Prognostic and Diagnostic Markers in the Renal (Transplant) Biopsy

The scope of this thesis, entitled ''Prognostic and Diagnostic Markers in the Renal (Transplant) biopsy'', was to evaluate potentially important diagnostic and prognostic pathological features in renal transplant biopsies in the post-transplantation period

Új lehetőségek a vesetranszplantáció eredményeinek javítására

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Neural control of immunity in hypertension: council on hypertension mid career award for research excellence, 2019

The nervous system and the immune system share the common ability to exert gatekeeper roles at the interfaces between internal and external environment. Although interaction between these 2 evolutionarily highly conserved systems has been recognized for long time, the investigation into the pathophysiological mechanisms underlying their crosstalk has been tackled only in recent decades. Recent work of the past years elucidated how the autonomic nervous system controls the splenic immunity recruited by hypertensive challenges. This review will focus on the neural mechanisms regulating the immune response and the role of this neuroimmune crosstalk in hypertension. In this context, the review highlights the components of the brain-spleen axis with a focus on the neuroimmune interface established in the spleen, where neural signals shape the immune response recruited to target organs of high blood pressure

New Therapies of Liver Diseases

In this Special Issue of the journal, advancements in the treatment of liver diseases are illustrated by international experts in the field. New treatment options for primary biliary cirrhosis and, hopefully, primary sclerosing cholangitis are discussed. Up-to-date pharmacological therapy for preventing liver cirrhosis decompensation and treating acute-on-chronic liver failure is highlighted. Furthermore, new treatments for cholangiocarcinoma, based on biological and tissue markers, will be available in the near future, aiming to surpass the current unsatisfactory results of traditional therapies. Immunotherapy has been applied to hepatocellular carcinoma (HCC). The new first-line treatment, combining atezolizumab plus bevacizumab for HCC in the intermediate and advanced stages, will allow for an increase in patient survival in the near future. Liver transplantation (LT) remains the preferred treatment for many patients with end-stage liver diseases and HCC. The selection criteria for LT in patients with HCC moved from morphological to dynamic criteria, such as those derived from the assessment of tumor responses to locoregional and/or systemic treatments before transplantation. This allowed many patients who would have been excluded from a transplantation with the old selection criteria to access one. Finally, a very interesting issue regarding new indications for liver transplantation is illustrated

Clinical features of COVID-19 among patients with end-stage renal disease on hemodialysis in the context of high vaccination coverage during the omicron surge period: a retrospective cohort study

Background We determined the clinical presentation and outcomes of the Omicron variant of severe acute respiratory syndrome coronavirus 2 infection in hemodialysis patients and identified the risk factors for severe coronavirus disease (COVID-19) and mortality in the context of high vaccination coverage. Methods This was a retrospective cohort study involving hemodialysis patients who were vaccinated against COVID-19 during March–September 2022, when the Omicron variant was predominant, and the COVID-19 vaccination rate was high. The proportion of people with severe COVID-19 or mortality was evaluated using univariate logistic regression. Results Eighty-three (78.3%) patients had asymptomatic/mild symptoms, 10 (9.4%) had moderate symptoms, and 13 (12.3%) had severe symptoms. Six (5.7%) patients required intensive care admission, two (1.9%) required mechanical ventilation, and one (0.9%) was kept on high-flow nasal cannula. Of the five (4.7%) mortality cases, one was directly attributed to COVID-19 and four to pre-existing comorbidities. Risk factors for both severe COVID-19 and mortality were advanced age; number of comorbidities; cardiovascular diseases; increased levels of aspartate transaminase, lactate dehydrogenase, blood urea nitrogen/creatinine ratio, brain natriuretic peptide, and red cell distribution; and decreased levels of hematocrit and albumin. Moreover, the number of COVID-19 vaccinations wasa protective factor against both severe disease and mortality. Conclusions Clinical features of hemodialysis patients during the Omicron surge with high COVID-19 vaccination coverage were significant for low mortality. The risk features for severe COVID-19 or mortality were similar to those in the pre-Omicron period in the context of low vaccination coverage.This work was supported by a research fund of Chung-Ang Jeil Hospital, Chungbuk, South Korea (CAJ-2022-AS 01). Data analysis was supported by the Bio and Medical Technology Development Program of the National Research Foundation, funded by the Korean government (No. 2021M3E5E3081425)

