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Current urinalysis practices in Belgian laboratories towards the 2023 EFLM European urinalysis guideline. 比利时实验室目前的尿液分析方法,以实现 2023 年 EFLM 欧洲尿液分析指南。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-11 DOI: 10.1080/17843286.2024.2414155
Lieve Van Hoovels, Bénédicte Vanhove, An-Sofie Decavele, Arnaud Capron, Matthijs Oyaert

Objectives/background: We aimed to investigate routine urinalysis practices in Belgian laboratories and verify these findings against the 2023 European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) European Urinalysis Guideline.

Methods: A questionnaire was developed to collect information on pre- to postanalytical aspects of urine test strip and particle analysis. The questionnaire was distributed by Sciensano to all Belgian laboratories, licensed to perform urine particle analysis.

Results: Sixty-six percent of the Belgian laboratories (75/113) participated. The responding laboratories served physicians in private (25%), hospital (60%) and university hospital (15%) setting. All laboratories performed test strip and particle analysis, predominantly automatically (97% and 96%, respectively). In addition, most laboratories (87%) used intelligent verification criteria to optimize diagnostic accuracy. Almost all laboratories (≥90%) screened and reported a minimal biochemistry panel (glucose, protein, pH, ketones) and particle count (red and white blood cells). Independent of the technology, a notable variability was observed regarding medical cut-off values and advanced particle differentiation and reporting. Internal quality control was extensively performed for urine test strip (91%) and particle analysis (96%), while external QC was less common (32% and 36%, respectively). Consequently, only few laboratories were ISO15189 accredited for urine test strip (15%) and particle analysis (17%).

Conclusion: There is considerable variability in current urinalysis performed in Belgian laboratories. The 2023 EFLM urinalysis guideline has the potential to guide clinical laboratories towards improving their urinalysis practices. Additional efforts are required to implement these recommendations into clinical practice in Belgium.

目标/背景:我们旨在调查比利时实验室的常规尿液分析方法,并对照欧洲临床化学和实验室医学联合会(EFLM)2023 年欧洲尿液分析指南验证这些调查结果:编制了一份调查问卷,以收集尿液试纸和颗粒分析的分析前和分析后方面的信息。Sciensano公司向比利时所有获得尿液颗粒分析许可证的实验室发放了调查问卷:66%的比利时实验室(75/113)参与了问卷调查。参与调查的实验室为私立医院(25%)、医院(60%)和大学医院(15%)的医生提供服务。所有实验室都进行了试纸和颗粒分析,主要是自动分析(分别为 97% 和 96%)。此外,大多数实验室(87%)使用智能验证标准来优化诊断准确性。几乎所有实验室(≥90%)都筛查并报告了最基本的生化分析(葡萄糖、蛋白质、pH 值、酮体)和微粒计数(红细胞和白细胞)。与技术无关的是,在医学截止值和高级微粒分辨与报告方面存在显著差异。尿液试纸(91%)和微粒分析(96%)广泛采用内部质量控制,而外部质量控制较少(分别为 32% 和 36%)。因此,只有少数实验室的尿液试纸(15%)和颗粒分析(17%)通过了 ISO15189 认证:结论:比利时实验室目前进行的尿液分析存在很大差异。2023 EFLM尿液分析指南有可能指导临床实验室改进尿液分析方法。比利时还需要进一步努力将这些建议落实到临床实践中。
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引用次数: 0
Immune landscape in the glomerular transcriptome of nephrotic syndrome and anca-associated vasculitis. 肾病综合征和相关血管炎肾小球转录组中的免疫景观。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-05 DOI: 10.1080/17843286.2024.2394272
Si Feng, Jianwei Yi, Zhihong He, Zhidan Zhu, Peidan Wei

Background: ANCA-associated vasculitis (AAV), and nephrotic syndrome encompassing diseases including minimal change disease (MCD), focal and segmental glomerulosclerosis (FSG), membranous nephropathy (MN), remain a challenge due to their varied immunological characteristics. Recent therapeutic advancements have highlighted the importance of understanding these diseases' immunological landscapes.

Methods: This study analyzed transcriptomics data from renal glomerular tissues of patients with AAV, FSG, MCD, MN, and normal controls. Utilizing an immune-related gene set of 883 genes, methods including Gene Set Variation Analysis (GSVA), LASSO regression, and Weighted Correlation Network Analysis (WGCNA) were used. Predictions of immune cell compositions were made through CIBERSORT, TIMER, MCPcounter, and quanTIseq algorithms.

Results: The study revealed distinct immunogenetic pathways enriched in each disease: hematopoietic cell lineage in ANCA, linoleic acid metabolism in FSG, PPAR signaling in MCD, and drug metabolism in MN. Classifiers based on immune gene expression showed high accuracy (AUC: ANCA 0.812, FSG 0.99, MCD 1, MN 0.888). Co-expression modules and PPI networks highlighted unique pathways for each disease. Predictions of immune cell composition showed elevated macrophages in FSG and MN, with Treg levels elevated across all four diseases compared to normal controls and highest in FSG. Correlation analyses demonstrated significant associations between classifier scores and immune cell types.

