC) were employed to evaluate the clinical utility of the model. The Kaplan-Meier (KM) survival curves were utilized to ascertain the model's aptitude for risk stratification. RESULTS: Hematological markers, namely Procalcitonin (PCT) and C-reactive protein (CRP)-to-albumin ratio (CAR), were identified through machine learning and multivariate logistic regression. These variables were subsequently utilized to formulate a predictive model, presented in the form of a nomogram. The ROC curve exhibited commendable predictive accuracy in both internal validation (AUC = 0.861) and external validation (AUC = 0.896). Within a specific threshold probability range, both DCA and CIC demonstrated notable performance. Moreover, the KM survival curve further substantiated the nomogram's efficacy in risk stratification. CONCLUSIONS: Based on hematological parameters, especially CAR and PCT, a simple nomogram was established to stratify prognostic risk in patients with renal transplant-related PCP.
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BACKGROUND: The objective of this study was to formulate and validate a prognostic model for postoperative severe Pneumocystis carinii pneumonia (SPCP) in kidney transplant recipients utilizing machine learning algorithms, and to compare the performance of various models. METHODS: Clinical manifestations and laboratory test results upon admission were gathered as variables for 88 patients who experienced PCP following kidney transplantation. The most discriminative variables were identified, and subsequently, Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), K-Nearest Neighbor (KNN), Light Gradient Boosting Machine (LGBM), and eXtreme Gradient Boosting (XGB) models were constructed. Finally, the models' predictive capabilities were assessed through ROC curves, sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and F1-scores. The Shapley additive explanations (SHAP) algorithm was employed to elucidate the contributions of the most effective model's variables. RESULTS: Through lasso regression, five features-hemoglobin (Hb), Procalcitonin (PCT), C-reactive protein (CRP), progressive dyspnea, and Albumin (ALB)-were identified, and six machine learning models were developed using these variables after evaluating their correlation and multicollinearity. In the validation cohort, the RF model demonstrated the highest AUC (0.920 (0.810-1.000), F1-Score (0.8), accuracy (0.885), sensitivity (0.818), PPV (0.667), and NPV (0.913) among the six models, while the XGB and KNN models exhibited the highest specificity (0.909) among the six models. Notably, CRP exerted a significant influence on the models, as revealed by SHAP and feature importance rankings. CONCLUSIONS: Machine learning algorithms offer a viable approach for constructing prognostic models to predict the development of severe disease following PCP in kidney transplant recipients, with potential practical applications.
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Background and aims: In the course of clinical practice, hepatic ischemia/reperfusion (I/R) injury is a prevalent pathophysiological event and is caused by a combination of complex factors that involve multiple signaling pathways such as MAPK and NF-κB. USP29 is a deubiquitinating enzyme important during the development of tumors, neurological diseases, and viral immunity. However, it is unknown how USP29 contributes to hepatic I/R injury. Methods and results: We systematically investigated the role of the USP29/TAK1-JNK/p38 signaling pathway in hepatic I/R injury. We first found reduced USP29 expression in both mouse hepatic I/R injury and the primary hepatocyte hypoxia-reoxygenation (H/R) models. We established USP29 full knockout mice (USP29-KO) and hepatocyte-specific USP29 transgenic mice (USP29-HTG), and we found that USP29 knockout significantly exacerbates the inflammatory infiltration and injury processes during hepatic I/R injury, whereas USP29 overexpression alleviates liver injury by decreasing the inflammatory response and inhibiting apoptosis. Mechanistically, RNA sequencing results showed the effects of USP29 on the MAPK pathway, and further studies revealed that USP29 interacts with TAK1 and inhibits its k63-linked polyubiquitination, thereby preventing the activation of TAK1 and its downstream signaling pathways. Consistently, 5z-7-Oxozeaneol, an inhibitor of TAK1, blocked the detrimental effects of USP29 knockout on H/R-induced hepatocyte injury, further confirming that USP29 plays a regulatory role in hepatic I/R injury by targeting TAK1. Conclusion: Our findings imply that USP29 is a therapeutic target with promise for the management of hepatic I/R injury via TAK1-JNK/p38 pathway-dependent processes.
