Successful transplantation of four kidney grafts from two small pediatric donors with anuric acute renal failure into adult recipients

Background Kidneys from infants with anuric acute kidney injury (AKI) only rarely get accepted for transplantation despite encouraging data that such kidneys can have very good long-term outcome. Methods We report the transplantation of four kidney grafts from two pediatric donors (3 and 4 years) with anuric acute kidney injury as single kidneys into four adult recipients. Results All grafts gained function within 14 days posttransplantation, only one recipient needed dialysis after transplantation. None of the recipients suffered from surgical complications. One month after transplantation, all recipients were free of dialysis. Estimated glomerular filtration rates (eGFR) 3 months after transplantation were 37, 40, 50, and 83 mL/min/1.73 m2. eGFR increased further through month 6, reaching 45, 50, 58, and 89 mL/min/1.73 m2. Conclusion These cases highlight the feasibility of successful transplantation of single pediatric kidney grafts into adult recipients despite anuric AKI of the donor

Plasma exchange for treatment of a therapy-related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma : case report

Key Clinical Message: Thrombotic microangiopathies are a side effect of anti-VEGF therapies, which are often limited to the kidneys but can also occur systemically and be life-threatening. Screening for increasing proteinuria is essential. We present the case of a 65-year-old male patient with a multifocal HCC, Barcelona clinic liver cancer (BCLC) classification B at the time of diagnosis. The HCC was treated with nine sessions of transarterial chemoembolization (TACE), and after a progress, the therapy was switched to a combination of atezolizumab and bevacizumab. Five months after therapy change, he presented with an acute kidney injury. The histopathology of the renal biopsy showed findings of a thrombotic microangiopathy (TMA), which we treated with 12 sessions of therapeutic plasma exchange in combination with steroids, resulting in a decreased TMA activity and later in a remission of the TMA. This case suggests the importance of monitoring the kidney function and proteinuria in patients under anti-vascular endothelial growth factor (VEGF) therapy and shows a rare differential diagnosis for a worsening of kidney function in these patients. Furthermore, it shows that therapeutic plasma exchange might be a valuable therapeutic option for patients with TMA due to anti-VEGF therapy

Validating quantitative PCR assays for cfDNA detection without DNA extraction in exercising SLE patients

Circulating cell-free DNA (cfDNA) has been investigated as a screening tool for many diseases. To avoid expensive and time-consuming DNA isolation, direct quantification PCR assays can be established. However, rigorous validation is required to provide reliable data in the clinical and non-clinical context. Considering the International Organization for Standardization, as well as bioanalytical method validation guidelines, we provide a comprehensive procedure to validate assays for cfDNA quantification from blood plasma without DNA isolation. A 90 and 222 bp assay was validated to study the kinetics of cfDNA after exercise in patients with systemic lupus erythematosus (SLE). The assays showed ultra-low limit of quantification (LOQ) with 0.47 and 0.69 ng/ml, repeatability ≤ 11.6% (95% CI 8.1–20.3), and intermediate precision ≤ 12.1% (95% CI 9.2–17.7). Incurred sample reanalysis confirmed the precision of the procedure. The additional consideration of pre-analytical factors shows that centrifugation speed and temperature do not change cfDNA concentrations. In SLE patients cfDNA increases ~ twofold after a walking exercise, normalizing after 60 min of rest. The established assays allow reliable and cost-efficient quantification of cfDNA in minute amounts of plasma in the clinical setting. Additionally, the assay can be used as a tool to determine the impact of pre-analytical factors and validate cfDNA quantity and quality of isolated samples

Immunoadsorption and plasma exchange : efficient treatment options for neurological autoimmune diseases

Background Therapeutic plasma exchange (TPE) and immunoadsorption (IA) are first or second line treatment options in patients with neurological autoimmune diseases, including multiple sclerosis, neuromyelitis optica spectrum disorders (NMSOD), chronic inflammatory demyelinating polyneuropathy, acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré syndrome), and autoimmune encephalitis. Methods In this prospective randomized controlled monocentric study, we assessed safety and efficacy of therapy with IA or TPE in patients with neurological autoimmune diseases. Treatment response was assessed using various neurological scores as well by measuring immunoglobulin and cytokine concentrations. Clinical outcome was evaluated by application of specific scores for the underlying diseases. Results A total of 32 patients were analyzed. Among these, 19 patients were treated with TPE and 13 patients with IA. IA and TPE therapy showed a comparable significant treatment response. In patients with MS and NMOSD, mean EDSS before and after treatment showed a significant reduction after treatment with IA. We observed a significant reduction of the pro-inflammatory cytokines IL-12, lL-17, IL-6, INF-γ, and tumor necrosis factor alpha during IA treatment, whereas this reduction was not seen in patients treated with TPE. Conclusions In summary, both IA and TPE were effective and safe procedures for treating neurological autoimmune diseases. However, there was a trend towards longer therapy response in patients treated with IA compared to TPE, possibly related to a reduction in plasma levels of pro-inflammatory cytokines seen only in the IA-treated group