Conclusion: This study offers accurate classifiers for AAV, FSG, MCD, and MN, and reveals distinct immunological pathways. These findings advance personalized treatments and highlight potential therapeutic targets in AAV and nephrotic syndrome. Further research should validate these results for clinical applications.

背景:ANCA相关性血管炎(AAV)和肾病综合征包括微小病变(MCD)、局灶性和节段性肾小球硬化症(FSG)、膜性肾病(MN)等疾病,由于其免疫学特征各不相同,因此仍然是一项挑战。最近的治疗进展凸显了了解这些疾病免疫学特征的重要性:本研究分析了 AAV、FSG、MCD、MN 患者和正常对照组肾小球组织的转录组学数据。利用由 883 个基因组成的免疫相关基因组,采用了基因组变异分析(GSVA)、LASSO 回归和加权相关网络分析(WGCNA)等方法。通过CIBERSORT、TIMER、MCPcounter和quanTIseq算法对免疫细胞组成进行了预测:研究发现,每种疾病都富集了不同的免疫遗传通路:ANCA的造血细胞系、FSG的亚油酸代谢、MCD的PPAR信号转导和MN的药物代谢。基于免疫基因表达的分类器显示出很高的准确性(AUC:ANCA 0.812,FSG 0.99,MCD 1,MN 0.888)。共表达模块和 PPI 网络突出了每种疾病的独特通路。对免疫细胞组成的预测显示,FSG 和 MN 的巨噬细胞水平升高,与正常对照组相比,所有四种疾病的 Treg 水平均升高,其中 FSG 的 Treg 水平最高。相关分析表明,分类器得分与免疫细胞类型之间存在显著关联:这项研究为 AAV、FSG、MCD 和 MN 提供了准确的分类器,并揭示了不同的免疫途径。这些发现推进了个性化治疗,并突出了 AAV 和肾病综合征的潜在治疗靶点。进一步的研究应验证这些结果的临床应用价值。
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引用次数: 0
Expansion of MALDI-TOF MS database as a strategy for identification of Haemophilus species other than H. influenzae. 扩展 MALDI-TOF MS 数据库,将其作为鉴定流感嗜血杆菌以外菌种的一种策略。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-05 DOI: 10.1080/17843286.2024.2386216
Eva Willems, Hannelore Hamerlinck, Anne-Sophie Messiaen, Petra Schelstraete, Eva Van Braeckel, Yannick Vande Weygaerde, Bruno Verhasselt, Jerina Boelens, Stien Vandendriessche

Objectives: This study aimed to evaluate an expanded matrix-assisted laser desorption-ionization-time of flight mass spectrometry (MALDI-TOF MS) database for the identification of Haemophilus species other than H. influenzae (Hi).

Methods: A total of 144 Haemophilus species, cultured from respiratory samples from people (living) with cystic fibrosis, were identified with MALDI-TOF MS and 16S rRNA sequencing. Of these, 99 Haemophilus strains showed >99% similarity with the best matching strain in the National Center for Biotechnology Information (NCBI) database and were assigned to a single Haemophilus subspecies using both MALDI-TOF MS and 16S rRNA sequencing. The MS profiles of a subset of strains (n = 58/99) were added to the Bruker MALDI-TOF MS database. Subsequently, 270 different strains that were analyzed previously in a routine setting were re-analyzed.

Results: 16S rRNA sequencing reliably identified 99/144 Haemophilus strains (>99% similarity). H. haemolyticus 16S rRNA identification was suboptimal since only 3/21 H. haemolyticus strains attained a similarity of >99% with H. haemolyticus 16S rRNA sequence in the NCBI database. Expansion of the MALDI-TOF MS database improved the number of reliable identifications only moderately for H. haemolyticus, H. influenzae and H. paraphrohaemolyticus (<10%). By contrast, improved identification was more outspoken for H. parahaemolyticus, H. parainfluenzae, H. sputorum and H. pittmaniae (>85%).

Conclusion: 16S rRNA sequencing is a valuable method for the identification of Haemophilus sp. other than Hi. Expansion of the MALDI-TOF MS database, based on 16S rRNA sequencing results, increased the proportion of reliable identifications and in this study resulted in an increase of 10% of Haemophilus sp. other than Hi strain identifications.

