Abstract Background Childhood parasomnias are believed to be a benign disorder due to immaturity of some neural circuits, synapses and receptors. The aim of our study was to explore a possible ...connection with other neurological developmental disorders. Methods 72 children (mean age 9.9 ± 5.0 years, 47 boys) were clinically examined and 88 nocturnal v-PSG and 22 v-EEG recordings were evaluated. The most frequent diagnostic findings were: sleepwalking in 24 children, confusional arousal in 21, sleep terror in 8, groaning and enuresis each in 7, non-specific arousal disorder in 4 patients, and REM-related parasomnia in only one child. For statistical evaluation chi-square test, the two-sample t -test and Mann–Whitney rank test were used. Results Perinatal risk history was found in 38% of the cohort. Developmental disorders were diagnosed in 30 children (41.7%), more frequently in combinations with: attention-hyperactivity disorder (30.6%), dyslexia and dysgraphia (13.9%), developmental dysphasia (9.7%), mild motor and/or intellectual dysfunction (6.9%). Abnormal movements in sleep, some of them also regarded as developmental, were diagnosed in 37 children (51.4%). Sleep-related breathing disorders were found in 29 patients (40.3%) –snoring (29.2%) and/or sleep apnea (11.1%). Only 16.7% had no comorbidity. Most of the children (60%) showed 2 or 3, exceptionally up to 5 comorbidities. Children, in whom no parasomnia was found in close relatives, had a mild but non-significant earlier onset of the disease (4.4 ± 4.0 against 6.3 ± 4.3 years). Conclusion Childhood parasomnias are frequently associated with perinatal risk factors and developmental comorbidities, and can be regarded as a disorder of sleep maturation.
Recent literary data suggest that high pre- and post-transplant serum levels of the soluble CD30 (sCD30) molecule may be a risk factor for acute rejection and worse prognosis of the transplanted ...kidney. The aim of our study was to correlate the concentrations of sCD30 and the presence of HLA antibodies as defined by flow cytometry and ELISA with the clinical course and graft prognosis after transplantation. One hundred and seventeen kidney transplant patients were included into the study. The incidence of rejection episodes, graft function and graft survival for up to 1 year post-transplant were evaluated. Soluble CD30 levels before transplantation were virtually the same in patients who experienced rejection and in non-rejecting patients. In both patient groups, a significant decrease of sCD30 was detected 2 weeks after transplantation (104.4 U/ml before vs. 37.0 U/ml post-transplant,
P
<
0.001). However, there was a substantial difference in the level of decrease of sCD30 between rejecting and non-rejecting patients. Patients without rejection had lower sCD30 values (31.2 U/ml post-transplant) compared to patients who experienced rejection episodes (62.9 U/ml),
P
<
0.04. Multifactorial analysis showed that antibodies to HLA class II antigens and elevated concentrations of sCD30 shortly after transplantation were associated with increased risk for acute rejection in the first post-transplant year. Measurement of soluble CD30 after transplantation, taken into consideration with the presence of HLA class II antibodies, might be helpful for evaluating the potential risk for acute rejection.
The B-cell activating factor (BAFF) cytokine has important functions for the survival and maturation of B lymphocytes, which implies that this cytokine might play a role in the development of ...antibody-mediated rejection (AMR) after kidney transplantation. In our study, we compared the concentrations of the soluble BAFF cytokine in kidney graft recipients with AMR and patients without rejection with the goal of testing the hypothesis whether BAFF level measurement might be useful as a diagnostic marker of AMR. The study included a cohort of 19 high-risk patients with diagnosed AMR and 17 control patients free of rejection. BAFF was measured in all patients before transplantation, during the rejection episodes, and three months after transplantation in patients free of rejection using the Luminex technique. Before transplantation, the serum concentrations of BAFF in patients with AMR and kidney recipients without rejection did not significantly differ. After transplantation, however, BAFF levels were significantly lower in patients with AMR and also in patients with concurrent humoral and cellular rejection compared with patients without rejection (
p
< 0.05 and
p
< 0.01, respectively). No correlation was found between BAFF and the production of donor-specific antibodies (DSA) before and after transplantation. Patients experiencing AMR and simultaneous cellular and AMR had significantly lower concentrations of BAFF in comparison with patients free of rejection.