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Quinasas Quinasa Quinasa PAM , Daño por Reperfusión , Animales , Ratones , Hígado , Quinasas Quinasa Quinasa PAM/genética , Ratones Noqueados , Ratones Transgénicos , Daño por Reperfusión/genética , Proteasas Ubiquitina-Específicas/genéticaRESUMEN
Hepatocellular carcinoma (HCC) is the most common subtype, accounting for about 90% of all primary liver cancers. The liver is rich in a large number of immune cells, thus forming a special immune microenvironment, which plays a key role in the occurrence and development of hepatocellular carcinoma. Nowadays, tumor immunotherapy has become one of the most promising cancer treatment methods. Immune checkpoint inhibitors (ICIs) combined with VEGF inhibitors are listed as first-line treatment options for advanced HCC. Therefore, the search for a potential biomarker to predict the response to immunotherapy in HCC patients is urgently needed. The G protein-coupled receptor 55 (GPR55), a lysophosphatidylinositol (LPI) receptor, has recently emerged as a potential new target for anti-tumor therapy. Previous studies have found that GPR55 is highly expressed in breast cancer, pancreatic cancer, skin cancer and cholangiocarcinoma, and is involved in tumor proliferation and migration. However, the role and mechanism of GPR55 in HCC has not been elucidated. Therefore, this article discusses the clinical significance of GPR55 in HCC and its correlation with the immune response of HCC patients, so as to provide theoretical basis for improving the prognosis of HCC.
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Neoplasias de los Conductos Biliares , Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/genética , Pronóstico , Conductos Biliares Intrahepáticos , Microambiente Tumoral , Receptores de CannabinoidesRESUMEN
Genetic modification (GM) technology is a technology that changes the characteristics of species through changing the genes of species. Public attitudes toward GM technology have an important impact on the technology's development. Previous surveys conducted in China used to assess public attitudes toward GM have mostly focused on the explicit level, which is recognized and acknowledged through the self-report method. However, the corresponding research on the implicit level is still lacking, which is unconscious and automated. The public attitudes toward the complete concept of GM are still unclear. In order to fill this gap, this study uses a questionnaire survey (Study 1), and interaction verification of the SC-IAT paradigm and the GNAT paradigm (Study 2) to investigate the explicit and implicit attitudes of Chinese university students towards GM. The role of education level is also examined in this study. The results show that the explicit attitudes of Chinese university students towards GM are generally positive, and the main effect of education level is significant. Finally, the mediating effect of the cognitive level between education level and explicit GM attitude is significant. However, the implicit GM attitudes of university students are generally negative, and neither the main effect of education level nor the mediating effect of cognition level is significant. University students as the future consumers and an important part of public opinion, their attitude to GM will affect the development of GM technology to a large extent. This study provides a theoretical basis for improving Chinese university students' attitudes toward GM, and also provides new research ideas for the public view of GM.
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The 5-item Gratitude Questionnaire (GQ-5) is one of the most commonly used instruments to measure dispositional gratitude in adolescents. The purpose of this study was to verify the longitudinal measurement invariance (LMI) and gender measurement invariance (GMI) of the GQ-5 that was administered to an adolescent sample twice over the course of 18 months (N = 669). Single-group confirmatory factor analysis (CFA) was adopted to examine the LMI and multiple-group CFA was conducted to assess the GMI. The results showed that the GQ-5 had strong invariance (i.e., equality of factor patterns, loadings, and intercepts) across time and gender. Validation of latent factor mean differences showed that females had higher gratitude scores than males. In addition, the GQ-5 exhibited good internal consistency indices across time and a moderate stability coefficient was also found across an 18-month time interval in adolescents. In summary, our study showed that LMI and GMI of the GQ-5 are satisfactory and the GQ-5 is a reliable instrument for measuring gratitude in adolescents.
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Psicometría , Adolescente , China , Análisis Factorial , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
The research focuses on the application of positive psychology theory, and studies the educational utility of national films by using deep learning (DL) algorithm. As an art form leading China's film and TV industry, national films have attracted the interest of many domestic scholars. Meanwhile, researchers have employed various science and technologies to conduct in-depth research on national films to improve film artistic levels and EDU-UTL. Accordingly, this paper comprehensively studies the EDU-UTL of national films using quality learning (Q-Learning) combined with DL algorithms and educational psychology. Then, a deep Q-Learning psychological model is proposed based on the convolutional neural network (CNN). Specifically, the CNN uses the H-hop matrix to represent each node, and each hop indicates the neighborhood information. The experiment demonstrates that CNN has a good effect on local feature acquisition, and the representation ability of the obtained nodes is also powerful. When K = 300, the psychological factor Recall of Probability Matrix Decomposition Factorization, Collaborative DL, Stack Denoising Automatic Encoder, and CNN-based deep Q-Learning algorithm is 0.35, 0.71, 0.76, and 0.78, respectively. The results suggest that CNN-based deep Q-Learning psychological model can enhance the EDU-UTL of national films and improve the efficiency of film education from the Positive Psychology perspective.
