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Chen J, Li J, Huang F, Fang J, Cao Y, Zhang K, Zhou H, Cai J, Cui W, Chen C, Zhang G. Clinical characteristics, risk factors and outcomes of Klebsiella pneumoniae pneumonia developing secondary Klebsiella pneumoniae bloodstream infection. BMC Pulm Med 2023; 23:102. [PMID: 36978069 PMCID: PMC10052803 DOI: 10.1186/s12890-023-02394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Purpose
The clinical characteristics of Klebsiella pneumoniae (KP) pneumonia and KP bloodstream infection (KP-BSI) are often reported, while the risk factors for KP pneumonia developing into secondary KP-BSI (KP-pneumonia/KP-BSI) are largely unknown. Therefore, this study attempted to investigate the clinical characteristics, risk factors and outcomes of KP-pneumonia/KP-BSI.
Methods
A retrospective observational study was conducted at a tertiary hospital between January 1, 2018, and December 31, 2020. The patients were divided into groups of KP pneumonia alone and KP pneumonia/KP-BSI, and the clinical information were collected from medical records electronic system.
Results
A total of 409 patients were finally recruited. According to the multivariate logistic regression analysis, male sex (adjusted odds ratio [aOR] 3.7; 95% CI, 1.44–9.5), immunosuppression (aOR, 13.52; 95% CI, 2.53,72.22), APACHE II score higher than 21 (aOR, 3.39; 95% CI, 1.41–8.12), serum procalcitonin (PCT) levels above 1.8 ng/ml (aOR, 6.37; 95% CI, 2.67–15.27), ICU stay of more than 2.5 days before pneumonia onset (aOR, 1.09; 95% CI, 1.02,1.17), mechanical ventilation (aOR, 4.96; 95% CI, 1.2,20.5), Klebsiella pneumoniae isolates producing extended spectrum β-lactamase (ESBL-positive KP) (aOR, 12.93; 95% CI, 5.26–31.76), and inappropriate antibacterial therapy (aOR, 12.38; 95% CI, 5.36–28.58) were independent factors of KP pneumonia/KP BSI. In comparison with the patients with KP pneumonia alone, the patients with KP pneumonia/KP BSI showed an almost 3 times higher incidence of septic shock (64.4% vs. 20.1%, p < 0.01), a longer duration of mechanical ventilation, and longer lengths of ICU stay and total hospital stay (median days, 15 vs. 4,19 vs. 6, 34 vs. 17, respectively, both p < 0.01). Additionally, the overall in-hospital crude mortality rate in the patients with KP-pneumonia/KP-BSI was more than two times higher than that in those with KP pneumonia alone (61.5% vs. 27.4%, p < 0.01).
Conclusion
Factors including male sex, immunosuppression, APACHE II score higher than 21, serum PCT levels above 1.8 ng/ml, ICU stay of more than 2.5 days before pneumonia onset, mechanical ventilation, ESBL-positive KP, and inappropriate antibacterial therapy are independent risk factors for KP pneumonia/KP-BSI. Of note, the outcomes in patients with KP pneumonia worsen once they develop secondary KP-BSI, which merits more attention.
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Yan L, Li YM, Li Y, Bai YJ, Wan ZL, Fan JW, Luo LM, Wang LL, Shi YY. Role of serum CXCL9 and CXCL13 in predicting infection after kidney transplant: A STROBE study. Medicine (Baltimore) 2021; 100:e24762. [PMID: 33725942 PMCID: PMC7982190 DOI: 10.1097/md.0000000000024762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023] Open
Abstract
Chemokines are majorly involved in inflammatory and immune responses. The interferon-γ-inducible chemokines C-X-C motif chemokines 9 and 10 (CXCL9 and CXCL10) are considerably associated with Th1 cells and monocytes, and their expression levels rapidly increase during the early episodes of renal allograft rejection and various infectious diseases. CXCL13 is one of the most potent B-cell and T follicular helper-cell chemoattractants. The expression of CXCL13 in the presence of infection indicates an important chemotactic activity in multiple infectious diseases. C-C motif chemokine ligand 2 (CCL2) can attract monocytes and macrophages during inflammatory responses. However, there are no studies on the role of these chemokines in posttransplant infection in kidney transplant recipients.In this study, CXCL9, CXCL10, CXCL13, and CCL2 were analyzed using the Bio-Plex suspension array system before transplant and 30 days after transplant.The serum levels of CXCL9 and CXCL13 30 days after kidney transplant were associated with infection within 1 year after transplant (P = .021 and P = .002, respectively). The serum levels of CXCL9 and CXCL13 before surgery and those of CCL2 and CXCL10 before and after surgery were not associated with infection within 1 year after transplant (P > .05). The combination of postoperative day (POD) 30 CXCL9 and postoperative day 30 CXCL13 provided the best results with an area under the curve of 0.721 (95% confidence interval, 0.591-0.852), with a sensitivity of 71.4% and specificity of 68.5% at the optimal cutoff value of 52.72 pg/mL.As important chemokines, CXCL9 and CXCL13 could be used to predict the occurrence of infection after kidney transplant.
