Caracterização clínica de pessoas submetidas a transplante renal: sensibilização imunológica / Clinical characterization of people undergoing kidney transplantation: immune sensitization / Caracterización clínica de las personas sometidas a un trasplante renal: sensibilización inmunológica

Resumo Enquadramento: O enxerto renal atua como um corpo estranho no organismo do doente, constituindo-se, assim, como um procedimento indutor de intensa reação inflamatória. Objetivo: Objetivou-se avaliar a caracterização clínica de pessoas submetidas a transplante renal com a sensibilização imunológica. Metodologia: Trata-se de um estudo descritivo, documental e retrospectivo, com abordagem quantitativa de tratamento e análise de dados, realizado de junho a agosto de 2019. Resultados: Evidenciou-se estatisticamente a relação do anticorpos doador-específicos (DSA) com a disfunção de enxerto (p < 0,03) e a gravidez (p < 0,04). Realizou- se também o cruzamento da ocorrência de complicação com tempo de internamento (p < 0,00) e o valor da creatinina sérica na primeira semana pós-transplante (p < 0,006). Conclusão: De acordo com as características clínicas, a maioria apresentou disfunção do enxerto, presença de DSA e complicações. Com isto, aponta-se a necessidade de um acompanhamento crítico e individualizado do paciente transplantado.

Abstract Background: The kidney transplant is a foreign body in the patient's organism, thus constituting a procedure that triggers an intense inflammatory reaction. Objective: To assess the clinical characteristics of people undergoing kidney transplantation with immune sensitization. Methodology: A descriptive, documentary, and retrospective study with a quantitative approach to data treatment and analysis was carried out between June and August 2019. Results: The association between donor-specific antibodies (DSA) and graft dysfunction (p < 0.03) and pregnancy (p < 0.04) was statistically significant. The occurrence of complications was also associated with the length of hospital stay (p < 0.00) and serum creatinine levels in the first week after transplant (p < 0.006). Conclusion: The clinical characterization showed that most patients had graft dysfunction, DSA, and complications, meaning that transplanted patients require a critical and individualized follow-up.

Resumen Marco contextual: El injerto renal actúa como un cuerpo extraño en el organismo del paciente, por lo que constituye un procedimiento que induce una intensa reacción inflamatoria. Objetivo: El objetivo es evaluar la caracterización clínica de las personas sometidas a un trasplante renal con sensibilización inmunológica. Metodología: Se trata de un estudio descriptivo, documental y retrospectivo, con un enfoque cuantitativo en el tratamiento y el análisis de los datos, realizado de junio a agosto de 2019. Resultados: Se observó una relación estadística entre los anticuerpos específicos del donante (DSA) y la disfunción del injerto (p < 0,03) y el embarazo (p < 0,04). La aparición de complicaciones también se cruzó con la duración de la estancia hospitalaria (p < 0,00) y el valor de la creatinina sérica en la primera semana postrasplante (p < 0,006). Conclusión: Según las características clínicas, la mayoría presentó disfunción del injerto, presencia de DSA y complicaciones. Con esto, se apunta la necesidad de un seguimiento crítico e individualizado del paciente sometido a un trasplante.

Fatores sociodemográficos de pacientes HIV em uso de terapia antiretroviral e sua associação ao índice de desenvolvimento humano municipal / Sociodemographic factors of HIV patients on antiretrovirals and their association with the Municipal Human Development Index

O objetivo do trabalho foi avaliar fatores sociodemográficos e laboratoriais dos pacientes infectados pelo HIV em uso de terapia antirretroviral (TARV) associados ao Índice de Desenvolvimento Humano Municipal (IDHM). O estudo envolveu 4.900 pacientes de 116 municípios do Paraná, atendidos no período de 2012 a 2015. Os pacientes foram divididos em três grupos de acordo com o tamanho e o IDHM do município de residência. Cidades de pequeno porte/IDHM médio apresentaram taxas mais elevadas de mulheres, indivíduos mais jovens e baixa escolaridade, quando comparadas com as cidades de grande porte/IDHM alto. As taxas totais de resposta imunológica, virológica e completa à TARV foram de 71,9%, 68,2% e 57,1%, respectivamente, com melhores resultados para o grupo vivendo em municípios de grande porte/IDHM alto. Apesar dessas diferenças, as respostas imunológica e virológica foram semelhantes entre os grupos, sugerindo que o grau de desenvolvimento do município não está associado com a efetividade da terapia para o HIV-1. (AU)