研究目的本研究旨在评估扩展的基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)数据库,以鉴定除流感嗜血杆菌(Hi)以外的其他嗜血杆菌:方法:通过 MALDI-TOF MS 和 16S rRNA 测序鉴定了从囊性纤维化患者(活体)呼吸道样本中培养出的 144 种嗜血杆菌。其中,99 株嗜血杆菌与美国国家生物技术信息中心(NCBI)数据库中的最佳匹配菌株相似度大于 99%,并通过 MALDI-TOF MS 和 16S rRNA 测序被归入单一的嗜血杆菌亚种。一部分菌株(n = 58/99)的 MS 图谱被添加到布鲁克 MALDI-TOF MS 数据库中。随后,对之前在常规情况下分析过的 270 株不同菌株进行了重新分析:结果:16S rRNA 测序可靠地鉴定出 99/144 株嗜血杆菌(相似度大于 99%)。溶血嗜血杆菌 16S rRNA 鉴定结果不理想,因为只有 3/21 株溶血嗜血杆菌与 NCBI 数据库中的溶血嗜血杆菌 16S rRNA 序列相似度大于 99%。MALDI-TOF MS 数据库的扩展仅适度提高了溶血嗜血杆菌、流感嗜血杆菌和副溶血嗜血杆菌(副溶血嗜血杆菌、副流感嗜血杆菌、唾液腺嗜血杆菌和皮特嗜血杆菌(>85%))的可靠鉴定数量。根据 16S rRNA 测序结果扩充 MALDI-TOF MS 数据库可提高可靠鉴定的比例,在本研究中,除 Hi 菌株外,其他嗜血杆菌的鉴定率提高了 10%。
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引用次数: 0
Single center, real-world retrospective study of CAR-T cell therapy for relapsed/refractory large B-cell lymphoma beyond second line: five-year results at the University Hospitals Leuven. CAR-T细胞疗法治疗复发/难治性大B细胞淋巴瘤二线治疗的单中心真实世界回顾性研究:鲁汶大学医院的五年研究成果。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-01 Epub Date: 2024-09-18 DOI: 10.1080/17843286.2024.2399365
Jan Brijs, Jonas Van Ham, Benedicte Dubois, Franky Sinap, Vibeke Vergote, Daan Dierickx, Peter Vandenberghe

Introduction: Large B-cell lymphomas (LBCL) are the most frequently aggressive B-cell non-Hodgkin lymphomas. Anti-CD19 chimeric antigen receptor (CAR)-T cell therapy has emerged as a new, powerful treatment for relapsed or refractory (R/R) disease. Two CAR-T cell products, tisagenlecleucel (tisa-cel,) and axicabtagene ciloleucel (axi-cel), are reimbursed in Belgium for R/R LBCL beyond second line.

Objectives and methods: We conducted a retrospective cohort study to report the outcome with tisa-cel and axi-cel for R/R LBCL beyond second line in the years 2019-2023 at the University Hospitals Leuven for 79 patients selected for apheresis and CAR-T infusion.

Results: Eleven patients (14%) did not proceed to CAR-T cell infusion. For infused patients (n = 68), the best overall response rate (ORR)/complete response (CR) rate was 64%/49% for tisa-cel and 88%/66% for axi-cel (p = 0.04 for ORR). After a median follow-up of 13.8 months, progression-free survival (PFS) and overall survival (OS) at 1 year were 30% and 43% for tisa-cel and 48% and 62% for axi-cel. Cytokine release syndrome (CRS) (all grades/grade ≥3) occurred in 82%/9% after tisa-cel and in 97%/0% after axi-cel. Immune effector cell-associated neurotoxicity syndrome (ICANS) (all grades/grade ≥3) occurred in 24%/18% after tisa-cel and in 54%/40% after axi-cel. The non-relapse mortality in the infusion cohort was 13%.

Conclusion: Our real-world data show high and durable response rates, with a non-significant trend towards a higher efficacy and higher toxicity for axi-cel compared to tisa-cel. Our results are in line with other real-world registries except for a shorter median OS and more high-grade ICANS.