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Affiliation(s)
- Lin Yan
- Department of Laboratory Medicine
| | | | - Yi Li
- Department of Laboratory Medicine
| | | | | | | | | | | | - Yun-Ying Shi
- Department of Nephrology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Wuhou District, Chengdu, Sichuan, China
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Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Flores-Umanzor E, Ivey-Miranda JB, Pujol-Lopez M, Cepas-Guillen P, Fernandez-Valledor A, Caldentey G, Farrero M, García A, Sitges M, Perez-Villa F, Moreno A, Andrea R, Castel Md MA. Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? Rev Port Cardiol 2020; 40:57-61. [PMID: 33303301 DOI: 10.1016/j.repc.2019.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/05/2018] [Accepted: 02/03/2019] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus species can have various clinical presentations including invasive pulmonary aspergillosis (IPA), which has high mortality (53-78%). AIMS To establish the characteristics of IPA infection in HT recipients and their outcomes in our setting. METHODS Of 328 heart transplantations performed in our center between 1998 and 2016, five cases of IPA were identified. Patient medical records were examined and clinical variables were extracted. RESULTS All cases were male, with a mean age of 62 years. The most common indication for HT was nonischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The imaging assessment was based on chest radiography and chest computed tomography. The most commonly reported radiological abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and A. fumigatus was isolated in four cases on BAL culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three patients, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection occurred in three patients. All patients survived after a mean follow-up of 18 months. CONCLUSIONS IPA is a potentially lethal complication after HT. An early diagnosis and prompt initiation of aggressive treatment are the cornerstone for better survival.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Juan Betuel Ivey-Miranda
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Department of Cardiology, Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Margarida Pujol-Lopez
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Guillen Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana García
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Felix Perez-Villa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Disease Department, Hospital Clínic, IDIBAPS, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María A Castel Md
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Luo Y, Tang Z, Hu X, Lu S, Miao B, Hong S, Bai H, Sun C, Qiu J, Liang H, Na N. Machine learning for the prediction of severe pneumonia during posttransplant hospitalization in recipients of a deceased-donor kidney transplant. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:82. [PMID: 32175375 DOI: 10.21037/atm.2020.01.09] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Pneumonia accounts for the majority of infection-related deaths after kidney transplantation. We aimed to build a predictive model based on machine learning for severe pneumonia in recipients of deceased-donor transplants within the perioperative period after surgery. Methods We collected the features of kidney transplant recipients and used a tree-based ensemble classification algorithm (Random Forest or AdaBoost) and a nonensemble classifier (support vector machine, Naïve Bayes, or logistic regression) to build the predictive models. We used the area under the precision-recall curve (AUPRC) and the area under the receiver operating characteristic curve (AUROC) to evaluate the predictive performance via ten-fold cross validation. Results Five hundred nineteen patients who underwent transplantation from January 2015 to December 2018 were included. Forty-three severe pneumonia episodes (8.3%) occurred during hospitalization after surgery. Significant differences in the recipients' age, diabetes status, HBsAg level, operation time, reoperation, usage of anti-fungal drugs, preoperative albumin and immunoglobulin levels, preoperative pulmonary lesions, and delayed graft function, as well as donor age, were observed between patients with and without severe pneumonia (P<0.05). We screened eight important features correlated with severe pneumonia using the recursive feature elimination method and then constructed a predictive model based on these features. The top three features were preoperative pulmonary lesions, reoperation and recipient age (with importance scores of 0.194, 0.124 and 0.078, respectively). Among the machine learning algorithms described above, the Random Forest algorithm displayed better predictive performance, with a sensitivity of 0.67, specificity of 0.97, positive likelihood ratio of 22.33, negative likelihood ratio of 0.34, AUROC of 0.91, and AUPRC of 0.72. Conclusions The Random Forest model is potentially useful for predicting severe pneumonia in kidney transplant recipients. Recipients with a potential preoperative potential pulmonary infection, who are of older age and who require reoperation should be monitored carefully to prevent the occurrence of severe pneumonia.
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Affiliation(s)
- You Luo
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Zuofu Tang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xiao Hu
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Shuo Lu
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Bin Miao
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Songlin Hong
- Fane Data Technology Corporation, Tianjin 300384, China
| | - Haiyun Bai
- Fane Data Technology Corporation, Tianjin 300384, China
| | - Chen Sun
- Fane Data Technology Corporation, Tianjin 300384, China
| | - Jiang Qiu
- Department of Kidney Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Ning Na
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Flores-Umanzor E, Ivey-Miranda JB, Pujol-Lopez M, Cepas-Guillen P, Fernandez-Valledor A, Caldentey G, Farrero M, García A, Sitges M, Perez-Villa F, Moreno A, Andrea R, Castel MA. Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? Rev Port Cardiol 2019; 38:497-501. [PMID: 31495716 DOI: 10.1016/j.repc.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 02/03/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). OBJECTIVES To establish the characteristics of IPA infection in HT recipients and their outcomes in our center. METHODS Among 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. RESULTS All cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. CONCLUSIONS IPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival.