Risk factors and outcomes of oncohematologic patients admitted to Pediatric Intensive Care Unit: ONCOTIPNET, an Italian multicenter study

openNegli ultimi decenni sono stati fatti grandi progressi nell’ambito dell’oncologia pediatrica grazie a una conoscenza più profonda della biologia del cancro, che ha permesso di migliorare l’outcome dei pazienti attraverso protocolli di cura ottimizzati. Tuttavia i bambini con tumore possono sviluppare gravi complicanze legate alla malattia di base e ai trattamenti oncologici e possono necessitare di cure intensivistiche. L’obbiettivo primario del nostro studio è descrivere la popolazione di bambini affetti da tumore ricoverati nelle terapie intensive italiane considerando le variabili legate al periodo antecedente al ricovero in TIP e al ricovero in TIP stesso. L’obbiettivo secondario è identificare i fattori di rischio associati alla mortalità e alla durata di degenza. Materiali e metodi: Questo lavoro è uno studio multicentrico a cui hanno partecipato 14 terapie intensive pediatriche italiane, costituito da una parte retrospettiva e da una parte prospettica. Nello studio sono stati inclusi 538 pazienti ricoverati in terapia intensiva pediatrica tra gennaio 2019 e aprile 2022. La fase retrospettiva ha coinvolto 239 pazienti, mentre la prospettica 299. I dati registrati riguardano sia variabili relative alla fase precedente al ricovero in terapia intensiva che al ricovero in TIP stesso. Nel nostro lavoro sono state analizzate la popolazione generale dello studio, la popolazione di pazienti con tumore solido in rapporto a quella di pazienti con tumore ematologico e la popolazione di bambini trapiantati in rapporto ai bambini non trapiantati. I fattori di rischio per mortalità e durata di degenza relativi al pre-ricovero in TIP e alla degenza in TIP sono stati analizzati mediante analisi univariate e multivariate. Risultati: Tra i 538 pazienti inclusi nello studio il 54% erano maschi. L’età media è stata 7 anni (IRQ 2-12). Le diagnosi di malattia di base sono state le seguenti: tumore solido (51%), leucemia linfoblastica acuta (23%), leucemia mieloide acuta (6.2%), linfoma non Hodgkin (3.8%), linfoma di Hodgkin (6.1%), altro (15%). Il 19% dei pazienti erano stati sottoposti a trapianto di midollo. Le cause principali di ricovero sono state complicanze respiratorie (32%) e neurologiche (23%). La mortalità in terapia intensiva pediatrica è stata del 13%. 428 pazienti sono stati inclusi nelle analisi dei fattori di rischio per la mortalità in TIP e per la durata di degenza in TIP. Dall’analisi multivariata della mortalità sono risultate significative in pre-ricovero le seguenti variabili: HSCT (Hematopoietic Stem Cell Transplantation) (p=0.013), O-PEWS (Oncological Pediatric Early Warning Score) (p=0.010), PIM (Pediatric Index of Mortality) 3 score (p<0.001) and priorità (p=0.012); durante il ricovero le variabili: insufficienza multiorgano (p=0.004) e episodio di arresto cardiaco (p<0.001). Dall’analisi multivariata sulla durata della degenza in TIP è risultata significativa in pre-ricovero in TIP la variabile insufficienza multiorgano (p=0.049); durante la degenza le variabili: durata della ventilazione invasiva e/o non invasiva (p<0.001) e la presenza di NPT (p=0.004). Conclusioni: Il nostro studio riporta una minor mortalità dei pazienti pediatrici oncologici ricoverati in terapia intensiva rispetto agli studi presenti in letteratura. Il riconoscimento precoce dei pazienti a più alto rischio, un’appropriata tempistica nel ricovero in TIP ed un’adeguata terapia potrebbero migliorare ancora di più la sopravvivenza dei pazienti. Il O-PEWS e lo score PIM 3 sono importanti strumenti per determinare la gravità del paziente. Hanno inoltre significato predittivo per la mortalità. Sarebbero tuttavia necessari nuovi aggiornamenti delle linee guida riguardo i criteri di ricovero in TIP, l’appropriatezza e le tempistiche del supporto intensivo in modo da poter assicurare il miglior approccio interdisciplinare e, di