前言大 B 细胞淋巴瘤(LBCL)是最常见的侵袭性 B 细胞非霍奇金淋巴瘤。抗CD19嵌合抗原受体(CAR)-T细胞疗法已成为治疗复发或难治性(R/R)疾病的一种新的强效疗法。在比利时,两种CAR-T细胞产品--tisagenlecleucel(tisa-cel)和axicabtagene ciloleucel(axi-cel)--可用于治疗二线以上的复发性/难治性LBCL:我们进行了一项回顾性队列研究,以报告鲁汶大学医院在2019-2023年期间对79名被选中进行血液净化和CAR-T输注的R/R LBCL二线以上患者使用tisa-cel和axi-cel的结果:结果:11名患者(14%)未进行CAR-T细胞输注。输注患者(n = 68)的最佳总反应率(ORR)/完全反应率(CR)分别为:tisa-cel 64%/49%,axi-cel 88%/66%(ORR p = 0.04)。中位随访13.8个月后,tisa-cel的无进展生存期(PFS)和1年总生存期(OS)分别为30%和43%,axi-cel为48%和62%。细胞因子释放综合征(CRS)(所有等级/等级≥3)的发生率在 tisa-cel 后为 82%/9%,在 axi-cel 后为 97%/0%。免疫效应细胞相关神经毒性综合征(ICANS)(所有分级/分级≥3)的发生率为24%/18%,阿西凝胶后为54%/40%。输注组的非复发死亡率为13%:我们的真实世界数据显示,阿西凝胶的反应率高且持久,与替萨凝胶相比,阿西凝胶的疗效更高,毒性更强,但趋势并不明显。除了中位OS较短和高级别ICANS较多之外,我们的结果与其他真实世界登记结果一致。
{"title":"Single center, real-world retrospective study of CAR-T cell therapy for relapsed/refractory large B-cell lymphoma beyond second line: five-year results at the University Hospitals Leuven.","authors":"Jan Brijs, Jonas Van Ham, Benedicte Dubois, Franky Sinap, Vibeke Vergote, Daan Dierickx, Peter Vandenberghe","doi":"10.1080/17843286.2024.2399365","DOIUrl":"https://doi.org/10.1080/17843286.2024.2399365","url":null,"abstract":"<p><strong>Introduction: </strong>Large B-cell lymphomas (LBCL) are the most frequently aggressive B-cell non-Hodgkin lymphomas. Anti-CD19 chimeric antigen receptor (CAR)-T cell therapy has emerged as a new, powerful treatment for relapsed or refractory (R/R) disease. Two CAR-T cell products, tisagenlecleucel (tisa-cel,) and axicabtagene ciloleucel (axi-cel), are reimbursed in Belgium for R/R LBCL beyond second line.</p><p><strong>Objectives and methods: </strong>We conducted a retrospective cohort study to report the outcome with tisa-cel and axi-cel for R/R LBCL beyond second line in the years 2019-2023 at the University Hospitals Leuven for 79 patients selected for apheresis and CAR-T infusion.</p><p><strong>Results: </strong>Eleven patients (14%) did not proceed to CAR-T cell infusion. For infused patients (<i>n</i> = 68), the best overall response rate (ORR)/complete response (CR) rate was 64%/49% for tisa-cel and 88%/66% for axi-cel (<i>p</i> = 0.04 for ORR). After a median follow-up of 13.8 months, progression-free survival (PFS) and overall survival (OS) at 1 year were 30% and 43% for tisa-cel and 48% and 62% for axi-cel. Cytokine release syndrome (CRS) (all grades/grade ≥3) occurred in 82%/9% after tisa-cel and in 97%/0% after axi-cel. Immune effector cell-associated neurotoxicity syndrome (ICANS) (all grades/grade ≥3) occurred in 24%/18% after tisa-cel and in 54%/40% after axi-cel. The non-relapse mortality in the infusion cohort was 13%.</p><p><strong>Conclusion: </strong>Our real-world data show high and durable response rates, with a non-significant trend towards a higher efficacy and higher toxicity for axi-cel compared to tisa-cel. Our results are in line with other real-world registries except for a shorter median OS and more high-grade ICANS.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"79 4","pages":"276-284"},"PeriodicalIF":1.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A characterization of the HIV population with limited/exhausted treatment options: a multicenter Belgian study. 治疗方案有限/用尽的艾滋病毒感染者的特征:比利时多中心研究。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-01 Epub Date: 2024-05-30 DOI: 10.1080/17843286.2024.2359184
Rakan Nasreddine, Gilles Darcis, Jean Cyr Yombi, Paul De Munter, Eric Florence, Jens Van Praet, Rémy Demeester, Sabine D Allard, Melanie Schroeder, Ange-Clarisse Dusabineza, Marc Delforge, Stéphane De Wit

Objective: Describe the prevalence and characteristics of people living with HIV (PLWH) in Belgium with limited/exhausted treatment options.

Methods: A cross-sectional, multicenter study involving adult treatment-experienced individuals with limited/exhausted treatment options defined as having a multi-drug resistant HIV-1 or a history of multiple treatment changes. The primary outcome was to determine the prevalence of these individuals and classify them based on their two most recent consecutive HIV-1 viral loads (VLs): suppressed (2 VLs < 50 copies/mL), intermediate (≥1 VL between 50-200 copies/mL), or unsuppressed (2 VLs > 200 copies/mL). Secondary outcome was to characterize the participants included in this analysis.

Results: There were 119 individuals included (prevalence of 0.97%; 119 of 12 282 in care). The majority were aged > 50 years (88.2%), women represented 35.3%, and individuals were primarily White (54.7%). Median (IQR) CD4+ T-cell count was 635 (400-875) cells/µL and most (42%) were on a 3-drug ART regimen. Overall, 87.4% were classified as suppressed, 9.2% as intermediate, and 3.4% as unsuppressed. On multivariable analysis, CD4+ T-cell count < 200 cells/µL was associated with being classified as intermediate or unsuppressed (p = 0.004).