Abstract Aims We studied the influence of IL-4 gene polymorphisms on the IPF phenotype, i.e., extent of radiological changes (HRCT interstitial (IS) and alveolar (AS) score) and histopathological ...markers from lung biopsies. Patients and methods 46 IPF patients underwent genotyping, 43 of them had HRCT and 14 patients had a surgical lung biopsy. The HRCT scans were evaluated for AS and IS. The histopathological evaluation comprised myofibroblast foci (MF), intensity of inflammation and fibrosis (Ashcroft score) and numbers of eosinophils and granulomas. For immunohistochemical evaluation primary antibodies against PAR-2, CD124, TGF beta, YY-1 and TSLP were used. The IL-4 and IL-4 R alpha gene polymorphisms were characterized. Results We found a correlation between eosinophils in lung biopsies and AS. The Ashcroft score was higher in IL-4 HA 2 GCC and MF were more frequent in IL-4 HA 2 TCC carriers. A relationship was found between IL-4 (−1098) A2 T and PAR-2 expression and IL-4 (−590) A1 T, IL-4 HA1TTT and CD124 expression. AS was lower in IL-4 (−590) A1 C, in IL-4 HA1 TCC and in IL-4RA (+1902) A1 A carriers. Conclusions We suggest that the polymorphisms of IL-4 genes might influence the phenotype of IPF reflected by histopathological changes in lung biopsies and HRCT score.
Abstract Background Our retrospective study included a cohort of 47 patients who underwent living donor kidney transplantation. The pre-transplant frequencies of donor-specific Interferon-gamma ...(IFN-γ) producing cells were defined using enzyme-linked immunosorbent spot (ELISpot) assay and correlated with incidence of acute cellular (ACR), antibody-mediated rejection (AMR) and kidney graft survival up to one year after transplantation. Results We found a statistically significant correlation between the frequencies of IFN-γ-producing cells and the number of mismatches in HLA antigens between patients and their respective donors – for Class I – A and B (r = 0.399, p < 0.01) and for Class I and Class II antigens – A, B and DR (r = 0.409, p < 0.01). No significant relationship was observed between the numbers of IFN-γ-secreting cells and incidence of acute rejection (neither ACR, nor AMR). However, there was a trend of elevated frequencies of IFN-γ-producing cells in patients who developed ACR or AMR in comparison with kidney recipients free of rejection (91 ± 82 and 114 ± 75 vs. 72 ± 70/5 × 104 peripheral blood mononuclear cells respectively). Patients with concurrent acute cellular and antibody-mediated rejection had also higher numbers of IFN-γ-producing memory/effector cells compared to patients with cellular rejection only. Conclusion Pre-transplant determination of the numbers of IFN-γ-producing donor-specific memory cells using the ELISpot technique may provide clinically relevant results when evaluating the risk of development of acute cellular and antibody-mediated rejection. These frequencies are influenced by the degree of HLA mismatching between patients and their respective kidney donors.
The aim of our study was to retrospectively analyse the clinical data and the histological findings of 343 patients (pts) followed up with IgA nephropathy (IgAN) in our department of nephrology. We ...have assessed the main demographic, clinical and histological data, and the medical treatment of IgAN pts.
Multivariate analysis was used to evaluate the effect of different variables on ≥50% increase of plasma creatinine level from baseline during a median follow-up of 4 years.