The objective of the study was to evaluate sociodemographic and laboratory factors of HIV patients on use of antiretroviral therapy (cART) associated with the Municipal Human Development Index (IDHM). The study enrolled 4,900 HIV-patients from 116 municipalities in the state of Paraná, in the South of Brazil, attended from 2012 to 2015. Patients were divided into three groups according to the size and the IDHM of the city of origin. Small sized/medium-IDHM cities showed higher rates of women, individuals with low educational level and young age, when compared to large sized/high-IDHM ones. The general rates of immunologic, virologic and complete responses to cART were of 71.9%, 68.2% and 57.1%, respectively, and better results were observed in the group from large size/high-IDHM cities. Despite these differences, immunologic and virologic responses were similar between the groups, demonstrating that the municipality level of development is not associated with the effectiveness of HIV-1 therapy. (AU)

Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts / Monitoramento da terapia com anticorpo policlonal antilinfócitos T em transplantados renais: comparação da contagem de células T CD3+ e de linfócitos totais

ABSTRACT Objective: To investigate the correlation between total lymphocyte and CD3+ T cell counts in peripheral blood in renal transplant patients treated with anti-thymocyte globulin, and discuss related outcomes. Methods: A single-center, retrospective study involving 226 patients submitted to kidney transplant between 2008 and 2013, and treated with anti-thymocyte globulin for induction or treatment of cellular rejection. Doses were adjusted according to CD3+ T cell or total lymphocyte counts in peripheral blood. Results: A total of 664 paired samples were analyzed. The Spearman's correlation coefficient was 0.416 (p<0.001) for all samples combined; the overall Kappa coefficient was 0.267 (p<0.001). Diagnostic parameters estimated based on total lymphocyte counts were also calculated using the number of CD3+ T cells (gold standard), with a cut off of >20 cells/mm3. Conclusion: Total lymphocyte and CD3+ T cell counts in peripheral blood are not equivalent monitoring strategies in anti-thymocyte globulin therapy.

RESUMO Objetivo: Investigar a correlação entre a contagem de linfócitos totais e células T CD3+ no sangue periférico em receptores de transplante renal submetidos a tratamento com globulina antitimocitária, e discutir resultados relacionados. Métodos: Estudo retrospectivo de centro único envolvendo 226 pacientes submetidos a transplante renal entre 2008 e 2013 e tratados com globulina antitimocitária, para fins de indução ou tratamento de rejeição celular. As doses foram ajustadas de acordo com a contagem de células T CD3+ ou linfócitos totais no sangue periférico. Resultados: No total, 664 amostras pareadas foram analisadas. O coeficiente de correlação de Spearman para as amostras em geral foi de 0,416 (p<0,001) e o coeficiente Kappa, de 0,267 (p<0,001). Os parâmetros diagnósticos estimados com base na contagem de linfócitos totais foram recalculados, empregando-se o número de células T CD3+ (padrão-ouro) e adotando-se o ponto de corte >20 células/mm3. Conclusão: A contagem de linfócitos totais no sangue periférico não substitui a contagem de células T CD3+ enquanto estratégia de monitorização da terapia à base de globulina antitimocitária.

Immunologic dissonance and its clinical significance in sepsis / 解放军医学杂志

Sepsis is essentially a result from immunological dissonance provoked by severe insults such as fulminant infection,severe trauma and extensive burns.It originates from excessive inflammatory responses and develops into immune paralysis or immunosupression.It has been demonstrated that cellular immune response plays a vital role in the pathogenesis of sepsis.In the stage of excessive inflammation,several kinds of immune cells are activated by pathogen-associated molecular patterns (PAMPs) or damage-associated molecular patterns (DAMPs) and subsequently produce a vast number of pro-inflammatory cytokines,while during the stage of immune paralysis,excessive apoptosis could result in decrease of immune cells with functional compromise.Inhibitory or regulatory immune cell subsets eventually dominate the direction of immune response and the production of inhibitory cytokines is enhanced.For clinical practice,surveillance of changes and shift in overall immune function is a basis for immunotherapy,especially to immunomodulation therapy.However,there is still a lack of adequate indexes or markers for integral evaluation of host immune state in the development of sepsis.