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BACKGROUND: Cytochrome P450 3A5 (CYP3A5) includes two active genotypes, namely CYP3A5*1/*1 or *1/*3 with the fast metabolic activity and CYP3A5*3/*3 with slow metabolic. We retrospectively analyzed the correlation between CYP3A5 gene polymorphism and the susceptibility to the BK virus (BKV) infection in renal transplant recipients. METHODS: According to the inclusion/ exclusion criteria, we selected 134 recipients who received kidney transplantation at the Renmin Hospital of Wuhan University from January 2019 to December 2019. Based on the pre-operative CYP3A5 sequencing results, 134 recipients were divided into two groups: those expressing the fast metabolic CYP3A5*1/*1 or *1/*3 genotype; and, those expressing slow metabolic CYP3A5*3/*3 genotype. These two recipient groups were then analyzed for the BKV infection rate with different metabolic types to establish the potential relationship between CYP3A5 gene polymorphism and BKV infection. RESULTS: The overall incidence of BKV viruria was 37.3%, whereas BKV viremia was 4.5% among all 134 recipients. The fast metabolism group had 9.1% incidence of BKV viremia and 49.1% incidence of BKV viruria. In contrast, the slow metabolism group had only 1.3%incidence of BKV viremia (P = 0.031) with only 29.1% BKV viruria (P = 0.011). The incidence of low levels of urinary BKV in the fast metabolism group was higher than that in the slow metabolism group (P = 0.005), while no significant statistical difference in the incidence of high levels of urinary BKV and high and low levels of blood BKV. CONCLUSION: After kidney transplantation, CYP3A5 gene polymorphism of recipients present a certain relationship with the occurrence of BKV infection, which may be of value for the prediction and prevention of BKV infection.
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Citocromo P-450 CYP3A , Trasplante de Riñón , Infecciones por Polyomavirus , Infecciones Tumorales por Virus , Humanos , Virus BK , Citocromo P-450 CYP3A/genética , Enfermedades Renales/cirugía , Trasplante de Riñón/efectos adversos , Polimorfismo Genético , Infecciones por Polyomavirus/epidemiología , Infecciones por Polyomavirus/genética , Estudios Retrospectivos , Receptores de Trasplantes , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/genética , Viremia/epidemiología , Viremia/genéticaRESUMEN
OBJECTIVE: This study investigated the clinical characteristics of patients with tuberculosis (TB) following renal transplantation (RT) in order to identify markers or signs that can facilitate early diagnosis. METHODS: A retrospective analysis was performed on 12 cases of Mycobacterium tuberculosis infection treated at our hospital between 2005 and 2020. RESULTS: The incidence of TB after RT at our hospital was 0.9%, and the median postoperative onset time was 22 months. The average age of patients included in our analysis was 44.2 ± 9.4 years; 11 of the 12 patients were male, and most patients had (low) fever as the first or only manifestation. Five patients had respiratory symptoms; 5 had typical computed tomography (CT) presentation; and 2 had a confirmed history of TB. Two sputum smears from 12 patients were positive by acid fast staining, and M. tuberculosis was detected in peripheral blood samples by metagenomic next-generation sequencing (NGS). One patient had a positive result in the purified protein derivative (PPD) test, 7 were positive with the interferon gamma release assay (IGRA), 8/12 patients were confirmed to have TB infection by NGS and 1 was confirmed positive by lung biopsy. CONCLUSION: Because of the use of immunosuppressive agents, most patients with TB following RT have atypical clinical symptoms and CT findings, and may have a high probability of a false negative result with the traditional PPD test and a low probability of M. tuberculosis detection, making early diagnosis difficult. Therefore, in RT recipients with prolonged fever of unknown origin and unusual clinical manifestations, especially those who are unresponsive to antibiotic treatment, a diagnosis of TB should be considered. The interferon gamma release assay and NGS are relatively new detection methods with high sensitivity and specificity; these along with regular, repeated testing by various approaches can aid the early diagnosis of TB.