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Affiliation(s)
- Eduardo Flores-Umanzor
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain.
| | - Juan Betuel Ivey-Miranda
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain; Instituto Mexicano del Seguro Social, Department of Cardiology, Cardiology Hospital, Mexico City, Mexico
| | - Margarida Pujol-Lopez
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - Pedro Cepas-Guillen
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | | | - Guillen Caldentey
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - Marta Farrero
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - Ana García
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - Marta Sitges
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - Felix Perez-Villa
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - Asunción Moreno
- University of Barcelona, Hospital Clinic, Infectious Disease Department, Barcelona, Spain
| | - Rut Andrea
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
| | - María A Castel
- University of Barcelona, Cardiology Department, Cardiovascular Institute, Barcelona, Spain
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Flores-Umanzor E, Ivey-Miranda JB, Pujol-Lopez M, Cepas-Guillen P, Fernandez-Valledor A, Caldentey G, Farrero M, García A, Sitges M, Perez-Villa F, Moreno A, Andrea R, Castel MA. Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- Alexis Guenette
- Division of Infectious Disease, University Health Network, University of Toronto, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada
| | - Shahid Husain
- Division of Infectious Disease, Multi-Organ Transplant Program, University Health Network, University of Toronto, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada.
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Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment. Clin Microbiol Rev 2017; 30:277-319. [PMID: 27903593 DOI: 10.1128/cmr.00010-16] [Citation(s) in RCA: 336] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is a significant cause of hospitalization of children in North America and one of the leading causes of death of infants less than 1 year of age worldwide, second only to malaria. Despite its global impact on human health, there are relatively few therapeutic options available to prevent or treat RSV infection. Paradoxically, there is a very large volume of information that is constantly being refined on RSV replication, the mechanisms of RSV-induced pathology, and community transmission. Compounding the burden of acute RSV infections is the exacerbation of preexisting chronic airway diseases and the chronic sequelae of RSV infection. A mechanistic link is even starting to emerge between asthma and those who suffer severe RSV infection early in childhood. In this article, we discuss developments in the understanding of RSV replication, pathogenesis, diagnostics, and therapeutics. We attempt to reconcile the large body of information on RSV and why after many clinical trials there is still no efficacious RSV vaccine and few therapeutics.
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Byrne DD, Reboli AC. Rare Yeast Infections: Risk Factors, Clinical Manifestations, Treatment, and Special Considerations. CURRENT CLINICAL MICROBIOLOGY REPORTS 2017. [DOI: 10.1007/s40588-017-0073-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bagheri Lankarani K, Hojati SA, Heydari ST. Use of C-Reactive Protein as a Diagnostic Tool for Early Detection of Bacterial Infection After Liver Transplantation. HEPATITIS MONTHLY 2016; 16:e41054. [PMID: 27826321 PMCID: PMC5097178 DOI: 10.5812/hepatmon.41054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/13/2016] [Indexed: 02/06/2023]
Affiliation(s)
| | - Seyede Amine Hojati
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Seyede Amine Hojati, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran, E-mail:
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
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DeWitt JC, Germolec DR, Luebke RW, Johnson VJ. Associating Changes in the Immune System with Clinical Diseases for Interpretation in Risk Assessment. CURRENT PROTOCOLS IN TOXICOLOGY 2016; 67:18.1.1-18.1.22. [PMID: 26828330 PMCID: PMC4780336 DOI: 10.1002/0471140856.tx1801s67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This overview is an update of the unit originally published in 2004. While the basic tenets of immunotoxicity have not changed in the past 10 years, several publications have explored the application of immunotoxicological data to the risk assessment process. Therefore, the goal of this unit is still to highlight relationships between xenobiotic-induced immunosuppression and risk of clinical diseases progression. In immunotoxicology, this may require development of models to equate moderate changes in markers of immune functions to potential changes in incidence or severity of infectious diseases. For most xenobiotics, exposure levels and disease incidence data are rarely available, and safe exposure levels must be estimated based on observations from experimental models or human biomarker studies. Thus, it is important to establish a scientifically sound framework that allows accurate and quantitative interpretation of experimental or biomarker data in the risk assessment process.
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Affiliation(s)
- Jamie C DeWitt
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Dori R Germolec
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
| | - Robert W Luebke
- Cardiopulmonary and Immunotoxicology Branch, United States Environmental Protection Agency, Research Triangle Park, North Carolina
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Molecular Diagnosis in Fungal Infection Control. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bianchi D, Vespasiani G, Bove P. Acute kidney injury due to bilateral ureteral obstruction in children. World J Nephrol 2014; 3:182-192. [PMID: 25374811 PMCID: PMC4220350 DOI: 10.5527/wjn.v3.i4.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/28/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.
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