Research progress on relationship between complement activation and tumor immunity / 中华检验医学杂志

Complement system is a central part of the innate immune response that has developed as a first defense against non-self cells.Complement activation has traditionally been considered part of the body's immunosurveillance against cancer.However,recent studies have demonstrated that activated components of the complement system can assist the escape of tumor cells from immunosurveillance,promote angiogenesis,activate mitogenic signaling pathways,sustain cellular proliferation and insensitivity to apoptosis,and participate in tumor cell invasion and migration.This review reviewed the progress of complement activation and tumor immune surveillance and immune evasion,in order to provide a new strategy for antitumor immunotherapy.

Chronic psychological stress and its impact on the development of aggressive breast cancer / Estresse psicológico crônico e seu impacto no desenvolvimento de neoplasia mamária agressiva

Objective To investigate the clinicopathological findings of women diagnosed with breast cancer and study the impact of chronic psychological stress on the pathological characteristics of these tumors.Methods We investigated a cohort composed of women diagnosed with breast cancer and divided into two groups. One group was categorized as presenting with chronic psychological stress (by using the Self-Reporting Questionnaire − SRQ-20). Another group of women with breast cancer, but with no previous history of chronic psychological stress, comprised the Control Group. Clinical and pathological data were assessed.Results Women presenting with a history of chronic distress were significantly overweight when compared to the Control Group. Furthermore, it was observed that these stressed women also had a significant percentage of aggressive breast cancer subtype, the HER2 amplified tumor, which could be putatively associated with the loss of immunosurveillance.Conclusion Our findings suggested an interaction among chronic psychological stress, overweight, and the development of more aggressive breast tumors.

Objetivo Investigar os achados clínico-patológicos de mulheres diagnosticadas com câncer de mama e estudar o impacto do estresse psicológico crônico nas características patológicas desses tumores.Métodos Investigamos uma coorte composta por mulheres diagnosticadas com câncer de mama divididas em dois grupos. O primeiro foi classificado pela apresentação de estresse psicológico crônico (por meio do Self-Reporting Questionnaire− SRQ-20). Outro grupo de mulheres com câncer de mama, mas sem história prévia de estresse psicológico crônico, foi denominado Grupo Controle. Os dados clínicos e patológicos foram avaliados.Resultados As mulheres com histórico de estresse crônico apresentaram-se significativamente acima do peso quando comparadas com o Grupo Controle. Além disso, verificou-se que estas mulheres estressadas apresentaram um porcentual significativo de um subtipo de câncer de mama agressivo, o HER2, o que poderia estar associado à possível perda da imunovigilância.Conclusão Nossos resultados sugeriram uma ligação entre o estresse psicológico crônico, o excesso de peso e o desenvolvimento de tumores de mama com maior agressividade.

Application of three non-invasive immune rejection monitoring techniques after heart transplantation / 中华器官移植杂志

ObjectiveTo explore the effect and safety of three non-invasive immune rejection monitor techniques including intramyocardial electrogram (IMEG),tissue Doppler imaging (TDI) and multiple rejection relative genes expression detection in the peripheral blood.MethodsTotally 103 well recovered heart transplant cases were recruited The IMEG,TDI and gene expression detection techniques were used to monitor the rejection.The endomyocardial biopsy (EMB) was performed routinely after 1,3,and 12 months,or with clinic severe symptom,or with obvious abnormal noninvasive monitoring results,The patients were divided into different groups and were subjected to the test of TDI and quantitative real-time fluorescent quantitative reverse transcription-polymerase chain reaction(RT-PCR) technique test to observe the expression patterns of 16 immune rejection relative genes after heart transplantation.Results were also compared with those of the normal people.Results The sensitivity of IMEG was 92.9％,the specificity was 99.2％,positive predictive rate was 70.0％,and negative predictable rate was 99.8％.The routine echo can only detect the abnormality in the severe cardiac function impair.The TDI parameters in the grade Ⅰ or Ⅱ rejection group were decreased as compared with the controls (P＜0.05).The parameters Em,Sm and Tem were significantly reduced in grade ≥Ⅱ group as compared with the grade 0 or Ⅰ rejection group (P＜0.05).On the onset of acute rejection,the expression of ITGA4,FKB and IL1R2 was up-regulated,and that of PF4,ITGAM,TGF-β1and RHOU was down-regulated.ConclusionThe high negative prediction of the IMEG could be used as a non-invasive,convenient and safe monitoring technique for rejection reaction without any biopsies.It has a better correlation to use TDI and the Em,Am,Tem,Sm and Tsm could be used as the early sensentive parameters to detect the immune rejection.The real time quantitation RT-PCR methods were constructed successfully to detect the multiple immune relative genes expression and had clinic application value.

