Treatment of Immunoglobulin A Nephropathy Recurrence Post-Renal Transplant.

Immunoglobulin A nephropathy (IgAN) is the most commonly occurring glomerulonephritis. Recurrence of disease in the transplanted kidney can significantly reduce allograft survival rates. Currently, there is no definitive management plan for IgAN recurrence in a transplant that reduces the rate of decline of allograft function and prolongs time to dialysis or re-transplantation. Herein we present a 48-year-old man who had received a renal transplantation in 2006 following his diagnosis of IgAN. In 2015, the patient was noted to have an elevated blood pressure and proteinuria (urinary protein:creatinine ratio [uPCR] 170 mg/mmol). A transplant biopsy confirmed recurrent IgAN. A year later, he presented with dipstick hematuria, nephrotic-range proteinuria (uPCR 820 mg/mmol), and a serum creatinine of 90 to 140 µmol/L. A second biopsy revealed mesangioproliferative glomerulopathy consistent with crescentic IgAN. An optimal management plan is currently unknown for recurrent crescentic IgAN in the transplanted kidney. We decided to treat this patient with oral cyclophosphamide daily and high-dose prednisolone. The treatment has so far yielded a positive response and managed to preserve allograft function without significant adverse effects for our patient. Our case illustrates the importance of timely biopsies to identify recurrence of disease and highlights an effective therapeutic option for recurrent IgAN with crescent formation in a transplant.

Experiences with anaerobic treatment of fat-containing food waste liquids: two full scale studies with a novel anaerobic flotation reactor.

Fat-containing food waste can be effectively treated in a new type of reactor, the so-called BIOPAQ-Anaerobic Flotation Reactor or BIOPAQ(®) anaerobic flotation reactor (AFR). In the reactor a flotation unit is integrated to retain the sludge. In this study results from two plants with a 430 and 511 m(3)-AFR, respectively, are presented. In one reactor, which is fed with water originating from different food liquid streams, over 99% of fat and oils were removed. Over 90% of the chemical oxygen demand (COD) was removed. When the last solids were removed from the effluent with a tilted plate settler, 98% COD removal was attained. The effluent concentrations of extractable hydrolysed and non-hydrolysed fats were less than 40 mg/l. Apparently the variations in the liquid streams deriving from the tank cleaning activities did not disturb the system. Only extremely high concentrations of fats could disturb the system, but the inhibition was reversible. In the reactor treating water from an ice-cream factory, which contained fats up to approximately 50% of influent COD, a COD removal efficiency of 90% was achieved. At volumetric loading rates varying from 1 to 8 kg COD/m(3)/d, biogas was produced at an average specific gas production of 0.69 m(3)/kg COD-removed.

Postnatal health and welfare of offspring conceived in vitro: a case for epidemiological studies.

In vitro fertilization (IVF) has established itself as an important technique in human assisted reproduction and in livestock improvement. In both humans and livestock the possible long-term effects on health and welfare of offspring born after IVF and in vitro culture to the blastocyst stage are still largely unknown. Epidemiological studies in humans, using data collected for individuals born after normal (i.e. non-assisted) pregnancies, have provided evidence for associations between prenatal life events and adult-life disease. Due to the relatively short time that elapsed since the first IVF baby was born, comparable studies for IVF offspring are not yet possible. However, animal experiments and epidemiological studies with the available data from the livestock industry (mainly dairy cattle) may contribute to a better understanding of the risks involved.

Cross-shift changes in blood inflammatory markers occur in the absence of airway obstruction in workers exposed to grain dust.