Conclusion: In this analysis of PLWH in Belgium, individuals with limited/exhausted treatment options represented a small fraction. Most were on a 3-drug ART regimen, were virologically suppressed, and had a CD4+ T-cell count within normal range. A small proportion were not virologically suppressed while others, despite being suppressed, were on ≥ 4-drug ART regimens. As such, new therapeutic options are needed to achieve and maintain virologic suppression in such individuals while decreasing their pill burden.

目标:描述比利时治疗方案有限/用尽的艾滋病毒感染者(PLWH)的患病率和特征:描述比利时治疗方案有限/用尽的艾滋病病毒感染者(PLWH)的发病率和特征:这是一项横断面多中心研究,涉及治疗方案有限/用尽的成年治疗经验者,其定义为对多种药物产生抗药性的 HIV-1 感染者或有多次更换治疗方案的历史。主要结果是确定这些人的患病率,并根据他们最近连续两次的 HIV-1 病毒载量(VLs)对他们进行分类:抑制型(两次 VLs 均为 200 copies/mL)。次要结果是分析参与分析者的特征:结果:共纳入 119 人(流行率为 0.97%;12 282 人中有 119 人接受护理)。大多数人的年龄大于 50 岁(88.2%),女性占 35.3%,主要为白人(54.7%)。CD4+ T 细胞计数中位数(IQR)为 635 (400-875) cells/µL,大多数患者(42%)采用三药抗逆转录病毒疗法。总体而言,87.4%的患者被归类为抑制型,9.2%为中度抑制型,3.4%为未抑制型。在多变量分析中,CD4+ T 细胞计数 p = 0.004):在这项对比利时 PLWH 的分析中,治疗方案有限/用尽的患者只占一小部分。大多数人正在接受三药抗逆转录病毒疗法,病毒已被抑制,CD4+ T 细胞计数在正常范围内。一小部分人的病毒未被抑制,而另一部分人尽管病毒已被抑制,但仍在使用≥ 4 种药物的抗逆转录病毒疗法。因此,需要新的治疗方案来实现并维持这些患者的病毒抑制,同时减轻他们的药片负担。
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引用次数: 0
Recurrent rejections after liver transplantation for hepatocellular carcinoma with stem cell features in an adult patient. 一名成年患者因干细胞特征肝细胞癌接受肝移植手术后出现复发性排斥反应。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-01 Epub Date: 2024-07-03 DOI: 10.1080/17843286.2024.2376304
S Meganck, S Raevens, K Ferdinande, X Verhelst, A Hoorens, H Degroote, A Geerts, H Van Vlierberghe

Patients with hepatoblastoma featuring carcinoma characteristics have better outcomes after liver transplantation, than after chemotherapy and resection. Possibly this should be extrapolated to aggressive subtypes of hepatocellular carcinomas in non-cirrhotic livers, where early liver transplantation might also be indicated. However, the risks associated with liver transplantation and immunosuppressive treatment after liver transplantation are once again demonstrated by this case of a 32-year-old women with a negative personal and familial history of liver diseases. She underwent transplantation (DBD) for a hepatocellular carcinoma with stem cell features (HCC-HS; an aggressive 'hepatoblast subtype' of hepatocellular carcinoma) after chemotherapeutical downstaging techniques failed to sufficiently downstage the tumor. Despite being on conventional immunosuppressive regimens (tacrolimus and mycophenolate mofetil with initial corticosteroids tapered), this patient still developed two severe rejection episodes, one of which necessitated retransplantation (DCD). Both episodes were preceded by alterations in tacrolimus trough levels, either intentionally, when tacrolimus was reduced within a nephroprotective regimen, or unintentionally, when rifampicin, a CYP3A4 inducer, significantly lowered the trough levels. Together, these episodes stress the importance of therapeutic drug monitoring of tacrolimus. Furthermore, the patient experienced an everolimus-linked drug-induced thrombotic microangiopathy, underwent multiple ERCPs for an anastomotic stricture and only one and a half year after the first liver transplantation she already suffers from long-term immunosuppressive-related side effects such as impaired glucose tolerance, hypertension and a potential cardiomyopathy. At present, she is still alive and experienced no recurrence of her primary tumor. Her case underscores the significant challenges in post-liver transplantation care.