In our group of IgAN pts, the male gender (68%) predominated over female gender (32%). At the time of renal biopsy, the median age of IgAN pts was 32.3 (18-90) years, the median level of serum creatinine was 119 μmol/L and the median level of proteinuria was 1.8 g/day. Most of the pts were found to have arterial hypertension (56.7%). The majority of the pts with arterial hypertension were treated with inhibitors of angiotensin-converting enzyme (80.4%) and the remaining pts (42.6%) were treated with angiotensin II receptor blockers. Fifty per cent of the pts (170 pts) were treated of corticosteroids, 21% of the pts (71 pts) used a combined immunosuppressive treatment of corticosteroids and cyclophosphamide, 8% of the pts (27 pts) took azathioprine, 1.5% of the pts (5 pts) took cyclosporine and 1.5% of the pts (5 pts) were given mycophenolate mofetil. Hypertension at presentation, fibrointimal proliferation of arterial vessels, interstitial fibrosis and interstitial inflammation were shown to be associated with ≥50% increase of plasma creatinine level from baseline in univariate analysis (P<0.05 for hypertension and fibrointimal proliferation; P<0.01 for interstitial fibrosis and inflammation). Using stepwise logistic regression presenting proteinuria>2 g/day odds ratio (OR)=2.24, P<0.01, tubular atrophy (OR=4.97, P<0.01) and damage of tubular epithelium (OR=1.78, P<0.05) were found as risk factors for ≥50% increase of plasma creatinine level from baseline.
Our retrospective analysis found valuable information not only about the clinical, laboratory and histological findings in IgAN pts but also information about the risk factors influencing the progression of renal insufficiency.
Infectious complications of the diabetic foot may be influenced by impaired renal function and by immunosuppression therapy.
Aims: To assess differences in microbial findings and resistance to ...antibiotics between transplant recipients, hemodialysis patients, and other patients with the diabetic foot.
Methods: 207 patients treated in the foot clinic for diabetic ulcers from 12/1998 to 12/1999 were included into this retrospective study. Patients were divided into three groups (transplant, dialysis, and other patients). Occurrence of individual bacterial species and resistance to antibiotics was compared between study groups.
Results: Study groups did not differ significantly in ulcer grades defined by the Wagner classification or in the mean number of pathogens per patient. The prevalence of individual microorganisms did not differ between the study groups. However, the study groups differed significantly in the occurrence of microbial resistance to antibiotics. Transplant patients had more frequently
Staphylococcus aureus resistant to oxacillin (
P<.01), imipenem (
P<.01), co-trimoxazole (
P<.01),
Enterococcus species resistant to ampicillin (
P<.01), piperacillin (
P<.01), and dialysis patients had more frequently
Pseudomonas species resistant to piperacillin (
P<.05) and cefpirom (
P<.05) in comparison with the other two groups.
Conclusions: Transplant patients had significantly more resistant microorganisms in comparison with dialysis and other patients with the diabetic foot. Empiric antibiotic selection based on general population data should be modified in transplant patients with diabetic foot according to actual susceptibility to antibacterial drugs.
Introduction
Immune response probably changes during human life, being influenced by cumulative exposure to environmental factors and individual genetic background.
Methods
Patients investigated for ...suspected interstitial lung disease were prospectively enrolled. After completing the diagnostic process, 121 patients were diagnosed extrinsic allergic alveolitis (EAA) and 136 sarcoidosis. Three groups according to age were established (<30 years, 30–60 years, >60 years), clinical manifestation, vital capacity (VC), forced expired volume in 1 s (FEV1), lung diffusing capacity for carbon monoxide‐transfer factor (TLCO) and bronchoalveolar lavage fluid (BALF) differential cell count were compared among the groups.
Results
Age subgroups of EAA patients did not significantly differ in lung functions. In the group above 60 years, non‐significantly higher neutrophils and eosinophils counts and CD4/CD8 ratio were observed. Sarcoidosis patients were significantly younger than EAA group and had significantly better lung functions (VC, FEV1, TLCO). Patients with sarcoidosis above 60 years of age had significantly higher percentages of neutrophils in BALF compared with younger patients. BALF percentage of neutrophils positively correlated with age.
Conclusions
Presented results may support the hypothesis that reactivity of immune system changes during the life, which may result in different manifestation of interstitial lung diseases according to age.
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