Syndrome of inappropriate anti-diuretic hormone secretion secondary to disseminated strongyloidiasis in a kidney transplant recipient: A case report.

Background: Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is associated with strongyloidiasis. Herein, a rare case of severe SIADH secondary to disseminated strongyloidiasis in a kidney transplant recipient is reported. Case presentation: A case involving a 43-year-old male kidney transplant recipient with severe disseminated Strongyloides stercoralis infection is reported. The patient was a construction worker with a history of consuming undercooked yellow eel and sashimi. On admission, the patient presented with poor appetite, nausea, vomiting and diarrhea. Laboratory investigations revealed persistent significant hyponatremia and low serum osmolality, confirming the diagnosis of SIADH. S. stercoralis was detected in the stool and bronchoalveolar lavage fluid. He was treated with empirical albendazole because S. stercoralis was detected in the stool; however, his symptoms and hyponatremia did not improve until ivermectin was administered, after which SIADH resolved quickly. Conclusion: This case suggests that S. stercoralis infection should be included in the differential diagnosis when a kidney transplant recipient presents with gastrointestinal symptoms and SIADH. In such situations, pre- or post-transplant screening for S. stercoralis is needed, and early ivermectin treatment is very important.

Human mesenchymal stromal cells ameliorate cisplatin induced acute and chronic kidney injury via TSG-6.

Cisplatin is widely employed in tumor chemotherapy, but nephrotoxicity is an unavoidable side effect of cisplatin. Several studies have demonstrated that mesenchymal stromal cells (MSCs) ameliorate cisplatin-induced kidney injury, but the underlying mechanisms are unknown. In this study, the cisplatin-induced kidney injury mouse model was established by subjecting a single intraperitoneal injection with cisplatin. One hour before cisplatin injection, the mice received human bone marrow MSCs (hBM-MSCs) with or without siRNA-transfection, recombinant human tumor necrosis factor (TNF)-α-stimulated gene/protein 6 (rhTSG-6), or PBS through tail vein. In addition, cisplatin-stimulated HK-2 cells were treated with hBM-MSCs or rhTSG-6. hBM-MSCs treatment remarkably ameliorated cisplatin-induced acute and chronic kidney injury, as evidenced by significant reductions in serum creatinine (Scr), blood urea nitrogen (BUN), tubular injury, collagen deposition, α-smooth muscle actin accumulation, as well as inflammatory responses, and by remarkable increased anti-inflammatory factor expression and Treg cells infiltration in renal tissues. Furthermore, we found that only a few hBM-MSCs engrafted into damaged kidney and that the level of human TSG-6 in serum of mice increased significantly following hBM-MSCs administration. Moreover, hBM-MSCs significantly increased the viability of damaged HK-2 cells and decreased the levels of inflammatory cytokines in the culture supernatant. However, knockdown of TSG-6 gene in hBM-MSCs significantly attenuated their beneficial effects in vivo and in vitro. On the contrary, treated with rhTSG-6 achieved similar beneficial effects of hBM-MSCs. Our results indicate that systemic administration of hBM-MSCs alleviate cisplatin-induced acute and chronic kidney injury in part by paracrine TSG-6 secretion.

Clinical characteristics and prognosis of pulmonary renal syndrome in West China.

Pulmonary renal syndrome (PRS) is a rare and life-threatening syndrome. Interstitial lung disease (ILD) has been recently considered another phenotype of lung dysfunction in patients with PRS, but there are very limited data. The characteristics of fifty PRS patients were retrospectively reviewed after a 3-year follow-up, and the differences between PRS patients whose lung dysfunction presented as diffuse alveolar hemorrhage (DAH group) and those with interstitial lung disease (ILD group) were also analyzed. The median age at diagnosis of PRS patients was 50.78 ± 17.88 years, and the main symptoms at disease onset were proteinuria (94.00%), hemoptysis (68.00%), dyspnea (32.00%) and fever (12.00%). DAH patients were younger and had significantly lower hemoglobin levels, a higher incidence of hemoptysis, and higher serum creatinine levels at onset than ILD patients. Univariate analyses of PRS patients showed that respiratory failure and the initiation of mechanical ventilation predicted patient death and that the initiation of hemodialysis and higher serum creatinine levels at onset predicted ESRD. Multivariate analyses showed that respiratory failure and anti-GBM antibody positivity could independently predict patient death. Survival analyses showed that 1- and 3-year patient survival rates and ESRD-free survival rate were not significantly different between the two groups. ILD was another important phenotype of lung dysfunction in patients with PRS. Poor outcomes were observed in PRS patients with ILD and in PRS patients with DAH.