Phylogeny-and abundance-based metrics allow for the consistent comparison of core gut microbiome diversity indices across host species

The filtering of gut microbial datasets to retain high prevalence taxa is often performed to identify a common core gut microbiome that may be important for host biological functions. However, prevalence thresholds used to identify a common core are highly variable, and it remains unclear how they affect diversity estimates and whether insights stemming from core microbiomes are comparable across studies. We hypothesized that if macroecological patterns in gut microbiome prevalence and abundance are similar across host species, then we would expect that increasing prevalence thresholds would yield similar changes to alpha diversity and beta dissimilarity scores across host species datasets. We analyzed eight gut microbiome datasets based on 16S rRNA gene amplicon sequencing and collected from different host species to (1) compare macroecological patterns across datasets, including amplicon sequence variant (ASV) detection rate with sequencing depth and sample size, occupancy-abundance curves, and rank-abundance curves; (2) test whether increasing prevalence thresholds generate universal or host-species specific effects on alpha and beta diversity scores; and (3) test whether diversity scores from prevalence-filtered core communities correlate with unfiltered data. We found that gut microbiomes collected from diverse hosts demonstrated similar ASV detection rates with sequencing depth, required different sample sizes to sufficiently capture rare ASVs across the host population. This suggests that sample size rather than sequencing depth tends to limit the ability of studies to detect rare ASVs across the host population. Despite differences in the distribution and detection of rare ASVs, microbiomes exhibited similar occupancy-abundance and rank-abundance curves. Consequently, increasing prevalence thresholds generated remarkably similar trends in standardized alpha diversity and beta dissimilarity across species datasets until high thresholds above 70%. At this point, diversity scores tended to become unpredictable for some diversity measures. Moreover, high prevalence Frontiers in Microbiology. Filtering Effects on Core Microbiome thresholds tended to generate diversity scores that correlated poorly with the original unfiltered data. Overall, we recommend that high prevalence thresholds over 70% are avoided, and promote the use of diversity measures that account for phylogeny and abundance (Balance-weighted phylogenetic diversity and Weighted Unifrac for alpha and beta diversity, respectively), because we show that these measures are insensitive to prevalence filtering and therefore allow for the consistent comparison of core gut microbiomes across studies without the need for prevalence filtering.publishedVersio

Manejo da mastalgia

Breast pain is a common problem in the setting of both primary care and specialized breast treatment clinics. For the majority of women, breast pain is a self-limiting condition that requires no treatment other than reassurance. Nevertheless, in a few cases, severe, prolonged cyclical or noncyclical breast pain may affect social, sexual, and work aspects of the patient's life. Firstly, when confronted with patients complaining of breast pain, physicians must determine whether it is of mammary or extramammary source. If the problem originates from the breast itself, further management depends on its nature, severity, and duration. In average, only 3 per cent of patients complaining from breast pain require pharmacological treatment. In this study, we reviewed the main aspects of breast pain, its etiology, and its pharmacological treatment.Mastalgia ou dor mamária é um sintoma comum tanto em clínicas especializadas quanto na atenção primária. Na maioria dos casos é condição auto-limitada que não requer outro tratamento senão esclarecimento e tranqüilização. Em poucos casos, no entanto, mastalgia severa, prolongada, cíclica ou não, pode levar a distúrbios social, sexual e profissional sérios para a paciente. Primeiramente, o clínico deve estabelecer se a patologia é de fato de origem mamária, ou extramamária, para após quantificar tal queixa e estabelecer tratamento farmacológico, ou não. Em média, apenas 3% das pacientes com mastalgia requerem tratamento medicamentoso. Neste estudo, fez-se revisão das principais causas de dor mamária e dos tratamentos farmacológicos mais importantes disponíveis no momento

Smart Connected Farms and Networked Farmers to Tackle Climate Challenges Impacting Agricultural Production

