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Clinical Significance Of Serum And Urine Soluble Interleukin 2 Receptor, C-Reactive Protein, Cystatin C, and Serum and Urine Creatinine in Renal Transplant Patients 肾移植患者血清和尿可溶性白介素2受体、C反应蛋白、胱抑素C及血清和尿肌酐的临床意义
IF 1 Q4 Medicine Pub Date : 2022-10-28 DOI: 10.37191/mapsci-2582-6549-3(2)-035
Kazim Khalid
Cytokines play a major role in the inflammatory and allo-specific components of allograft rejection, and in the migration of cells into graft tissue. IL-2 binding of sIL-2R plays a major role in T cell activation. It is suggested that high urinary sIL-2R (U/sIL-2R) in the first 3-5 post-transplant days identified the patient sub-group at risk of developing acute rejection (RX). However, it was difficult to distinguish between RX and infection (INFX) as both of these factors can potentially affect serum sIL-2R (S/sIL-2R) and U/sIL-2R concentrations independent of actual production rates. The aims of this study were to validate and extend previous findings of the use of sIL-2R in renal transplantation, to investigate other protein markers currently used such as serum C-reactive protein (CRP), serum cystatin C (cys. C), and serum and urine creatinine (S/creat. and UCRE) and attempt to differentiate RX from INFX. SIL-2R ELISA kit was validated and used to establish reference ranges in healthy donors, transplant (TX) recipients, and renal disease controls. These values were compared with serial estimations of S/sIL-2R and U/sIL-2R of patients post-TX. Levels of serum CRP, cys. C, S/creat. and UCRE were also investigated in the renal disease control and 21 TX subjects to determine if a panel of investigation would have enhanced clinical diagnosis. RX and INFX were determined retrospectively on an “intention to treat” basis. Results show that sIL-2R levels in normal serum and urine subjects are lower than in disease controls, that CRP and cys C are good indicators of RX as well as U/sIL-2R and S/sIL-2R, that UCRE is not a good marker of differentiation, and that stratifying levels of these markers according to treatment differentiated RX from INFX.
细胞因子在同种异体移植排斥反应的炎症和同种异体特异性成分以及细胞向移植组织的迁移中起主要作用。IL-2结合sIL-2R在T细胞活化中起重要作用。这表明,移植后最初3-5天的高尿sIL-2R (U/sIL-2R)可识别有发生急性排斥反应(RX)风险的患者亚组。然而,很难区分RX和感染(INFX),因为这两种因素都可能影响血清sIL-2R (S/sIL-2R)和U/sIL-2R浓度,而与实际生产速率无关。本研究的目的是验证和扩展sIL-2R在肾移植中使用的先前发现,研究目前使用的其他蛋白质标志物,如血清C-反应蛋白(CRP),血清胱抑素C (cys)。C),血清和尿肌酐(S/creat。和UCRE),并试图区分RX和INFX。对SIL-2R ELISA试剂盒进行验证,并用于建立健康供者、移植(TX)受者和肾脏疾病对照者的参考范围。将这些值与tx后患者S/sIL-2R和U/sIL-2R的序列估计值进行比较。血清CRP水平,cys。C, S /创造。和UCRE也在肾脏疾病控制和21 TX受试者中进行了调查,以确定调查小组是否会提高临床诊断。RX和INFX是在“治疗意向”的基础上回顾性确定的。结果显示,正常人血清和尿液中sIL-2R水平低于疾病对照组,CRP和cys C是RX的良好指标,U/sIL-2R和S/sIL-2R是RX的良好指标,UCRE不是分化的良好指标,根据治疗将这些标志物分层可区分RX和INFX。
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引用次数: 0
Should the First Rejected Kidney Implant be Removed? 第一个被排斥的肾植入物是否应该被移除?
IF 1 Q4 Medicine Pub Date : 2022-10-27 DOI: 10.37191/mapsci-2582-6549-3(2)-036
Kazim Khalid
Renal transplantation (TX) is widely used as a definitive therapy for chronic, end-stage organ failure. T cells are pivotal in rejection (RX), and RX is a process whereby donor tissue is recognized and destroyed by the host immune system. Within a rejecting graft it is likely that high concentrations of IL-2 are present. The binding of interleukin 2(IL-2) to its receptor (IL-2R) on human T cells constitutes the key regulatory event in the initiation and maintenance of the immune response.The receptor, IL-2R, is found in two forms: cellular and soluble. The surgical removal of a transplanted kidney following RX or failure can be hazardous. Two surgical techniques were applied: extracapsular and intracapsular removal. The technique of kidney transplant removal by either the intra- or extra-capsular route of the exact timing of the operation are important features for safe treatment of patients with end-stage graft failure.The results of the report are a prospective study on 21 renal TX recipients, and show that nephrectomy of previous TX kidney will reduce the levels of four markers in serum and urine.
肾移植(TX)被广泛用于慢性终末期器官衰竭的决定性治疗。T细胞在排斥反应(RX)中起关键作用,而RX是供体组织被宿主免疫系统识别和破坏的过程。在排异移植物中,可能存在高浓度的IL-2。白细胞介素2(IL-2)与其受体(IL-2R)在人T细胞上的结合是启动和维持免疫应答的关键调控事件。受体IL-2R以两种形式存在:细胞和可溶性。在RX或衰竭后,手术切除移植肾可能是危险的。采用两种手术技术:囊外和囊内切除。通过囊内或囊外途径进行肾移植手术的准确时机是安全治疗终末期移植失败患者的重要特征。本报告的结果是一项对21例肾TX受者的前瞻性研究,结果显示既往TX肾切除会降低血清和尿液中四种标志物的水平。
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引用次数: 0
A case of disseminated extranodal Rosai–Dorfman disease diagnosed by skin manifestations 皮肤表现诊断为弥漫性结外Rosai–Dorfman病1例
IF 1 Q4 Medicine Pub Date : 2022-10-24 DOI: 10.1002/cia2.12286
Shintaro Saito MD, Akihiko Uchiyama MD, PhD, Yayoi Shibusawa MD, PhD, Sei-ichiro Motegi MD, PhD