Significance of monitoring acute humoral rejection after renal transplantation / 中华器官移植杂志

Objective To investigate the possible mechanisms of acute humoral rejection (AHR) after renal transplantation and the significance of early diagnosis and prevention.Methods The clinical data of 296 cases receiving renal transplantations from January 2006 to December 2010 were retrospectively analyzed. After renal transplantation,the dynamic changes of panel reactive antibodies (PRA) and donor specific antibodies (DSA) in peripheral blood were monitored by using ELISA,and C4d deposition and molecular markers of infiltrating lymphocytes in biopsy tissue were observed by using immunohistochemistry.The AHR was diagnosed according to Banff 2005 criteria and clinical related indexes. Results Among 296 patients,25 were diagnosed as AHR after transplantation with the incidence being 8.4％ (25/296).The AHR incidence after transplantation in patients positive and negative for PRA before transplantation was 23.1 ％ (6/26) and 7.0％ (19/270) respectively (P＜0.01).The DSA positive rate in the recipients with AHR and without AHR after transplantation was 80.0％ (20/25) and 6.7％ (4/60) respectively.Thcrc was significant difference in DSA and C4d positive rate between AHR and non-AHR patients (P＜0.001).By adjusting several therapies, such as the immunosuppressive program and (or) application of intravenous immunoglobulin,plasmapheresis,antithymocyte globulin and rituximab monoclonal antibody, 19 cases of AHR were reversed,and the remaining 6 cases had rupture of renal allograft due to ineffective treatment,leading to the removal of the transplanted kidney.Conclusion PRA and DSA were important for AHR after renal transplantation.Immediately monitoring of the PRA and DSA after transplantation is recommended in order to achieve the purposes of prevention,early diagnosis and rational treatment for AHR,thus improving the survival of the transplanted kidney.

Impact of different surveillance models on the quality of injury surveillance / 中华疾病控制杂志

Objective To find out the impact of different surveillance models on the quality of injury surveillance and to provide a scientific basis for improving the quality of injury surveillance based in emergency departments and based on the basic data for evaluating the quality and advancing its method.Methods On the premise of the same surveillance,process and method,the injury reports the two trained groups(part-time and full-time)filled out within one month from July 28th to August 27th in 2007 were collected.They were processed in the computer,examined,and finally compared.Results The omitted rate of PTSIS was 31.44%,higher than that of FTSIS,especially during the latter part of night when it was easier for the two models to be omitted.There was a difference in error in the report-filling:Part-time group was often found to have omitted "telephone number","the cause of injury" and "intent",while the full-time group more readily left out "injury severity","patient disposition",and "responder".The part-time group did a better job on "the mechanism of injury" and "disposition",and the integrity of their report-filling was greater than that of the full-time group by 12.84%.Conclusions The omitted rate of PTSIS is higher than that of FTSIS,while the quality of the report from PTSIS is better than that of FTSIS.Therefore in the condition of the limited resources,part-time groups' active participation in the injury surveillance should be encouraged.The full-time groups are expected to be trained for it if resources permit.