与化疗和切除术相比,具有癌特征的肝母细胞瘤患者接受肝移植后的疗效更好。这一点或许可以推广到非肝硬化肝细胞癌的侵袭性亚型,在这种情况下,早期肝移植可能也是适用的。然而,肝移植和肝移植后的免疫抑制治疗所带来的风险再次在这例 32 岁女性病例中得到证明,该女性个人和家族肝病史均为阴性。她因患有具有干细胞特征的肝细胞癌(HCC-HS;一种侵袭性 "肝母细胞亚型 "肝细胞癌)而接受了移植手术(DBD),因为化疗分期技术未能充分降低肿瘤的分期。尽管采用了常规的免疫抑制方案(他克莫司和霉酚酸酯,并减量使用皮质类固醇),该患者仍出现了两次严重的排斥反应,其中一次导致了再次移植(DCD)。两次发作之前,他克莫司的谷值都发生了变化,有的是有意为之,即在肾保护方案中减少了他克莫司的用量;有的是无意为之,即 CYP3A4 诱导剂利福平显著降低了谷值。这些情况共同强调了他克莫司治疗药物监测的重要性。此外,患者还经历了依维莫司相关药物引起的血栓性微血管病变,因吻合口狭窄接受了多次ERCP手术,并且在首次肝移植手术后仅一年半,她就出现了与免疫抑制剂相关的长期副作用,如糖耐量受损、高血压和潜在的心肌病。目前,她仍然活着,原发肿瘤也没有复发。她的病例凸显了肝移植术后护理所面临的重大挑战。
{"title":"Recurrent rejections after liver transplantation for hepatocellular carcinoma with stem cell features in an adult patient.","authors":"S Meganck, S Raevens, K Ferdinande, X Verhelst, A Hoorens, H Degroote, A Geerts, H Van Vlierberghe","doi":"10.1080/17843286.2024.2376304","DOIUrl":"10.1080/17843286.2024.2376304","url":null,"abstract":"<p><p>Patients with hepatoblastoma featuring carcinoma characteristics have better outcomes after liver transplantation, than after chemotherapy and resection. Possibly this should be extrapolated to aggressive subtypes of hepatocellular carcinomas in non-cirrhotic livers, where early liver transplantation might also be indicated. However, the risks associated with liver transplantation and immunosuppressive treatment after liver transplantation are once again demonstrated by this case of a 32-year-old women with a negative personal and familial history of liver diseases. She underwent transplantation (DBD) for a hepatocellular carcinoma with stem cell features (HCC-HS; an aggressive 'hepatoblast subtype' of hepatocellular carcinoma) after chemotherapeutical downstaging techniques failed to sufficiently downstage the tumor. Despite being on conventional immunosuppressive regimens (tacrolimus and mycophenolate mofetil with initial corticosteroids tapered), this patient still developed two severe rejection episodes, one of which necessitated retransplantation (DCD). Both episodes were preceded by alterations in tacrolimus trough levels, either intentionally, when tacrolimus was reduced within a nephroprotective regimen, or unintentionally, when rifampicin, a CYP3A4 inducer, significantly lowered the trough levels. Together, these episodes stress the importance of therapeutic drug monitoring of tacrolimus. Furthermore, the patient experienced an everolimus-linked drug-induced thrombotic microangiopathy, underwent multiple ERCPs for an anastomotic stricture and only one and a half year after the first liver transplantation she already suffers from long-term immunosuppressive-related side effects such as impaired glucose tolerance, hypertension and a potential cardiomyopathy. At present, she is still alive and experienced no recurrence of her primary tumor. Her case underscores the significant challenges in post-liver transplantation care.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"234-241"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults. 低镁血症可能与老年人的虚弱、步态和平衡问题以及基本的日常生活活动有关。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-01 Epub Date: 2024-06-07 DOI: 10.1080/17843286.2024.2364143
Suleyman Emre Kocyigit, Bilal Katipoglu

Objectives: The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA).

Methods: 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5-1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders.

Results: 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates.

Conclusion: Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.

研究目的该研究旨在探讨低镁血症、临床前低镁血症和正常镁血症与老年综合征和老年综合指标(CGA)之间的关系。所有患者均接受了 CGA 检查。患者被分为三组:镁(Mg)水平≤1.5 mg/dL、Mg水平1.5-1.8 mg/dL、Mg水平>1.8 mg/dL。这三个组别在人口统计学特征、合并症、CGA参数和老年综合征方面进行了比较。在对混杂因素进行调整后,对重要参数进行了回归分析:74.9%的参与者为女性,平均年龄为(76.5 ± 6.6)岁。低镁血症发生率为 14.2%。三组患者的人口统计学特征和用药情况(包括质子泵抑制剂和利尿剂)相似。低镁血症组的 FRIED 虚弱量表和定时起立行走测试持续时间较长,而低镁血症组的基本日常活动量(ADLs)和 Tinetti-POMA(以表现为导向的行动能力评估)评分较低。以正常镁血症为参照组时,FRIED虚弱量表、基本日常生活能力和POMA评分在低镁血症组更显著(分别为p = 0.025、p = 0.013和p = 0.011),但在临床前低镁血症组,无论协变量如何,均无显著性差异:结论:低镁血症,尤其是血清镁水平低于 1.5 毫克/分升,可能与体弱、基本日常活动能力、步态和平衡测试有关。在老年医学实践中,应从上述疾病风险的角度对低镁血症患者进行评估。
{"title":"Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults.","authors":"Suleyman Emre Kocyigit, Bilal Katipoglu","doi":"10.1080/17843286.2024.2364143","DOIUrl":"10.1080/17843286.2024.2364143","url":null,"abstract":"<p><strong>Objectives: </strong>The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA).</p><p><strong>Methods: </strong>217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5-1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders.</p><p><strong>Results: </strong>74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates.</p><p><strong>Conclusion: </strong>Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"160-167"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The 2024 Flemish consensus on screening for gestational diabetes mellitus early and later in pregnancy. 2024 年弗拉芒关于妊娠早期和晚期妊娠糖尿病筛查的共识。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-01 Epub Date: 2024-07-27 DOI: 10.1080/17843286.2024.2384258
Katrien Benhalima, Ina Geerts, Peggy Calewaert, Marijke Van Rijsselberghe, Dahae Lee, Niels Bochanen, Sabine Verstraete, Luk Buyse, Liesbeth Lewi, Rudi Caron, Inge Tency, Marianne Staquet, Pieter Vermeersch, Johan Wens