Rosai–Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis that was first described as sinus histiocytosis with massive lymphadenopathy by Rosai and Dorfman in 1969. While classical/nodal RDD is typical, extranodal involvement is seen in up to 43% of all cases, with 23% showing only extranodal lesions. Here, we present a case of disseminated extranodal RDD, where the initial symptoms were cutaneous manifestations.

Rosai - Dorfman病(RDD)是一种罕见的非朗格汉斯细胞性组织细胞增多症,于1969年由Rosai和Dorfman首次描述为窦性组织细胞增多症伴大量淋巴结病。虽然经典/淋巴结性RDD是典型的,但高达43%的病例可见到结外病变,其中23%仅表现为结外病变。在此,我们报告一例播散性结外RDD,其初始症状为皮肤表现。
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引用次数: 0
Cold-induced anaphylactic shock during playing in a thigh-deep river: A pediatric case 在大腿深的河里玩耍时冷致过敏性休克:一例儿科病例
IF 1 Q4 Medicine Pub Date : 2022-10-24 DOI: 10.1002/cia2.12285
Ayumi Sakai MD, Naoko Inomata MD, PhD, Kohei Yamakawa MD, Yukie Yamaguchi MD, PhD

We report a pediatric patient with acquired cold urticaria who developed a systemic reaction triggered by localized cold exposure. By determining the critical threshold temperature using TempTest®, we were able to minimize restriction in activities.