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Trasplante de Riñón , Tuberculosis , Adulto , Humanos , Interferón gamma , Ensayos de Liberación de Interferón gamma/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tuberculosis/diagnósticoRESUMEN
OBJECTIVE: To investigate the clinical features, early diagnosis, and treatment methods of Pneumocystis jirovecii pneumonia (PJP) after renal transplantation (RT). METHODS: We retrospectively analyzed the clinical data of 80 patients with confirmed PJP who underwent RT between 2018 and 2021 in our hospital. RESULTS: In the present study, the incidence of PJP was 6.2% (80/1300). A 50% of cases (40 out of 80 patients) had developed a PJP infection during the first 6 months after RT and 81.3% (65 out of 80 patients) within 12 months. The median onset time of PJP was 6.5 months after RT. The most common symptom was fever (73.8%), followed by progressive dyspnea (51.3%) and dry cough (31.3%). In the initial phase of PJP, the most frequent CT finding was the presence of diffuse ground-grass shadows. In all, 27.5%, 37.5%, and 35% patients were diagnosed by induced sputum metagenomic next-generation sequencing (mNGS), peripheral blood mNGS, and characteristic clinical diagnostic features, respectively. The median 1,3-ß-D-glucan level was 500 pg/mL, while the median C-reactive protein level was 63.4 mg/L. In most patients (83.8%), the procalcitonin levels were negative. The mean serum creatinine level was 171.9 ± 87.4 µmol/L. Of the 80 patients, 37 (46.2%) had coexisting cytomegalovirus (CMV) infection. All patients were treated with trimethoprim-sulfamethoxazole and third generation cephalosporin to prevent bacterial infection. The methylprednisolone dose (40-120 mg/d) varied according to illness. CONCLUSION: PJP usually occurs within 1 year after RT, typically within 6 months. Fever, dry cough, and progressive dyspnea are the most common clinical symptoms. PJP should be highly suspected if the patient has clinical symptoms and diffuse, patchy, ground-glass opacities on CT in both lungs after RT within 1 year. Peripheral blood or induced sputum mNGS is helpful for early diagnosis of PJP. Trimethoprim-sulfamethoxazole is still the first choice for the treatment of PJP. Combined use of caspofungin can reduce the dose and adverse reactions of trimethoprim-sulfamethoxazole in theory.
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Infecciones por Citomegalovirus , Trasplante de Riñón , Pneumocystis carinii , Neumonía por Pneumocystis , Tos/tratamiento farmacológico , Tos/etiología , Infecciones por Citomegalovirus/tratamiento farmacológico , Disnea/tratamiento farmacológico , Disnea/etiología , Humanos , Trasplante de Riñón/efectos adversos , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/epidemiología , Estudios Retrospectivos , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Background: Pneumocystis jirovecii pneumonia (PJP) and cytomegalovirus (CMV) infection are common opportunistic infections among renal transplantation (RT) recipients, and both can increase the risk of graft loss and patient mortality after RT. However, few studies had evaluated PJP and CMV co-infection, especially among RT patients. Therefore, this study was performed to evaluate the impact of CMV co-infection with PJP among RT recipients. Methods: We retrospectively analyzed the clinical data of patients with confirmed diagnosis of PJP between 2015 and 2021 in our hospital. We divided patients into PJP and PJP+CMV groups according to their CMV infection status, and the clinical severity and outcomes of the two groups were evaluated. Results: A total of 80 patients after RT were diagnosed with PJP. Of these, 37 (46.2%) patients had co-existing CMV viremia. There were no statistically significant intergroup differences in age, sex, diabetes, onset time of PJP after RT and postoperative immunosuppressant. Compared to serum creatinine (Cr) at admission, the serum Cr at discharge in both the PJP and PJP+CMV groups were decreased. The PJP+CMV group had a higher C-reactive protein level, higher procalcitonin level, and lower albumin level than the PJP group. The PJP+CMV group showed a higher PSI score than the PJP group. Moreover, the initial absorption time of the lesion was longer in the PJP+CMV group. However, the duration of hospitalization showed no significant differences between the two groups. The mortality rate was 9.4-times higher in the PJP+CMV group than in the PJP group. The rate of admittance to the intensive care unit was 3.2-times higher in the PJP+CMV group than in the PJP group. Conclusion: CMV co-infection may result in more serious inflammatory response. RT patients with PJP+CMV infection had more severe clinical symptoms, slower recovery from pneumonia, and higher mortality than those with PJP alone. Therefore, when RT patients present with severe PJP, the possibility of CMV co-infection should be considered. Short-term withdrawal of immunosuppressants in case of severe infection is safe for the renal function of RT patients.