Grain dust is well known to cause both acute and chronic respiratory disorders, and endotoxins are considered key components in this. Since endotoxins are known to elicit proinflammatory mediators, we investigated cytokine (tumor necrosis factor [TNF], interleukin-6, interleukin-8) release and a number of proinflammatory and anti-inflammatory proteins (soluble TNF receptors, lipopolysaccharide (LPS) binding protein, bactericidal permeability increasing protein (BPI), C-reactive protein) in plasma of workers exposed to grain dust. In two surveys during 1 week, lung function was measured daily before and after the shift, using flow-volume curves and/or forced oscillation measurements. On Monday and Friday, blood samples (30 mL) were drawn and cytokine release was determined by enzyme-linked immunosorbent assay in supernatant of isolated monocytes or whole blood culture, either unstimulated or on the ex vivo stimulation with 3 ng/mL or 1,000 ng/mL endotoxin. Individual exposures were determined from stationary dust measurements at every workplace combined with personal task analysis during all shifts. In both surveys, no cross-week change in lung function parameters was observed. In the first survey (average exposure: 20.2 mg/m3), monocyte spontaneous TNF release was increased sevenfold cross week (p<0.001) and was significantly related both to individual dust exposure (r=0.62) of that week and the increase in soluble TNF receptor 75 kD (r=0.85). In the second survey, where average exposure was much lower (3.67 mg/m3), impedance parameters indicated a significant improvement of airway function, and cross-week changes in inflammatory markers were minimal. Therefore, we conclude that inflammatory events can be used to monitor adverse respiratory effects of moderate grain dust exposure.

Comorbidity of obsessive compulsive disorder in bipolar disorder.

The comorbidity of OCD and bipolar disorder has not been systematically examined. Therefore, we determined the frequency of patients meeting DSM-III criteria for OCD syndrome in a sample of 149 inpatients with DSM-III major affective disorder who had received a clinically reviewed structured diagnostic interview. The frequency of OCD syndrome was not significantly different between subjects with major depression (35.2%, n = 105) and bipolar disorder (35.1%, n = 37). This suggests that OCD is equally common in bipolar as in unipolar patients.

Respiratory symptoms and lung function in animal feed workers.

In a study among 194 male workers exposed to endotoxin-containing organic dust in animal feed mills, lung function was measured by flow volume curves and impedance measurements and respiratory symptoms were recorded by means of a validated questionnaire. The aims were to detect and localize airway obstruction caused by fodder dust and endotoxin, and to relate respiratory symptoms to both types of lung function measurements. Flow volume and impedance parameters were significantly related to present exposure. All impedance parameters, of the spirometric measures only FEF25, were significantly related to cumulative dust or endotoxin exposure. The changes in impedance parameters were for overall increasing resistance at 8 Hz and decreasing reactance at 8 Hz, reflecting an increase in peripheral airflow obstruction, with increasing exposure. The changes in all lung function parameters were more strongly related to (cumulative) endotoxin exposure than to inspirable dust exposure. All impedance parameters and FEV1 showed a good correlation with complaints of chronic bronchitis and breathlessness. Impedance measurement of the respiratory system proved to be a useful tool for objectively assessing (early) airflow obstruction in workers exposed to inspirable dust and endotoxin and in localizing airflow obstruction.

Respiratory effects of coal dust exposure: clinical effects and diagnosis.

During the past two decades, growing evidence has been reported on the role of respirable inorganic dust in the development of airflow obstruction, impaired diffusion capacity, chronic bronchitis, and emphysema, irrespective of the extent of possible pneumoconiotic abnormalities. These nonpneumoconiotic effects associated with dust exposure in miners and the relationship between dust exposure and mortality are reviewed. When pneumoconiotic changes can be visualized by different radiologic techniques, including computed tomography (CT) and high-resolution CT, assessment of the respiratory impairment in coal workers at present requires evaluation of the ventilatory and gas exchange capacity.

Airflow obstruction and monocyte TNF release in coal workers.

