Antibody-Mediated Rejection and Recurrent Primary Disease: Two Main Obstacles in Abdominal Kidney, Liver, and Pancreas Transplants

The advances in acute phase care have firmly established the practice of organ transplantation in the last several decades. Then, the next issues that loom large in the field of transplantation include antibody-mediated rejection (ABMR) and recurrent primary disease. Acute ABMR is a daunting hurdle in the performance of organ transplantation. The recent progress in desensitization and preoperative monitoring of donor-specific antibodies enables us to increase positive outcomes. However, chronic active ABMR is one of the most significant problems we currently face. On the other hand, recurrent primary disease is problematic for many recipients. Notably, some recipients, unfortunately, lost their vital organs due to this recurrence. Although some progress has been achieved in these two areas, many other factors remain largely obscure. In this review, these two topics will be discussed in light of recent discoveries.

Secondary findings from whole-exome sequencing data in families with familial combined hyperlipidemia (FCHL)

Background During the interpretation of genome sequencing data, some types of secondary findings are identified that are located in genes that do not appear to be related to the causes of the primary disease. Although these are not the primary targets for evaluation, they have a high risk for some diseases different from the primary disease. Therefore, they can be vital for preventing and intervention from such disease. Results Here, we analyzed secondary findings obtained from WES in 6 families with FCHL disease who had an autosomal-dominant pattern based on their pedigrees. These finding are found in CDKAL1, ITGA2, FAM111A, WNK4, PTGIS, SCN10, TBX20, DCHS1, ANK2 and ABCA1 genes. Conclusions Secondary findings are very important and must be considered different variants from sequencing results in a diagnostic setting. Although we have considered these variants as secondary findings, some of them may be related to the primary disease.

Genotype resistance of hybrid corn varieties candidate against major corn diseases

The resistance level of several national superior corn varieties to the primary disease of corn is still varied and unstable. Therefore, evaluating the resistance of hybrid corn varieties candidate to the primary disease of corn is deemed necessary as an initial step in managing the disease. This study aimed to evaluate the resistance reaction of the hybrid corn varieties candidate against the primary disease of corn. This study was conducted at two different locations. The first location was at the Agricultural Technology Research and Assessment Installation (ATRAI) of the Indonesian Cereals Research Institute in Bajeng District, Gowa Regency, South Sulawesi first, where the test for P. phillipinensis downy mildew, leaf blight, and leaf rust was conducted. The next location was at the ATRAI of Muneng of the Research Institute for Various Nuts and Tubers in Probolinggo, East Java, where the test for the P. maydis downy mildew was conducted. The tests were carried out using plants as the source of the test pathogen inoculum planted around the experimental block. The four corn genotypes tested were CHC1, CHC02, CHC3, CHC5, and CHC5. Meanwhile, the comparison varieties used were P36, Pertiwi-6, PAC339, BISI18, Anoman, and Pulut. The test results showed the two hybrid corn varieties candidate that were moderately resistant to P. philipinensis, namely CHC1 and CHC2, with attack intensities of 30.94% and 32.07%, respectively; one variety candidate resistant to P. maydis, namely CHC1 with an attack intensity of 15.92%. Meanwhile, the five hybrid corn varieties candidate, namely CHC1, CHC02, CHC3, CHC5, and CHC5, showed a moderately resistant reaction to maydis leaf blight and leaf rust with an attack intensity of 35%.

The anesthesiologist and Covid-19 endocrinopathies

Covid-19 disease created a havoc since 2019, affected large number of number of people over worldwide. As the second wave is receding, we will be receiving patients with the long-term effects of Covid-19 for the surgeries either for their primary disease or for the complications arising from the Covid-19. Primarily, the Covid-19 is a disease affecting the pulmonary and cardiac system, many other systems including renal, hematology, central nervous, endocrine etc. also damaged with the same. Various endocrine glands are being involved in Covid-19 disease like pancreas, thyroid, pituitary, adrenals, reproductive system etc. as they are highly expressed with ACE. This may even lead to the permanent damage. Because of the unfamiliarity with the disease, plausible impact on the endocrine functions is still unclear. This article elaborates various endocrine manifestations of SARS Cov and SARS Cov-2 for better understanding and management of Covid-19 recovered patients.

