The Value of Urinary Decoy Cells Finding in Patients with Kidney Transplantation

Childhood infection with polyomaviruses leads to a life-long latent infection of renal and urinary tract epithelia. Replication in the reno-urinary epithelium is associated with viral cytopathic changes such as nuclear inclusions and decoy cells. During the 2005-2009 period, cytological urine analysis was performed in 154 samples (94 male and 60 female) from patients with kidney transplantation (n=19), simultaneous pancreas-kidney transplantation (SPKT) (n=9) and simultaneous kidney and liver transplantation (n=2). Urine samples were analyzed monthly following transplantation according to the protocol. The period from transplantation to the first occurrence of decoy cells in the urine and the period of decoy cell persistence in the urine were assessed. The presence of decoy cells (10 decoy cells) and red blood cells (100 E) per cytospin smear was semiquantitatively determined, along with analysis of inflammatory cells (neutrophilic granulocytes) and fungi. In patients with decoy cells detected, their sensitivity, specificity, and negative and positive predictive value for BK virus nephropathy were calculated. Correlation of the study parameters was estimated by use of Kruskal-Wallis test (Statistica 7.1, StatSoft Inc., Tulsa, USA). Decoy cells were found in 30 patients (20 male and 10 female), age median 40 (range 16-69) years, at a mean of day 115 (range day 5–747) post transplantation, whereas their presence was recorded for a mean of 141 (range 77–771) days. Immunohistochemical staining of kidney biopsy sample for polyomavirus (SV40 large T-antigen) yielded positive reaction in 2/30 (7%) patients. Erythrocyturia was present in 29/30 patients with decoy cells. The number of decoy cells per cytospin smear generally ranged less than 10 in 25/30 patients, whereas more than 10 decoy cells per cytospin smear were only recorded in 5/30 patients. Immunohistochemistry produced positive finding for BK virus in one patient with SPKT and simultaneous kidney and liver transplantation each, which was statistically significantly more common as compared with patients with kidney transplantation alone (p=0.0244). Immunohistochemical positivity for BK virus was more significant in cases with more than 10 decoy cells detected in cytospin smear (p=0.013). In BK nephropathy, the finding of urinary decoy cells showed a 100% sensitivity, 84% specificity, 100% negative predictive value and 6% positive predictive value. BK virus nephropathy remains a significant post transplantation complication

Parametrized dataflow scenarios

The FSM-based scenario-aware dataflow (FSM-SADF) model of computation has been introduced to facilitate the analysis of dynamic streaming applications. FSM-SADF interprets application's execution as an execution of a sequence of static modes of operation called scenarios. Each scenario is modeled using a synchronous dataflow (SDF) graph (SDFG), while a finite-state machine (FSM) is used to encode scenario occurrence patterns. However, FSM-SADF can precisely capture only those dynamic applications whose behaviors can be abstracted into a reasonably sized set of scenarios (coarse-grained dynamism). Nevertheless, in many cases, the application may exhibit thousands or even millions of behaviours (fine-grained dynamism). In this work, we generalize the concept of FSM-SADF to one that is able to model dynamic applications exhibiting fine-grained dynamism. We achieve this by applying parametrization to the FSM-SADF's base model, i.e. SDF, and defining scenarios over parametrized SDFGs. We refer to the extension as parametrized FSM-SADF (PFSM-SADF). Thereafter, we present a novel and a fully parametric analysis technique that allows us to derive tight worst-case performance (throughput and latency) guarantees for PFSM-SADF specifications. We evaluate our approach on a realistic case-study from the multimedia domain

Urine Immunocytology as a Noninvasive Diagnostic Tool for Acute Kidney Rejection: a Single Center Experience