Current Status of Ultrasound in Acute Rejection After Renal Transplantation: A Review with a Focus on Contrast-Enhanced Ultrasound.

Renal transplantation has developed into the best treatment for end-stage renal disease, but severe cases can even lead to loss of renal allograft function due to rejection and complications caused by surgical procedures. If a series of postoperative complications can be reduced or even avoided, the quality of life of recipients will be significantly improved. Acute rejection in a transplanted kidney is one of the main complications after renal transplantation. Early detection and diagnosis will significantly help the prognosis of transplanted kidney patients. As a seminal morphological and hemodynamic examination method, ultrasound can monitor the tissue structure and arteriovenous blood flow of the transplanted kidney, providing information on the transplanted kidney's gross shape and blood perfusion. Ultrasound is a commonly used detection method after renal transplantation. At present, two-dimensional ultrasound, color Doppler ultrasound, three-dimensional ultrasound, and contrast-enhanced ultrasound have been applied in the monitoring of complications after renal transplantation. Contrast-enhanced ultrasound, as a non-invasive, radiation-free, and easy to perform examination technique, can qualitatively and quantitatively evaluate the microcirculatory blood perfusion of the transplanted kidney. It can reflect the function of the transplanted kidney more objectively and sensitively. In recent years, contrast-enhanced ultrasound has attracted attention as a new technology that can quantitatively monitor the transplanted kidney's microcirculation perfusion. A large number of studies have shown that contrast-enhanced ultrasound has unique advantages in monitoring acute rejection after renal transplantation compared with other imaging methods, providing a reliable basis for clinical intervention. This article reviews the current status of and recent research on contrast-enhanced ultrasound in acute rejection after renal transplantation.

Physiological clearance of amyloid-beta by the kidney and its therapeutic potential for Alzheimer's disease.

Amyloid-ß (Aß) accumulation in the brain is a pivotal event in the pathogenesis of Alzheimer's disease (AD), and its clearance from the brain is impaired in sporadic AD. Previous studies suggest that approximately half of the Aß produced in the brain is cleared by transport into the periphery. However, the mechanism and pathophysiological significance of peripheral Aß clearance remain largely unknown. The kidney is thought to be responsible for Aß clearance, but direct evidence is lacking. In this study, we investigated the impact of unilateral nephrectomy on the dynamic changes in Aß in the blood and brain in both humans and animals and on behavioural deficits and AD pathologies in animals. Furthermore, the therapeutic effects of the diuretic furosemide on Aß clearance via the kidney were assessed. We detected Aß in the kidneys and urine of both humans and animals and found that the Aß level in the blood of the renal artery was higher than that in the blood of the renal vein. Unilateral nephrectomy increased brain Aß deposition; aggravated AD pathologies, including Tau hyperphosphorylation, glial activation, neuroinflammation, and neuronal loss; and aggravated cognitive deficits in APP/PS1 mice. In addition, chronic furosemide treatment reduced blood and brain Aß levels and attenuated AD pathologies and cognitive deficits in APP/PS1 mice. Our findings demonstrate that the kidney physiologically clears Aß from the blood, suggesting that facilitation of Aß clearance via the kidney represents a novel potential therapeutic approach for AD.

Primary mucinous adenocarcinoma of the left renal pelvis with ectopic inferior vena cava and invasion of the left renal vein and the adjacent inferior vena cava: a case report.