获得性冷性荨麻疹(ACU)是一种以局部皮肤反应为特征的物理荨麻疹。据报道,ACU患者在局部冷暴露后发生全身反应,最常见的是完全浸入冷水,但很少由局部接触冷水或冰引起一个四岁的小女孩抱怨夏天在河边玩耍时浑身发痒。水深及大腿,她的腿完全浸在水里,浑身都被水淹了(图1)。她的脸和嘴唇发紫,失去了知觉,最终无法动弹。不久,她的父母把她从水里捞出来,给她加热,症状逐渐消失。没有昆虫叮咬的迹象,发作前也没有吃过不寻常的食物。她拿着冰淇淋甜筒时手发痒,吃冰淇淋时舌头肿胀。没有盗汗、头痛、关节痛或发烧的发作。既往无其他内科疾病,家族史无特应性疾病或寒性荨麻疹。在实验室检查中,血清总IgE水平为32 IU/ml,未检测到冷球蛋白。使用冷刺激装置TempTest®4.0 (Emo Systems GmbH, Berlin, Germany)进行冷刺激试验,在4 - 17°C下诱发车轮,在4 - 19°C下诱发红斑(图1)。因此,患者被诊断为原发性ACU, CTT估计为17°C。在CTT为17°C的基础上,我们指导她保持皮肤温度在20°C以上,基本避免寒冷的环境和食物。此外,我们允许她在炎热的天气在室内温水和室外游泳池游泳不到30分钟,并开抗组胺药预防症状。ACU在人群中的患病率为0.05%,发病年龄多在2 ~ 4岁据报道,儿科发病病例比成人发病病例更容易出现全身反应(25% vs 16.7%)Alangari等人4报道,30名ACU儿童中有11名(36.7%)出现了全身反应,主要是由水生活动引发的,这可能涉及长时间暴露在较宽的体表区域。在以往的病例报告中,大多数全身性症状是由游泳或全身暴露的寒冷环境引发的。我们的病例比之前报道的局部暴露于冷水引发全身反应的病例年轻,后者的年龄为6.5岁。在寒冷性荨麻疹治疗中,根据个体患者的严重程度避免冷刺激是预防全身反应的必要条件。传统的冰块测试无法评估CTT,导致避免所有冷暴露的统一指令。最近,TempTest®被推荐在荨麻疹指南中,为ACU患者制定个性化的治疗计划ACU患者在广泛的冷暴露中可能涉及全身性反应,有时患者不到一半的身体暴露在冷水中。这些知识对于临床医生帮助患者避免危及生命的情况是不可避免的。此外,CTT的评估应考虑更好的患者自我管理。
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引用次数: 0
Adult-onset Still's disease following mRNA-1273 Moderna COVID-19 vaccination: A case report mRNA - 1273现代COVID - 19疫苗接种后成人发病Still's病:1例报告
IF 1 Q4 Medicine Pub Date : 2022-10-19 DOI: 10.1002/cia2.12281
Masahiro Iwata MD, Tatsuya Ogawa MD, PhD, Keisuke Anju MD, Naoko Okiyama MD, PhD, Toshifumi Nomura MD, PhD

A 57-year-old woman who was inoculated with the second dose of the mRNA-1273 Moderna COVID-19 vaccine and then developed adult-onset still’s disease as a result.

一名57岁的女性接种了第二剂信使核糖核酸1273莫德纳新冠肺炎疫苗,随后患上了成人发病的斯蒂尔病。
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引用次数: 2
A successful switch from guselkumab to tildrakizumab during the treatment of a patient with psoriasis vulgaris 在治疗寻常型牛皮癣患者期间,从guelkumab成功切换到tildrakizumab
IF 1 Q4 Medicine Pub Date : 2022-10-19 DOI: 10.1002/cia2.12284
Kazuki Yatsuzuka MD, Masamoto Murakami MD, PhD

This was the first case report in which an in-class IL-23 p19 inhibitor was switched (from guselkumab to tildrakizumab) during psoriasis vulgaris treatment. Four months after the switch, genital lesions, which were the patient's most significant complaint, improved with no subsequent worsening. We believe that our case will aid physicians who work in this problematic clinical setting.