Respiratory health of 102 retired coal miners was assessed by chest radiographs, lung function measurements, and questionnaires, and related to tumor necrosis factor-alpha (TNF-alpha) production by blood monocytes upon priming with different stimuli. The objective was to assess a possible relationship between airflow obstruction and TNF-alpha production in retired coal workers. No significant differences in lung function were observed between cases of coal workers' pneumoconiosis (CWP) (n = 27; > %) and references (n = 75; = > %), nor was the effect of cumulative exposure on flow volume or impedance parameters significant. TNF-alpha release upon stimulation of blood monocytes with coal mine dust was significantly increased in cases with International Labour Organisation (ILO) score 0/1 (doubtful cases) compared to references and cases with a higher ILO score. Airflow limitation defined either as a FEV1 < 80% (N = 10; 5 cases of CWP) or as a resonance frequency > 15 Hz accompanied by a negative frequency dependence of resistance (N = 9; 4 cases of CWP) was significantly related to high levels of TNF-alpha release upon stimulation with endotoxin and silica, with silica showing the strongest relation. These data suggest that in this group airflow limitation is associated with an increased expression of inflammatory mediators indifferent of the presence of pneumoconiosis.

Respiratory effects and serum type III procollagen in potato sorters exposed to diatomaceous earth.

Exposure to diatomaceous earth with low crystalline silica content (< 1%) is rarely reported to cause pneumoconiotic disease, whereas airway obstruction and bronchitis are more frequently reported. We investigated the occurrence of pneumoconiosis and airflow limitation in 172 male workers from 5 potato sorting plants (55 controls, 29 salesmen, 72 currently exposed, and 16 retired exposed) exposed to inorganic dust from former sea terraces (7.7-15.4 mg/m3), high in diatomaceous earth. The presence of fibrosis was evaluated by chest radiographs (exposed only) and serum levels of type III procollagen (P-III-P) were measured as an estimate of fibrogenetic activity. Lung function was assessed by flow volume curves and impedance measurements. A validated questionnaire was used to record respiratory symptoms. No pneumoconiotic abnormalities were demonstrated by chest radiographs. In line with this finding, serum P-III-P levels were not elevated in exposed workers as compared to controls, suggesting no differences in fibrogenetic activity. In fact, serum P-III-P levels decreased significantly (P < 0.03) with increasing cumulative exposure. Flow volume parameters indicated airflow obstruction, dose-related to (cumulative) dust exposure; the annual decline in forced expiratory flow volume (FEV1) was estimated at 10.5 ml/year (P < 0.05). Airway obstruction was confirmed by impedance analysis: In the retired group impedance changes were compatible with airway obstruction extending into the peripheral airways. We conclude that this exposure to quartz during potato sorting does not result in an increased risk for pneumoconiosis, but that (prolonged) surveillance in this group is desirable in order to detect early indications of airflow obstruction.

The symptom structure of panic attacks in depressed and anxious patients.

This study examined the panic symptom profiles of three diagnostic groups: those with panic disorder and no history of major depression; those with panic disorder with a history of major depressive episode but no current depression; and those current major depression with panic disorder. Patients were compared on the frequency of specific panic attack symptoms based on structured interview responses. The symptom profiles of all three groups were significantly correlated. The patients with past and current depressive episodes had the most similar symptom structure.

Setting acceptable exposure limits for toluene diisocyanate on the basis of different airway effects observed in animals.

Little epidemiological data are available to enable the development of a dose-response relationship for the effects of isocyanates, powerful sensitizing agents in humans. Remarkably, most classes of effects have been reproduced in some animal models and parallels between animals and man are impressive. In this paper animal data concerning different effects of TDI on the respiratory system were used to calculate acceptable exposure levels for humans. Animal data on respiratory irritation, sensitization, airway hyperresponsiveness, and gradual loss of pulmonary function are discussed. Two different approaches for extrapolation to man were applied to these data. The two models used to extrapolate animal data to man gave similar results. The extrapolations lead to acceptable exposure varying from 6 to 46 ppb. Most international acceptable levels for occupational airborne TDI exposure are within this range. Interestingly, the lowest standard is obtained using the data on respiratory irritation. It is, however, concluded that there is no critical (adverse) effect to define acceptable toluene diisocyanate exposure since the data were obtained from different studies and the accuracy of the applied extrapolation approach might depend on the biological effect considered. We recommend prior testing of "alternative" diisocyanates in one of the animal models described and calibrated for TDI.