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The coronavirus disease 2019 (COVID-19) has swept the world, posing a serious threat to people's lives and health. Several cases of COVID-19 infection in renal transplant recipients (RTRs) have been reported, but the treatment and prognosis have not been fully elucidated. We followed-up with RTRs infected with SARS-CoV2 in our center and classified them as five clinical types-asymptomatic, mild, moderate, severe, and critical. The immunosuppressive agents were not adjusted in asymptomatic carriers and mild patients, the former was mainly treated by isolation, and the latter was treated by low-dose intravenous immunoglobulin (IVIG) to enhance immunity. For moderate or severe patients, the immunosuppressive agents were largely reduced or even interrupted, low-dose IVIG was adopted, and low-dose methylprednisolone (MP) was used to inhibit inflammation and rejection. Immunosuppressants were discontinued early in critical patients; IVIG, high-dose MP, and antibiotics were used. Meanwhile, all patients received at least one antiviral drugs. After aggressive treatment, three patients developed acute kidney injury, and two showed reversal, while the remaining one lost the allograft kidney; one patient died, while other patients were discharged. For different clinical types of RTRs infected with COVID-19, personalized therapies were essential, Meanwhile, patients with COVID-19 infection may have different outcomes due to their different clinical manifestations.
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Tratamiento Farmacológico de COVID-19 , Huésped Inmunocomprometido/inmunología , Inmunosupresores/uso terapéutico , Trasplante de Riñón , SARS-CoV-2/efectos de los fármacos , Lesión Renal Aguda/patología , Adulto , Antivirales/uso terapéutico , COVID-19/inmunología , COVID-19/patología , COVID-19/terapia , Femenino , Humanos , Inmunización Pasiva/métodos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/efectos adversos , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Pronóstico , Receptores de Trasplantes , Sueroterapia para COVID-19RESUMEN
Since its emergence in December 2019 many end-stage renal disease (ESRD) patients have been infected with coronavirus disease 2019 (COVID-19). Herein, we describe the case of an ESRD patient who received a kidney transplant after recovering from COVID-19. We described the clinical course of COVID-19 and kidney transplant management, including the patient's symptoms, laboratory results, computed tomography, and antibody profiles. He recovered well, without complications. Chest computed tomography, PCR, and IgG results indicated no recurrence of COVID-19 during the subsequent two weeks. Therefore, kidney transplantation is feasible in an ESRD patient who has recovered from COVID-19, under a normal immunosuppressive regimen.
Asunto(s)
COVID-19/terapia , Huésped Inmunocomprometido , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Receptores de Trasplantes , Adulto , Antivirales/uso terapéutico , Glomerulonefritis/cirugía , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , SARS-CoV-2RESUMEN
Auditory verbal hallucination (AVH) is emphasized as a pathological hallmark of schizophrenia. Neuroimaging studies provide evidence linking AVH to overlapping functional abnormalities in distributed networks. However, no clear conclusion has still been reached. This study aimed to further explore the brain activity of patients with schizophrenia having AVH from both local activity (LA) and functional connectivity (FC) insights, while excluding confounding factors from other positive symptoms. A total of 42 patients with AVH (AVH patients group, APG), 26 without AVH (non-AVH patients group, NPG), and 82 normal controls (NC) underwent resting-state functional magnetic resonance imaging (fMRI). LA measures, including regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF), and FC measures were evaluated to understand the neuroimaging mechanism of AVH. APG showed increased ReHo and fALFF in the bilateral putamen (Put) compared with NPG and NC. FC analysis (using bilateral putamen as seeds) revealed that all patients showed abnormal FC of multiple resting-state network regions, including the anterior and post cingulate cortex, middle frontal gyrus, inferior parietal gyrus, and left angular gyrus. Interestingly, APG showed significantly decreased FC of insula extending to the superior temporal gyrus and inferior frontal gyrus compared with NPG and NC. The present findings suggested a significant correlation of abnormal LA and dysfunctional putamen-auditory cortical connectivity with the neuropathological mechanism of AVH, providing evidence for the functional disconnection hypothesis of schizophrenia.