Primary mucinous adenocarcinoma of renal pelvis is an extremely uncommon malignant tumor without typical clinical manifestations and imaging characteristics. A definite diagnosis often depends on postoperative pathological results. Operation is the preferred choice of treatment, but prognosis is unsatisfactory. We describe a 42-year-old male patient who was admitted for repeated and intermittent pain of left abdominal flank for more than 5 years and aggravation of the symptom for more than 1 month. In the course of disease, he was misdiagnosed twice as a renal cyst in other hospitals. However, mild percussive pain was discovered in the left kidney area during this hospitalization. Moreover, abdominal computed tomography (CT) scan of our hospital demonstrated that a huge mixed-density mass derived from left kidney, along with congenital variation of the inferior vena cava and filling defect area in the left renal vein and the adjacent inferior vena cava. After adequate preoperative preparation, he was treated with radical resection of the left kidney and artificial vascular replacement of the inferior vena cava segment containing the emboli. The mass was verified to be mucinous adenocarcinoma by postoperative pathological result. In the end, he was diagnosed as primary mucinous adenocarcinoma of the left renal pelvis with ectopic inferior vena cava and invasion of the left renal vein and the adjacent inferior vena cava. Two weeks after operation, he recovered and was discharged. There was no evidence of recurrence after more than 4 years of follow-up. Blood oncogenic biomarkers were valuable in diagnosis by reviewing literature. In conclusion, Primary mucinous adenocarcinoma of the kidney is easy to be misdiagnosed as renal cyst. Preoperative CT and blood oncogenic biomarkers are extremely important for preliminary diagnosis. Postoperative pathological result is the gold standard for final diagnosis. Although prognosis is generally unfavourable, radical resection of the tumor can benefit patients.

Reversible posterior leukoencephalopathy syndrome due to adrenal pheochromocytoma: A case report and literature review.

RATIONALE: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neuropathic syndrome with typical clinical and radiological features. There are large amounts of risk factors resulting in RPLS, those including hypertension, eclampsia, neoplasia treatment, renal failure, systemic infections, chemotherapy, and immunosuppressive therapy after organ transplantation. PATIENT CONCERNS: A 27-year-old male patient was admitted for a 2-week history of paroxysmal tic of limbs along with consciousness disorder. Blood pressure elevation was discovered for the first time on admission, and the highest record was 210/150 mmHg during hospitalization. Neurological examinations were positive among mental state, speech, reaction and pathological reflex. The computed tomography scan of the abdomen demonstrated a mass derived from right adrenal gland. The magnetic resonance imaging of the brain showed reversible lesions in the centrum ovale, paraventricular, area and corpus callosum. DIAGNOSES: After control of blood pressure and rationally preoperative preparation, the mass was radically resected and verified to be pheochromocytoma by postoperative pathologic findings. He was diagnosed as having RPLS due to adrenal pheochromocytoma. INTERVENTIONS: The right adrenal gland mass was completely removed after 2 weeks of α-blockers and ß-blockers to treat hypertension. OUTCOMES: One week after surgery, the cerebral lesions of RPLS gradually faded and the blood pressure was easy to control well. LESSONS: A few case reports of RPLS related to pheochromocytomas had been documented in the literature. Therefore, we believe that pheochromocytomas may be a potential risk factor of RPLS. If patients receive timely diagnosis and treatment, it can often lead to a favorable prognosis.

Necrostatin-1 Attenuates Renal Ischemia and Reperfusion Injury via Meditation of HIF-1α/mir-26a/TRPC6/PARP1 Signaling.

Necroptosis, oxidative stress, and inflammation are major contributors to the pathogenesis of ischemic acute kidney injury. Necrostatin-1 (Nec-1), an inhibitor of the kinase domain of receptor-interacting protein kinase-1 (RIP1), has been reported to regulate renal ischemia and reperfusion (I/R) injury; however, its underlying mechanism of action remains unclear. HK-2 cells were used to create an in vitro I/R model, in which the cells were subjected to hypoxia, followed by 2, 6, and 12 h of reoxygenation. For the in vivo study, a rat model of renal I/R was established in which samples of rat blood serum and kidney tissue were harvested after reperfusion to assess renal function and detect histological changes. Cell viability and necroptosis were analyzed using the Cell Counting Kit (CCK)-8 assay and flow cytometry, respectively. The expression levels of molecules associated with necroptosis, oxidative stress, and inflammation were determined by real-time PCR, western blotting, immunofluorescence staining, and ELISA. Luciferase and chromatin immunoprecipitation (ChIP) assays were performed to confirm the relevant downstream signaling pathway. We found that pretreatment with Nec-1 significantly decreased hypoxia-inducible factor-1α (HIF-1α) and miR-26a expression, as well as the levels of factors associated with necroptosis (RIP1, RIP3, and Sirtuin-2), oxidative stress (malondialdehyde [MDA], NADP+/NADPH ratio), and inflammation (interleukin [IL]-1ß, IL-10, and tumor necrosis factor alpha [TNF-α]) in I/R injury cells and the rat model. However, these effects could be reversed by miR-26a overexpression or TRPC6 knockdown. Mechanistic studies demonstrated that HIF-1α directly binds to the promoter region of miR-26a, and that TRPC6 is a potential target gene for miR-26a. Our findings indicate that Nec-1 can effectively protect against renal I/R injury by inhibiting necroptosis, oxidative stress, and inflammation, and may exert its effects through mediation of the HIF-1α/miR-26a/TRPC6/PARP1 signaling pathway.