寻常型银屑病(PSV)有多种治疗选择;在生物制剂方面,日本有10多种药物,包括肿瘤坏死因子(TNF)α抑制剂、白细胞介素(IL)17抑制剂、IL12/23p40抑制剂和IL23p19抑制剂。如果上述药物类别中的一种不能显著改善银屑病皮肤病变,我们通常会改用另一类药物。然而,我们也进行“包含”切换,例如,从一种IL17A抑制剂切换到另一种。1由于IL23 p19抑制剂相对较新,因此包含切换功效的证据有限。我们报道了银屑病患者首次成功地从古斯库单抗转为替拉基单抗。一名有10年PSV病史的35岁男子全身出现鳞状和红斑斑块。他的体重指数为30 kg/m2。皮肤损伤对局部皮质类固醇、免疫抑制剂、阿普司特和ustekinumab是难治性的。由于他不愿意使用自动注射器,我们给他开了古斯库单抗(每8周100毫克);这使他的银屑病面积和严重程度指数得分从11.3提高到2.4。然而,只剩下头皮和生殖器损伤。在开始使用古斯库单抗两年后,患者的皮肤病生活质量指数(DLQI)评分为6,主要是因为生殖器病变。此外,他负担不起每8周一次的治疗费用。因此,我们改用替拉单抗(初始给药后每12周100 mg
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引用次数: 1
Dupilumab treatment reduces serum SCCA2 levels in patients with atopic dermatitis Dupilumab治疗降低特应性皮炎患者血清SCCA2水平
IF 1 Q4 Medicine Pub Date : 2022-10-17 DOI: 10.1002/cia2.12282
Kanako Kita MD, Yasutomo Imai MD, PhD, Makoto Nagai MD, PhD, Masaru Natsuaki MD, PhD, Nobuo Kanazawa MD, PhD

Dupilumab treatment reduced serum SCCA2 levels in patients with atopic dermatitis. Interestingly, even though the skin eruptions had not yet fully disappeared, serum SCCA2 levels were reduced well to below normal by the administration of dupilumab.

杜匹单抗治疗可降低特应性皮炎患者血清SCCA2水平。有趣的是,即使皮肤皮疹还没有完全消失,血清SCCA2水平在使用杜匹单抗后也降低到正常水平以下。
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引用次数: 0
Relapsing erythema nodosum-like eruption in a patient with granulomatosis with polyangiitis 肉芽肿合并多血管炎患者复发性结节样红斑
IF 1 Q4 Medicine Pub Date : 2022-10-13 DOI: 10.1002/cia2.12283
Satomi Imamoto MD, Chie Miyabe MD, PhD, Ryujin Miyata MD, Yasuko Fukuya MD, PhD, Naoko Ishiguro MD, PhD

We report a rare case of granulomatosis with polyangiitis (GPA) who presented with relapsing erythema nodosum (EN)-like eruption as a solo vasculitis-associated cutaneous manifestation. We suggest that EN-like eruption alone can be a cutaneous symptom of GPA if subcutaneous medium-sized vessels are exclusively affected.