Background: Screening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. Due to a lack of evidence, the 2019 Flemish consensus did not recommend screening for GDM in early pregnancy. Recently, a large randomized controlled trial (TOBOGM) demonstrated that screening for GDM before 20 weeks reduces the risk of neonatal complications in women with risk factors when using higher cut-offs to define GDM compared to the criteria used later in pregnancy.

Methods: Based on this new evidence, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VBOV), diabetes nurse educators (BVVDV), dieticians (VBVD) and clinical chemists (RBSLM) have adapted the Flemish consensus on screening for GDM.

Background: Recommendations: As in 2019, this new consensus recommends universal screening for overt diabetes in early pregnancy preferably by measuring fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. Based on the new evidence, women with fasting plasma glucose 95-125 mg/dL (5.3-6.9 mmol/L) before 20 weeks gestation should be diagnosed as early GDM. In addition, in women with obesity and/or a history of GDM, it is advised to perform already a 75 g oral glucose tolerance test (OGTT) between 6 and 20 weeks gestation using higher cut-offs to diagnose early GDM [fasting ≥95 mg/dL (5.3 mmol/L), 1 hour ≥ 19 mg/dL (10.6 mmol/L) and/or 2 hour ≥ 162 mg/dL (9.0 mmol/L))]. The recommendation concerning screening for GDM between 24 and 28 weeks remains unchanged with a diagnosis of GDM based on the 75 g OGTT and IADPSG criteria [fasting ≥ 92 mg/dL (5.1 mmol/L), 1 hour ≥ 180 mg/dL (10.0 mmol/L) and/or 2 hour ≥ 153 mg/dL (8.5 mmol/L)].

背景:妊娠糖尿病(GDM)筛查对于改善妊娠结局和预防妊娠后 2 型糖尿病非常重要。由于缺乏证据,2019 年弗拉芒共识不建议在孕早期筛查 GDM。最近,一项大型随机对照试验(TOBOGM)表明,与妊娠晚期使用的标准相比,如果使用更高的临界值来定义 GDM,那么在 20 周前筛查 GDM 可降低有风险因素的妇女出现新生儿并发症的风险:基于这一新证据,糖尿病联盟(Diabetes Liga)成员、佛兰德全科医生协会(Domus Medica)、产科医生协会(VVOG)、助产士协会(VBOV)、糖尿病护士教育者协会(BVVDV)、营养师协会(VBVD)和临床化学家协会(RBSLM)对佛兰德 GDM 筛查共识进行了调整:背景:建议:与 2019 年一样,这一新共识建议在妊娠早期普遍筛查显性糖尿病,最好采用与非妊娠状态相同的诊断标准测量空腹血浆葡萄糖。根据新证据,妊娠 20 周前空腹血浆葡萄糖为 95-125 mg/dL (5.3-6.9 mmol/L)的女性应诊断为早期 GDM。此外,对于肥胖和/或有 GDM 病史的妇女,建议在妊娠 6-20 周之间进行 75 克口服葡萄糖耐量试验(OGTT),采用更高的临界值来诊断早期 GDM[空腹≥95 毫克/分升(5.3 毫摩尔/升),1 小时≥19 毫克/分升(10.6 毫摩尔/升)和/或 2 小时≥162 毫克/分升(9.0 毫摩尔/升)]。关于在 24-28 周之间筛查 GDM 的建议保持不变,诊断 GDM 的依据是 75g OGTT 和 IADPSG 标准[空腹≥ 92 mg/dL (5.1 mmol/L),1 小时≥ 180 mg/dL (10.0 mmol/L) 和/或 2 小时≥ 153 mg/dL (8.5 mmol/L)]。
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引用次数: 0
Case report: thyrotoxic periodic paralysis, an unusual cause of hypokalemia. 病例报告:甲亢性周期性麻痹,低钾血症的不寻常病因。
IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-01 Epub Date: 2024-06-13 DOI: 10.1080/17843286.2024.2365491
Noor Van den Broeck, Ruben Poesen, Joke Cuypers