Renal biopsy is a gold standard for establishing diagnosis of acute rejection of the renal allograft. However, being invasive, renal biopsy has potential significant complications and contraindications. Therefore, possibility to noninvasively diagnose acute rejection would improve follow-up of kidney transplant patients. The purpose of this study was to evaluate urine immunocytology for T cells as a method for noninvasive identification of patients with acute renal allograft rejection in comparison to renal biopsy. In this prospective study a cohort of 56 kidney, or kidney-pancreas transplant recipients was included. Patients either received their transplant at the University Hospital »Merkur«, or have been followed at the »Merkur« Hospital. Patients were subject to either protocol or indication kidney biopsy (a total of 70 biopsies), with simultaneous urine immunocytology (determination of CD3-positive cells in the urine sediment). Acute rejection was diagnosed in 24 biopsies. 23 episodes were T-cell mediated (6 grade IA, 5 grade IB, 1 grade IIA, 1 grade III and 10 borderline), while in 1 case acute humoral rejection was diagnosed. 46 biopsies did not demonstrate acute rejection. CD3-positive cells were found in 21% of cases with acute rejection and in 13% of cases without rejection (n.s.). A finding of CD3-positive cells in urine had a sensitivity of 21% and specificity of 87% for acute rejection (including borderline), with positive predictive value of 45% and negative predictive value of 68%. Although tubulitis is a hallmark of acute T cell-mediated rejection, detection of T cells in urine sediment was insufficiently sensitive and insufficiently specific for diagnosing acute rejection in our cohort of kidney transplant recipients

Worst-case Throughput Analysis for Parametric Rate and Parametric Actor Execution Time Scenario-Aware Dataflow Graphs

Scenario-aware dataflow (SADF) is a prominent tool for modeling and analysis of dynamic embedded dataflow applications. In SADF the application is represented as a finite collection of synchronous dataflow (SDF) graphs, each of which represents one possible application behaviour or scenario. A finite state machine (FSM) specifies the possible orders of scenario occurrences. The SADF model renders the tightest possible performance guarantees, but is limited by its finiteness. This means that from a practical point of view, it can only handle dynamic dataflow applications that are characterized by a reasonably sized set of possible behaviours or scenarios. In this paper we remove this limitation for a class of SADF graphs by means of SADF model parametrization in terms of graph port rates and actor execution times. First, we formally define the semantics of the model relevant for throughput analysis based on (max,+) linear system theory and (max,+) automata. Second, by generalizing some of the existing results, we give the algorithms for worst-case throughput analysis of parametric rate and parametric actor execution time acyclic SADF graphs with a fully connected, possibly infinite state transition system. Third, we demonstrate our approach on a few realistic applications from digital signal processing (DSP) domain mapped onto an embedded multi-processor architecture

First Documented Case of BK Nephropathy in Kidney Transplant Recipient in Croatia: Usage of Urine Cytology in Evaluation Process

BK virus associated nephropathy (BKVAN) in transplanted kidney, although recognized as a distinct entity in the 1970-es, continues to represent a challenge in kidney transplantation, mainly because the optimal treatment approach has not been determined yet. The fact that about 10–20% of patients have simultaneously some stage of acute rejection, complicate the treatment even more. Herein we present a case of BK nephropathy in the patient, one year after combined liver and kidney transplantation, complicated by episode of acute T-cell mediated rejection. Identification of decoy cells by cytology urine exam in patient with acute kidney graft function deterioration, raised suspicion of BKVAN. Diagnosis has been made by histological examination and confirmed with immunohistochemical staining for BK virus in kidney graft biopsy. One month after he had been treated for BKVAN with intravenous immunoglobulin, leflunomide and overall immunosuppression therapy reduction, there was further deterioration of graft function due to an episode of acute T-cell mediated rejection (Banff classification IA). He received 500 mg of metilprednisolon intravenously and mycophenolate mofetil had been reintroduced, which resulted in slow partial recovery of the graft function, but never to the baseline values. For the past two years his renal graft function has been stable, maintaining lower levels of immunosupressive therapy. According to our knowledge this is the first documented case of BK virus associated nephropathy, diagnosed and confirmed with immunohistochemical staining of tissue from kidney biopsy in Croatia

First Documented Case of BK Nephropathy in Kidney Transplant Recipient in Croatia: Usage of Urine Cytology in Evaluation Process

BK virus associated nephropathy (BKVAN) in transplanted kidney, although recognized as a distinct entity in the 1970-es, continues to represent a challenge in kidney transplantation, mainly because the optimal treatment approach has not been determined yet. The fact that about 10–20% of patients have simultaneously some stage of acute rejection, complicate the treatment even more. Herein we present a case of BK nephropathy in the patient, one year after combined liver and kidney transplantation, complicated by episode of acute T-cell mediated rejection. Identification of decoy cells by cytology urine exam in patient with acute kidney graft function deterioration, raised suspicion of BKVAN. Diagnosis has been made by histological examination and confirmed with immunohistochemical staining for BK virus in kidney graft biopsy. One month after he had been treated for BKVAN with intravenous immunoglobulin, leflunomide and overall immunosuppression therapy reduction, there was further deterioration of graft function due to an episode of acute T-cell mediated rejection (Banff classification IA). He received 500 mg of metilprednisolon intravenously and mycophenolate mofetil had been reintroduced, which resulted in slow partial recovery of the graft function, but never to the baseline values. For the past two years his renal graft function has been stable, maintaining lower levels of immunosupressive therapy. According to our knowledge this is the first documented case of BK virus associated nephropathy, diagnosed and confirmed with immunohistochemical staining of tissue from kidney biopsy in Croatia