Effects of Preoperative Drug Holiday On Sequester Separation and Treatment Outcome in Cancer Patients With Medication-Related Osteonecrosis of The Jaw

We aimed to investigate whether antiresorptive agent drug holidays contributed to the formation of sequester separation and treatment outcome in medication-related osteonecrosis of the jaw (MRONJ) patients whose primary disease was malignancy. A total of 105 MRONJ patients with malignant tumors as the primary disease who underwent surgery at Nagasaki University Hospital and Kansai Medical University Hospital from January 2009 to December 2020 were included. We recorded patient age, sex, primary disease (solid cancer, non-solid cancer), MRONJ stage, type and administration period of antiresorptive agents, presence of diabetes, corticosteroid use, drug holiday period, white blood cell count, serum, albumin, serum creatinine, outcomes, and computed tomography findings. We examined the relationship between a drug holiday and sequester separation and outcome. Drug holiday of more than 90 days (P=0.629) was not a significant factor for sequester separation in the univariate analysis. In the multivariate analysis, steroid use (P=0.009) and serum albumin (P=0.003) were extracted as factors affecting prognosis; withdrawal for more than 90 days (P=0.98) was not a significant factor. MRONJ patients with cancer as the primary disease should be operated early without drug holidays if their general condition is relatively good, clinical symptoms are strong, and quality of life is improved.

Reinfection with relapsing fever. Schubert (Wedge Med., June 1922)

On the basis of both his own observations and the data available in the literature, Schubert (Klin. Med., June 1922) comes to the conclusion that relapsing fever does not give persistent immunity, after which reinfection is sometimes observed in both humans and animals; the latter can proceed with 1.2 or more attacks, and the nature of the primary disease and its duration do not seem to have a noticeable effect on the course of the disease during reinfection. In the opinion of this author, in order to avoid the spread of the disease, it is necessary to withstand recurrent typhoid patients in medical institutions with a normal temperature of 20 days, and any attack that occurs after this period can be considered reinfection.

683Data envelopment analysis for predicting pre-diabetes for primary disease prevention

Background Identifying a population at risk of risks is imperative for primary disease prevention and allows the promotion of health maintenance in a healthy population. Previous studies on hypertension and dyslipidemia using data envelopment analysis (DEA) showed that populations at risk of risks could be identified using this method. In this study, we extended DEA to include pre-diabetes. Methods A retrospective cohort study was conducted using specific health check-up data from 2008 to 2013. DEA efficiency scores were calculated for healthy subjects with baseline glycated hemoglobin (HbA1c) <5.7%. Odds ratios (ORs) for pre-diabetes onset within 3 years were analyzed. Results Among 1,501 subjects, with 373 cases of disease onset (24.9%), the OR for the incidence of pre-diabetes (on the basis of a 0.1-point increase in the efficiency score) was 0.77 (90% confidence interval [CI] 0.68–0.86, p < 0.0002). After adjusting for age and sex, the OR was 0.66 (90% CI 0.58–0.75, p < 0.0001). Furthermore, for the subgroup with no conventional diabetes risk factors, the adjusted OR was 0.50 (90% CI 0.38–0.67, p = 0.0001). Conclusions We showed that the DEA efficiency score can help identify a pre-diabetes population at risk of risks. Further studies to validate these findings would be worthwhile for optimizing primary preventative measures. Key messages DEA was assessed for its ability to evaluate the risk of pre-diabetes. Results showed that an efficiency score could predict pre-diabetes onset and demonstrated the feasibility of applying this analysis in primary preventive healthcare.

Kidney transplantation outcomes in patients with IgA nephropathy and other glomerular and non-glomerular primary diseases in the new era of immunosuppression

Objectives Kidney transplant (KTx) recipients with IgAN as primary disease, were compared with recipients with other causes of renal failure, in terms of long-term outcomes. Methods Ninety-nine KTx recipients with end-stage kidney disease (ESKD) due to IgAN, were retrospectively compared to; i/ a matched case-control group of patients with non-glomerular causes of ESKD, and ii/ four control groups with ESKD due to glomerular diseases; 44 patients with primary focal segmental glomerulosclerosis (FSGS), 19 with idiopathic membranous nephropathy (IMN), 22 with lupus nephritis (LN) and 21 with pauci-immune glomerulonephritis (PIGN). Results At end of the observation period, graft function and survival, were similar between KTx recipients with IgAN and all other groups, but the rate of disease recurrence in the graft differed significantly across groups. The rate of IgAN recurrence in the graft was 23.2%, compared to 59.1% (p<0.0001) in the FSGS group, 42.1% (p = 0.17) in the IMN group, and 0% in the LN and PIGN groups (p = 0.01). IgAN recipients, who were maintained with a regimen containing tacrolimus, experienced recurrence less frequently, compared to those maintained with cyclosporine (p = 0.01). Graft loss attributed to recurrence was significantly higher in patients with FSGS versus all others. Conclusion Recipients with IgAN as primary disease, experienced outcomes comparable to those of recipients with other causes of ESKD. The rate of IgAN recurrence in the graft was significantly lower than the rate of FSGS recurrence, but higher than the one recorded in recipients with LN or PIGN. Tacrolimus, as part of the KTx maintenance therapy, was associated with lower rates of IgAN recurrence in the graft, compared to the rate cyclosporine.