Distinguishing between primary measles infection and vaccine failure reinfection by IgG avidity assay

In this study in the Islamic Republic of Iran 365 measles cases were evaluated to distinguish between primary infection with measles and reinfection due to secondary vaccine failure. All cases previously confirmed by detection of specific IgM were tested for IgG avidity. A secondary immune response was seen in 18.4% of patients. All unvaccinated patients [16.7%] showed a primary immune response. Of 244 patients with documented vaccination, 75.8% showed a primary immune response and 24.2% showed a secondary immune response, thereby indicating a secondary vaccine failure. Almost all measles reinfections [99%] were seen in patients >10 years old, indicating that vaccination for 10- year- old children is recommended

Measles seroepidemiology among adolescents and young adults: response to revaccination

We evaluated the seroprevalence of measles antibody and response to measles re-immunization in 590 previously vaccinated adolescents and young adults; 263 were seronegative. To differentiate between primary and secondary vaccine failure, anti- measles IgM and IgG titres were assessed again 2- 4 weeks after revaccination in 144 [105 seronegative, 39 seropositive] individuals: 75 seronegative participants responded to revaccination anamnestically [P < 0.001] and developed immunity 11 also showed IgM response [probably primary vaccine failure immunity]; 38 seropositive participants, remained seroprotected without significant increase in antibody titre [P = 0.577]. Primary vaccine failure was 4.7%; secondary vaccine failure was 27.1%. After revaccination, 87.3% were seroprotected

The immunological investigation and analysis on infection with HBV in kunming,China / 解放军医学杂志

Objective To investigate the distribution and to analyze the immunological mechanism of HBV-infected serum-type in Kunming City,China.Methods We studied all the 98462 tests of the "HbsAg,anti-HBs,HbeAg,anti-Hbe,anti-HBc" in our lab since 2000,from which we selected 426 samples that contain all kinds of serum-types of the HBV infection and 50 health samples as a control group.The HBV-DNA levels of the 426 samples were detected by real-time quantitative PCR,and the activity of ALT and AST were also detected at the same time.Results Among the 98462 samples,we found 12 kinds of HBV-infected serum-types in all,4 of which were recently found and infrequent in Kunming City(the proportions were lower than the others,P

Expression and distribution of ciliary neurotrophic factor and its receptor in normal and degenerative retina / 中华眼底病杂志

Objective To investigate the expression and characteristics distribution of ciliary neurotrophic factor (CNTF) and its receptor during the development of retina of healthy Sprague-Dawley(SD)and Royal College of Surgeons (RCS) rats with hereditary retinal degeneration. Methods The expression and distribution of ciliary neurotrophic factor and its receptor were detected by immunohistochemical staining in the retinal paraffin sections of SD and RCS rats from newborn to 12 moths old. Results In the normal retina of SD rats 0-7 days after birth, positive CNTF staining was found in all of the retinal layers and the staining of ganglion cells strengthened and other cells weakened as the age of rats increased; the staining of ganglion cells reached the peak at the 4th week and lasted till the agedness. The same results of the CNTF staining were also found in RCS rats retina. Weak positive staining of CNTFR in all of the retinal layers was seen in the 0-3-day-old SD rats; the ganglion cells were darkly stained and incontinuous positive staining at the site which would develop to be the external segment was found; as the age increased, the positive staining of external segment of photoreceptor enhanced and reached the peak at the 14-28th day after birth. At the 56th day, the staining of ganglion cells in retina of SD rats was strengthened while the staining of external segment weakened till the agedness. The expression of CNTFR in retina of 3-14-day-old RCS rats was the same as which of normal SD rats basically, but the staining of external segment weakened obviously from the 21st day on, and negative staining of external and positive ganglion cells were detected at the 28th day till the agedness. Conclusions Expression of CNTF in normal SD rats and RCS rats with hereditary retinal degeneration is almost the same. The presence of significant difference of expression of CNTFR between normal SD rats retina and RCS rats retina may provide the experimental gist for the CNTF treatment to retinal degeneration.

Sero-epidemiological study of measles after 15 years of compulsory vaccination in Alexandria, Egypt

Cases of measles among 165 vaccinated and unvaccinated children were studied and the level of measles antibody in 230 previously vaccinated children was determined. Associations between demographic factors and immunological response to vaccination were also investigated. Approximately 80% of the children with measles had been vaccinated; their cases had significantly lower rates of complication. Rural areas accounted for significantly higher numbers of unvaccinated cases. Vaccination status did not correspond to place of exposure, duration of prodrome or accuracy of preliminary diagnosis. The seropositivity rate among vaccinated children was 86.1% with no significant variation with age. We recommend a second dose of measles vaccine and maintaining high vaccine coverage