conseguenza, migliorare la sopravvivenzaIn the past decades, important progresses have been made in pediatric oncology thanks to a deep understanding of cancer biology that allowed improving patients’ survival and ameliorating their outcomes through the implementation of optimized treatment protocols. However, children with cancer still develop serious complications related either to their disease or to its treatment and may require intensive care. Thus, pediatric oncologic patients and particularly those who also undergo allogeneic hematopoietic stem cell transplantation during their treatment course are to be considered as a high-risk population for intensive care needs. The most common causes for pediatric intensive care unit (PICU) admission in these patients are respiratory and neurological complications, as well as sepsis and multiorgan failure. PICU treatments include respiratory support with invasive and non-invasive ventilation, renal replacement therapy, total parenteral nutrition and eventually extracorporeal membrane oxygenation. Despite various scores have been historically developed to assess the severity of patients’ clinical conditions during their hospitalization, evaluate the actual need for PICU admission and predict mortality, recent and robust studies regarding PICU admitted oncologic children are lacking in the literature. Aim of the study: Our study is aimed at describing the pediatric oncologic population admitted to different Italian PICUs with regard to pre-PICU admission variables and during PICU stay variables. Our secondary endpoint is to identify risk factors associated with PICU mortality and length of PICU stay. Materials and methods: This work is a multicenter retrospective and prospective study involving 14 Italian PICUs. Data were collected from a total of 538 patients admitted to 14 Italian PICUs between January 2019 and April 2022. The retrospective phase involved 239 patients, the prospective phase 299 patients. the data collected include before PICU admission variables and during PICU stay variables. These variables were analysed to describe the overall population of the study, the subpopulations of patients with solid tumor compared to children affected by an hematological neoplasm, and the subpopulations of children who underwent stem cell transplant compared to non-transplanted children. Univariate and multivariate analyses were performed to identify pre PICU admission and PICU stay risk factors for mortality outcome and for length of PICU stay outcome. Results: The 54% of the 538 study patients were males. Median age was 7 years (IRQ 2-12). The underlying diagnoses were: solid tumor (51%), acute lymphoblastic leukemia (23%), acute myeloid leukemia (6.2%), non-Hodgkin lymphoma (3.8%), Hodgkin lymphoma (6.1%), others (15%). 19% of the patients underwent HSCT. The most common admission causes were respiratory failure (32%) and neurological deficits (23%). Mortality in PICU was 13%. 428 patients were included in the analysis of risk factors for mortality in PICU and PICU length of stay (patients admitted after surgery who stayed in PICU less than 48 hours were excluded). The multivariate analysis for risk factors associated with mortality outcome showed significant values for the following pre-PICU admission predictors: HSCT (Hematopoietic Stem Cell Transplantation) (p=0.013), O-PEWS (Oncological Pediatric Early Warning Score) (p=0.010), PIM (Pediatric Index of Mortality) 3 score (p<0.001) and priority level (severity of illness) (p=0.012); PICU stay predictors: multiorgan failure (p=0.004) and cardiac arrest (p<0.001). The multivariate analysis for risk factors associated with length of PICU stay showed significant values for multiorgan failure (p=0.049) as before PICU admission predictor; PICU stay predictors: invasive and/or non-invasive ventilation length (p<0.001) and TPN (p=0.004). Conclusions: Our study reports a lower mortality for pediatric oncologic patients admitted to PICU compared to literature