To meet the grand challenges of agricultural production including climate change impacts on crop production, a tight integration of social science, technology and agriculture experts including farmers are needed. There are rapid advances in information and communication technology, precision agriculture and data analytics, which are creating a fertile field for the creation of smart connected farms (SCF) and networked farmers. A network and coordinated farmer network provides unique advantages to farmers to enhance farm production and profitability, while tackling adverse climate events. The aim of this article is to provide a comprehensive overview of the state of the art in SCF including the advances in engineering, computer sciences, data sciences, social sciences and economics including data privacy, sharing and technology adoption

Offspring Microbiomes Differ Across Breeding Sites in a Panmictic Species

High dispersal rates are known to homogenize host’s population genetic structure in panmictic species and to disrupt host local adaptation to the environment. Long-distance dispersal might also spread micro-organisms across large geographical areas. However, so far, to which extent selection mechanisms that shape host’s population genetics are mirrored in the population structure of the enteric microbiome remains unclear. High dispersal rates and horizontal parental transfer may homogenize bacterial communities between breeding sites (homogeneous hypothesis). Alternatively, strong selection from the local environment may differentiate bacterial communities between breeding sites (heterogeneous hypothesis). Furthermore, selection from age-specific environmental or physiological factors may differentiate the microbiome between juveniles and adults. Here, we analyzed the cloacal bacterial 16S rRNA gene of fledgling greater flamingos, Phoenicopterus roseus, across nine western Mediterranean breeding sites and four breeding seasons (n = 731) and adult birds (n = 27) from a single site. We found that fledgling cloacal microbiome, as measured by alpha diversity, beta diversity, the relative abundance of assigned sequence variants (ASVs) belonging to a phylum and genus composition within phylum, varied significantly between sampling sites and across time within site despite high adult dispersal rates. The spatio-temporal effects were stronger on individual ASV absence/presence than on ASV abundance (i.e., than on core microbiome composition). Spatial effects had a stronger effect than temporal effects, particularly on ASV abundance. Our study supports the heterogeneous hypothesis whereby local environmental conditions select and differentiate bacterial communities, thus countering the homogenizing effects of high-dispersing host species. In addition, differences in core microbiome between adult vs. fledgling samples suggests that differences in age-specific environmental and/or physiological factors result in differential selection pressure of core enteric microbiome between age classes, even within the same environment. In particular, the genus Corynebacterium, associated with both seasonal fat uptake and migration in previous studies, was much more abundant in high-dispersing fledglings than in more resident adults. To conclude, selection mechanisms that shape the host’s genetic structure cannot be extended to the genetic structure of the enteric microbiome, which has important implications regarding our understanding of both host local adaptation mechanisms and enteric microbiome population genetics

Doença de Mondor secundária a herpes zoster torácico

The Mondor's disease, or phlebitis of the thoracoepigastric vein, is self-restricted and clinically manifested by local pain associated with a tender, palpable, subcutaneous cord. It can be secondary to a local trauma, surgery, inflamatory processes or even to a breast cancer. Mammography and/or ultrasound should be carried out in women with this diagnosis who are age 35 or older to exclude the possibility of a nonpalpable breast cancer. Even though the disease not necessarily has to be associated to another event, twenty-five percent are associated with a subjacent neoplasia. We reported here a case of Mondor's disease secondary to an infra-mammary Herpes Zoster. The disease is rare on clinical practice and the physician must be aware of this rare diagnosis. In this case, the finding associated to herpetic lesions made it even more curious and special.A doença de Mondor, ou flebite da veia toracoepigástrica, é auto-limitada e manifestase clinicamente por dor local acompanhada por um cordão subcutâneo de temperatura elevada. Pode ser achado isolado ou estar associada a trauma local, intervenções cirúrgicas, processos inflamatórios ou mesmo a um carcinoma. Pacientes com esse diagnóstico e idade igual ou superior a 35 anos têm indicação de complementar sua avaliação radio e/ou ecograficamente para excluir carcinoma de mama impalpável, pois a doença de Mondor pode estar associada à neoplasia maligna subjacente em até 25% das vezes. Relatamos aqui um caso de doença de Mondor secundária a herpes Zoster em região infra-mamária. A doença de Mondor é entidade rara na prática médica e necessita de profissionais experientes para que se firme o diagnóstico, que é exclusivamente clínico. Vale salientar que, neste caso, o curioso e surpreendente é a doença estar associada a lesões herpéticas.&nbsp