多血管炎肉芽肿病(GPA),以前称为韦格纳肉芽肿病,是一种抗中性粒细胞胞浆抗体(ANCA)相关的系统性血管炎,以坏死性肉芽肿性炎症为特征,主要影响中小型血管大约30% - 50%的gpa患者有皮肤症状。2皮肤表现各不相同;可触及的紫癜是最常见的发现,丘疹、出血性大疱、溃疡和皮下结节也经常发生;脓疱、囊泡、斑点和点较少见一个61岁的妇女被转介到我们诊所评估红色结节在她的下肢。她在9年前被诊断为GPA。初诊时表现为高热、鼻出血、组织病理学肉芽肿性炎症引起的肺结节、口腔溃疡和血尿。给予口服皮质类固醇和静脉注射环磷酰胺(IVCY)治疗。随访期间,患者复发时多次出现结节性红斑(EN)样皮肤疹。在整个随访期间,细胞质ANCA和蛋白酶3 ANCA均为阴性。在目前的表现中,在下肢观察到多个en样硬化红斑病变(图1A)。硬化红斑的皮肤活检显示淋巴细胞浸润皮下静脉,纤维内膜增生阻塞血管腔(图1B - D)。en样皮肤症状被认为是由GPA的皮下血管炎引起的。随后,患者接受IVCY,随后口服皮质类固醇和硫唑嘌呤。初次皮肤活检六年后,患者出现流感样症状后腿部出现皮疹,再次被转介到我们的诊所。检查时,在小腿和足背观察到多发en样疹(图1E)。皮肤活检示隔膜炎伴混合细胞浸润;然而,即使在连续切片上也未观察到血管炎的组织学证据(图1F,G)。给予较高剂量的口服皮质类固醇,这导致皮肤病变的改善。没有单一的皮肤表现被明确地确定为gpa的病理特征。然而,可触及的紫癜是最常见的皮肤症状(47%),白细胞破坏性血管炎是最常见的病理类型(80%)en样出疹不被认为是典型的皮肤症状,在GPA中通常观察到多种皮肤症状。4据我们所知,这是第一个证明en样出疹是GPA中单独的血管相关皮肤表现的报告。先前的一份报告描述了一名GPA患者,表现为en样皮下结节和室间隔泛膜炎,但组织学上没有明显的血管炎这个病人也有可触及的紫癜,这是由皮肤小血管受累引起的。相比之下,我们的病人没有表现出任何与小血管炎相关的皮肤表现,包括紫癜、丘疹和大疱。我们的研究结果表明,常见于中等血管炎(如结节性多动脉炎)的ENlike爆发可能仅出现在GPA中。由于en样疹是GPA中相对罕见的皮肤表现,皮肤科医生应注意,如果仅影响皮下中等血管,en样疹也可能是GPA的皮肤症状。
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引用次数: 0
Criteria for Accepting or Rejecting Cord Blood Units 接受或拒绝脐带血单位的标准
IF 1 Q4 Medicine Pub Date : 2022-10-10 DOI: 10.37191/mapsci-2582-6549-3(2)-037
Khalid Kazim
Rare hematopoietic stem cell populations are responsible for the transplantation engraftment process. Umbilical cord blood (UCB) is usually processed to the total nucleated cell (TNC), but not to the mononuclear cell (MNC) fraction. TNC counts are used to determine UCB unit storage, release for transplantation and correlation with time to engraftment [1]. It has been mentioned in the literature that there are several factors that affect harvesting of cord blood stem cells [2]. It was set to analyze the relationship between fetal weight and other factors that led to rejection of CBUs brought to DCRC from public and private donations. In this retrospective study, 375 donations of CBUs from January 2018 to October 2018 at DCRC were recorded. From literature, factors that are usually involved in rejection of CBUs were recorded and analyzed to mark the leading cause of rejection criteria. In this study, it showed that results did not find infants’ birth weight or mother’s age to have any value in rejection. Other factors’ results will be discussed.
罕见的造血干细胞群负责移植植入过程。脐带血(UCB)通常被加工成总有核细胞(TNC),而不是单核细胞(MNC)部分。TNC计数用于确定UCB单位储存、移植释放以及与植入时间[1]的相关性。文献中提到,有几个因素会影响脐带血干细胞的采集。本研究旨在分析胎儿体重与其他因素之间的关系,这些因素导致了来自公共和私人捐赠的CBUs对DCRC的排斥反应。在本回顾性研究中,记录了2018年1月至2018年10月DCRC的375例CBUs捐赠。从文献中,记录和分析CBUs排斥反应的常见因素,标记排斥标准的主要原因。在这项研究中,结果显示婴儿的出生体重或母亲的年龄对排异反应没有任何影响。其他因素的结果将被讨论。
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引用次数: 0
Functional and Cellular Immunotherapy (FCIT) Concept 功能和细胞免疫治疗(FCIT)概念
IF 1 Q4 Medicine Pub Date : 2022-10-10 DOI: 10.37191/mapsci-2582-6549-3(2)-034
Khalid Kazim
Inflammation is the process by which the immune system recognizes and removes environmental factors, and begins the healing process. Inflammation can be either acute or chronic. However, the cause of many chronic inflammatory conditions is poorly understood. Chronic inflammatory responses are an ongoing process as long as the environmental factor is present. Sometimes, the response makes the body attack itself.In this paper a closer look at finding out the causes of chronic inflammations, how to treat them on an individual basis, how to reverse the disease early on, and how to repair damages that the inflammation has caused.
炎症是免疫系统识别和消除环境因素并开始愈合过程的过程。炎症可以是急性的也可以是慢性的。然而,许多慢性炎症的病因尚不清楚。只要环境因素存在,慢性炎症反应就是一个持续的过程。有时,这种反应会使身体攻击自己。本文将深入探讨慢性炎症的病因,如何个体化治疗,如何在早期逆转疾病,以及如何修复炎症造成的损害。
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引用次数: 0
期刊
Journal of Cutaneous Immunology and Allergy
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