[Determination of 50 antibiotic residues in drone pupa powder by liquid chromatography-tandem mass spectrometry].

A method was established for the determination of 50 kinds of antibiotic residues (macrolides, quinolones, sulfonamides, tetracyclines, nitroimidazoles, lincomycin and chloramphenicol) in drone pupa powder by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The samples were extracted with perchloric acid and lead acetate solution, and the protein was precipitated. The extraction solution was adjusted to pH 8 using dipotassium hydrogen phosphate, then the solution was purified by solid phase extraction (SPE) and analyzed by LC-MS/MS. The target compounds in the drone pupa powder were determined quantitatively and quantitatively by using multiple reaction monitoring and positive ion or negative ion modes. The recoveries of the 50 antibiotics were in the range of 70.2%-118.3%, and the relative standard deviations (RSDs) were 1.8%-13.6%. The method is simple, selective, and can be suitable for the analysis and confirmation of veterinary drug residues in drone pupa powder.

Efficacy of N-Acetylcysteine in Preventing Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis Study.

PURPOSE: To evaluate whether perioperative N-acetylcysteine (NAC) administration reduces the risk of cardiac surgery associated acute kidney injury (CSA-AKI). MATERIALS AND METHODS: A systematic literature review (Medline, PubMed, Cochrane, Biomedical central, Google Scholar) identified 10 studies (1391 patients; 695 NAC and 696 placebo) that compared the efficacy and adverse effects of perioperative NAC administration for CSA-AKI prevention in adults undergoing elective cardiac surgery. Meta-analysis was performed using Comprehensive Meta-Analysis statistical software. RESULTS: Patients in the NAC-treated and placebo groups had similar rate of CSA-AKI occurrence, change in creatinine levels, as well as the in-hospital mortality rate (RR = 0.841, 95% CI = 0.691 to 1.023, p = 0.083; pooled difference in means = -0.328, 95% CI = -0.712 to 0.056, p = 0.094; RR = 0.741, 95% CI = 0.388 to 1.418, p = 0.366, respectively). CONCLUSIONS: Our study does not support perioperative NAC administration as a mean to reduce the risk of CSA-AKI.

Fifty-one cases of fungal arteritis after kidney transplantation: A case report and review of the literature.

Fungal arteritis affecting graft arteries is a rare but life-threatening complication in kidney transplantation (KT). Here, we report the case of a patient with Aspergillus arteritis who experienced renal artery rupture 8 days after KT. We also reviewed 50 other reported cases of fungal arteritis after KT. We found that fungal contamination can occur during kidney graft harvest, preservation, and/or transplantation. Typically, early diagnosis, timely antifungal treatment, and emergency surgery seem crucial for avoiding life-threatening vascular complications.

A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients: A Meta-Analysis.

BACKGROUND: Peritoneal dialysis (PD) and hemodialysis (HD) have been considered the 2 standard pre-transplant dialysis modalities in patients awaiting kidney transplantation. However, the impact of pretransplant dialysis on the short- and long-term post-transplant outcomes remains controversial. METHODS: We searched PubMed, EMBASE and the Cochrane central register of controlled trials for this review. Twelve studies were identified by strict screening for the meta-analysis. RESULTS: We found that pretransplant PD patients had a significantly lower incidence of delayed graft function than HD patients, with an OR 0.67 (95% CI 0.62-0.72, p < 0.05). In contrast, there was no significant difference in the incidence of acute rejection, OR 0.96 (95% CI 0.75-1.16). Pretransplant PD had a better 5-year patient survival rate than HD, with a hazard ratio 0.86 (95% CI 0.79-0.95, p < 0.05); however, there were no significant differences in the graft survival rate (p = 0.08). CONCLUSIONS: We found that PD was a better choice of pretransplant dialysis modality than HD. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=446272.