Breast cancer : Clinical guidelines proposal

Prijedog kliničke smjernice “Rak dojke” izraðen je u okviru projekta reforme zdravstva na traženje Ministarstva zdravstva Republike Hrvatske, a izradila ga je Stručna grupa HLZ-a Hrvatskoga senološkog društva u sastavu: prof. dr. sc. Ivan Drinković, Poliklinika za radiologiju i ultrazvučnu dijagnostiku, Zagreb, Paula Podolski, dr. med., KBC Zagreb, Mladen Stanec, dr. med., Klinika za tumore, Zagreb, a na temelju smjernica: Scottish Intercollegiate Guidelines Network “Breast cancer”, New Zeland Guidelines Group “Guidelines for the Surgical Management of Breast Cancer”, te Canadian Medical Association “Questions and answers on breast cancer-A guide for women and their physicians”.Proposal for guidelines for the women breast cancer was made as a part of health reform project on demand of Ministery of Health, Republic of Croatia.It was made by Croatian Senology Society Working Group (Ivan Drinković,MD, PhD). Guidelines are based on: Scottish Intercollegiate Guidelines Network “Breast cancer”, New Zeland Guidelines Group “Guidelines for the Surgical Management of Breast Cancer” and Canadian Medical Association “Questions and answers on breast cancer · A guide for women and their physicians”. ”Guideline for clinical practice is systematicaly made documentation wich purpouse is to help physicians and patients to make decisions about clinical aproach to particulary clinical questions” (CEBM-Oxford

Polyomavirus Associated Nephropathy after Kidney and Pancreas Transplantation: Case Report

Polyomavirus virus associated nephropathy (PVAN) is an important cause of graft failure in the renal transplant population. The prevalence of PVAN has increased from 1% to 10% in the past decade, leading to loss of transplanted organ in 30% to 80% of cases. In the absence of specific antiviral drugs, early detection of disease and modification/reduction of immunosuppressive regimen is currently the cornerstone of therapy. In the setting of multiorgan transplantation, like simultaneous pancreas and kidney transplantation (SPKT), diagnosis and therapy of PVAN can be even more challenging problem. We report a first described case of PVAN in patient after SPKT in Croatia. Patient is a 32 years old Caucasian male with type 1 diabetes mellitus and end stage renal failure, diagnosed for PVAN 6 month after SPKT. Patient was treated with reduced immunosuppressive regimen. At 32 month follow up, patient has preserved kidney and pancreas function with estimated glomerular filtration (eGFR) rate of 91 mL/min and no signs of PVAN on his 2 year protocol kidney biopsy

Recommendations of the Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association for people with diabetes and healthcare professionals in the Republic of Croatia during COVID-19 pandemic

Radna skupina Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora pripremila je smjernice za postupanje u pandemiji COVID-19 za osobe sa šećernom bolešću i za zdravstvene djelatnike. U preporukama su naglašeni razmjeri pandemije i moguće posljedice za oboljele od šećerne bolesti. Opisana je klinička slika i ponovljene smjernice Nacionalnog stožera civilne zaštite kako se osobe od šećerne bolesti mogu zaštititi i što trebaju činiti za dobru regulaciju glikemije. Predložene su mjere koje trebaju provoditi zdravstvene ustanove koje skrbe o bolesnicima sa šećernom bolešću i načela zbrinjavanja glikemije u hitnom prijemu i tijekom hospitalizacije.The Working group of the Croatian Society for Diabetes and Metabolic Disorders of the Croatian Medical Association has prepared recommendations for people with diabetes and healthcare professionals in the age of COVID-19 pandemic. The recommendations emphasized the scale of the pandemic and the possible consequences for those suffering from diabetes. Enclosed are clinical presentation and directions of the National civil protection headquarters on the methods that enable people with diabetes to protect themselves, and maintain their blood glucose in target range as well. Measures have been proposed to be implemented by healthcare facilities that deliver care for patients with diabetes, and the principles of glycemic control in emergency department and during hospitalization