Introduction: Thyrotoxic periodic paralysis (TPP) is a type of hypokalemic periodic paralysis that is caused by an underlying thyrotoxicosis. It is a rare cause of hypokalemia due to intracellular potassium shift, causing acute muscle weakness.Case presentation: We present a case of a 19-year-old male of Thai descent with acute proximal symmetric lower limb weakness. The combination of these symptoms with profound hypokalemia, rapid recovery after normalization of serum potassium, and evidence of hyperthyroidism led to the diagnosis of thyrotoxic periodic paralysis, in this case due to an underlying Graves' disease.Conclusion: Clinicians should consider the diagnosis of TPP when a patient presents with the triad of acute paresis, profound hypokalemia and hyperthyroidism.

简介甲状腺毒症周期性麻痹(TPP)是一种低钾血症性周期性麻痹,由潜在的甲状腺毒症引起。它是一种罕见的因细胞内钾转移而导致低钾血症的病因,可引起急性肌无力:我们接诊了一例患有急性近端对称性下肢无力的 19 岁泰国裔男性患者。这些症状与严重的低钾血症、血清钾正常后的快速恢复以及甲状腺功能亢进的证据相结合,导致了甲亢性周期性麻痹的诊断,在该病例中,甲亢性周期性麻痹是由潜在的巴塞杜氏病引起的:结论:当患者出现急性瘫痪、深度低钾血症和甲状腺功能亢进三联征时,临床医生应考虑TPP的诊断。
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引用次数: 0
The potential role of vitamin D binding protein in kidney disease: a comprehensive review. 维生素 D 结合蛋白在肾病中的潜在作用:全面综述。
IF 1.6 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-04-01 Epub Date: 2024-01-03 DOI: 10.1080/17843286.2023.2301278
Joris R Delanghe, Charlotte Delrue, Reinhart Speeckaert, Marijn M Speeckaert

Chronic kidney disease (CKD) is a growing health concern with a complex etiological landscape. Among the numerous factors implicated, vitamin D binding protein (VDBP) has emerged as a focal point of scientific studies because of its critical role in vitamin D metabolism and immune modulation. The relationship between VDBP and CKD reveals a complex web of molecular and biochemical details that have great potential for improving diagnostic understanding and treatment strategies for CKD. This review summarizes the multifaceted roles of VDBP, including its molecular dynamics, interactions with vitamin D, and subsequent implications for kidney function. The main focus of the discussion is how VDBP affects bone mineral homeostasis, highlighted by the dysregulation of calcium and phosphorus metabolism, which is a part of the pathophysiology of CKD. The discussion also touches on the immunomodulatory scope of VDBP and how it may reduce the chronic inflammatory environment that accompanies CKD. The diagnostic potential of VDBP as a biomarker for CKD has been rigorously examined, highlighting its capacity to improve early detection and prognostic assessment. Modification of VDBP activity has the potential to slow the course of CKD and improve patient outcomes. Furthermore, a detailed examination of the genetic polymorphisms of VDBP and their implications for CKD susceptibility and treatment responsiveness provides a perspective for personalized medical methods. Prospects for the future depend on the expansion of studies that try to understand the molecular mechanisms underlying the VDBP-CKD interaction, in addition to clinical trials that evaluate the effectiveness of VDBP-focused treatment approaches.

慢性肾脏病(CKD)是一个日益令人担忧的健康问题,病因复杂。在众多相关因素中,维生素 D 结合蛋白(VDBP)因其在维生素 D 代谢和免疫调节中的关键作用而成为科学研究的焦点。VDBP 与慢性肾功能衰竭之间的关系揭示了复杂的分子和生化细节,这些细节对于改善慢性肾功能衰竭的诊断理解和治疗策略具有巨大的潜力。本综述总结了 VDBP 的多方面作用,包括其分子动力学、与维生素 D 的相互作用以及随后对肾功能的影响。讨论的主要焦点是 VDBP 如何影响骨矿物质平衡,重点是钙磷代谢失调,这是 CKD 病理生理学的一部分。讨论还涉及 VDBP 的免疫调节范围,以及它如何减轻伴随 CKD 出现的慢性炎症环境。VDBP 作为 CKD 生物标志物的诊断潜力已得到严格研究,突出了其改善早期检测和预后评估的能力。改变 VDBP 的活性有可能减缓 CKD 的进程并改善患者的预后。此外,对 VDBP 基因多态性及其对 CKD 易感性和治疗反应性的影响的详细研究为个性化医疗方法提供了一个视角。展望未来,除了评估以 VDBP 为重点的治疗方法的有效性的临床试验外,还有赖于扩大研究,努力了解 VDBP 与 CKD 相互作用的分子机制。
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引用次数: 0
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Acta Clinica Belgica
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