Molecular and immunological characterization of DNA ligase IV deficiency.

DNA ligase IV (LIG4) deficiency is an extremely rare autosomal recessive primary immunodeficiency disease caused by the LIG4 mutation. To date, fewer than 30 cases of patients have been reported worldwide. No reversion mutations have been previously identified in LIG4. This study enrolled seven Chinese patients with LIG4 deficiency who presented with combined immunodeficiency, microcephaly, and growth retardation. One patient (P1) acquired non-Hodgkin lymphoma. Four patients had impaired T cell proliferation function and skewed T cell receptor diversity. Five novel mutations in LIG4 and a potential hotspot mutation (c.833G>T; p.R278L) in the Chinese population were identified. TA cloning analysis of T cells, NK cells, granulocytes, and oral mucosa cells in P6 revealed wild-type clones and clones that contained both maternally and paternally inherited mutations, indicating possible somatic reversion which need further investigation since no functional or protein assays were possible for all the patients died and no cell lines were available.

Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis.

INTRODUCTION: The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. METHODS: Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003-2011, among 25,312 (23,995-26,644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564-1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003-2011 was 17.4% (15.8% to 19.0%). CONCLUSIONS: PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme.

[Pathogenesis of human metapneumovirus infection and research on attenuated live vaccine].

Numerous studies have indicated that human metapneumovirus (hMPV) is an important viral pathogen in acute respiratory infections in children, presenting similar manifestations with respiratory syncytial virus (RSV). HMPV infection peaks in the winter-spring season and is more prevalent in younger ages, especially in children less than 1 year old. Host innate immune response has been implicated in recognition of pathogen-associated molecular patterns (PAMPs) of the virus. This recognition occurs through host pattern recognition receptors (PRRs). Toll like receptors (TLRs) are one of the largest class of PRRs which initiate and regulate adaptive immune responses. Some studies have indicated that TLR 3 and TLR 4 may play critical roles in hMPV infection. Construction of recombinant mutant viruses lacking one or two N-linked glycosylation sites in the F protein by using site-directed mutagenesis and reverse genetics may be helpful for developing attenuated live vaccines.

Nutritional assessment of transgenic lysine-rich maize compared with conventional quality protein maize.

BACKGROUND: The gene sb401 encoding a lysine-rich protein has been successfully integrated into the genome of maize (Zea mays), its expression showing as increased levels of lysine and total protein in maize seeds. As part of a nutritional assessment of transgenic maize, nutritional composition, especially unintended changes in key nutrients such as proximates, amino acids, minerals and vitamins as well as in antinutrient (phytate phosphorus), and protein nutritional quality were compared between transgenic maize (inbred line 642 and hybrid line Y642) and conventional quality protein maize (QPM) Nongda 108. RESULTS: The contents of total protein, lysine, some other amino acids, several minerals and vitamin B2 in transgenic inbred line 642 and hybrid line Y642 were significantly higher than those in conventional QPM. Water-soluble protein and G2-glutelin were significantly promoted in transgenic maize Y642. CONCLUSION: Insertion of the lysine-rich sb401 gene increased the total protein and lysine content of transgenic maize varieties, leading to an improved amino acid score and therefore an improvement in the nutritive value of maize.

Subchronic feeding study of stacked trait genetically-modified soybean (3Ø5423 × 40-3-2) in Sprague-Dawley rats.

The genetically-modified (GM) soybean 3Ø5423 × 40-3-2 expresses siRNA for the fatty acid desaturase-2 enzyme which results in higher concentrations of oleic acid (18:1) relative to linoleic acid (18:2) compared with non-GM soybeans. It also expresses the CP4 EPSPS protein for tolerance to glyphosate. In this study, three different dietary concentrations (7.5%, 15% and 30% wt/wt) of 3Ø5423 × 40-3-2 or non-GM soybeans were fed to Sprague-Dawley rats for 90 days during which in-life nutritional and growth performance variables were evaluated followed by analysis of standard clinical chemistry, hematology and organ variables. Compared with rats fed the non-GM control diet, some statistically significant differences were observed in rats fed the 3Ø5423 × 40-3-2 diet. However the differences were not considered treatment-related and commonly fell within the normal ranges of the control group consuming the commercial diet. These results demonstrated that the GM soybean 3Ø5423 × 40-3-2 is as safe as non-GM soybeans.