Inflammatory changes in perivascular adipose tissue are associated with atherosclerotic lesions in the adjacent artery and can also be used as a marker in patient workup. While adipocyte size is known to be closely related to adipose tissue dysfunction and inflammation, it has not been widely studied in perivascular adipose tissue obtained from healthy human subjects without clinical atherosclerosis. In this cross-sectional study, we addressed this issue by measuring adipocyte size and defining its relationship to cardiovascular risk factors in a healthy cohort of living kidney donors. The presence of cardiovascular risk factors was established by a standardized questionnaire, clinical measurements and body composition analyses. Adipocyte size was measured in the perivascular depot. The proportions of various macrophage subtypes were determined by flow cytometry. To confirm the results, the proportion of CD68 + macrophages was additionally assessed by immunohistochemistry. A correlation and principal component analyses were performed to explore associations. Adipocyte size in perivascular adipose tissue correlated with markers of lipid metabolism, inflammation, and glucose metabolism. Further, the positive correlation with the pro-inflammatory subpopulation of macrophages suggests a strong local effect of perivascular adipose tissue. Perivascular adipocyte size was associated with cardiovascular risk factors and markers of inflammation in a healthy cohort of living kidney donors. This further supports the local role of adipose tissue dysfunction and inflammation in early atherosclerosis development and detection.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipidy * MeSH
- makrofágy metabolismus MeSH
- metabolismus lipidů MeSH
- průřezové studie MeSH
- tuková tkáň metabolismus MeSH
- tukové buňky * metabolismus cytologie MeSH
- velikost buňky MeSH
- zánět * metabolismus patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Intravenous immunoglobulins (IVIG) are commonly used in peri-transplant desensitization, but evidence supporting their efficacy is limited. We conducted a prospective, randomized single-center, open-label, Phase IIIb non-inferiority clinical pilot trial to compare the efficacy of IVIG (administered at a dose of 3 × 0.5 g/kg) versus no IVIG, in conjunction with rabbit anti-thymocyte globulin (5-7 mg/kg) induction, in pre-sensitized patients with donor-specific antibodies who had negative pre-transplantation Flow- and CDC-crossmatches, between July 2020 and November 2022. The primary endpoint was the rate of efficacy failure, defined as biopsy-proven rejection within 12-month post-transplant. Secondary endpoints included the incidence of rejection at protocol biopsies, evaluated by histology and biopsy-based transcripts diagnostics. Of the screened patients, 53 (72.6%) were excluded due to crossmatch positivity. Ten patients were randomized to the IVIG+, and 7 to the IVIG-arm. The trial was prematurely terminated due to futility at interim analysis. In the IVIG-arm, 3 patients (43%) experienced the primary endpoint compared to none in the IVIG+ arm (p = 0.026). MMDx identified one molecular ABMR in the IVIG+ and 2 in the IVIG-arm in 12-month protocol biopsies. There was one graft loss in the IVIG-arm. The results of this pilot study, although not definitive, do not support the use of IVIG-sparing regimens in HLA-incompatible kidney transplantation (NCT04302805). This study is registered on ClinicalTrials.gov under the identifier NCT04302805.
- MeSH
- antilymfocytární sérum * aplikace a dávkování MeSH
- desenzibilizace imunologická * metody MeSH
- dospělí MeSH
- intravenózní imunoglobuliny * aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- prospektivní studie MeSH
- rejekce štěpu * prevence a kontrola imunologie MeSH
- transplantace ledvin * škodlivé účinky MeSH
- výsledek terapie MeSH
- zvířata MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- randomizované kontrolované studie MeSH
The importance of macrophage polarization through atherogenesis is established. However, most studies rely on immunohistological approaches, which have several limitations, such as precluding comprehensive phenotypic analysis. The aim of this study was to perform an alternative analysis of macrophage phenotypes in advanced human atherosclerotic plaques and compare them with their presence in non-atherosclerotic arteries. Atherosclerotic plaques from 70 individuals indicated for carotid endarterectomy, and samples of non-atherosclerotic arterial tissue (renal artery, control group) from 45 living kidney donors were processed to obtain immunocytes and incubated with antibodies (CD45, CD14, CD16, CD36, CD163, and CD206) to be analyzed by flow cytometry. Macrophages in the atherosclerotic plaques tend to express CD16 more intensively than in non-atherosclerotic arterial tissue (transient, CD16lowp < 0.001, pro-inflammatory, CD16highp < 0.001), and the expression is more closely associated with CD36 expression. Both transient and pro-inflammatory macrophages are linked with the CD206-CD163+ or CD206+CD163+ phenotype in atherosclerotic plaques, while CD206-CD163- dominates within the anti-inflammatory (CD16neg) population in the control group. Interestingly, when evaluating all macrophages (regardless of CD16 expression), almost all are CD163+ in both groups, supporting the critical importance of using a combination of specific markers. Our results provide a deeper insight into macrophage subpopulations in advanced human atherosclerotic plaques compared with those in non-atherosclerotic vessels. Additionally, our data highlight the critical importance of using appropriate techniques, such as flow cytometry, allowing for simultaneous analysis of multiple markers to accurately and comprehensively characterize macrophages within the atherosclerotic plaque.
- Publikační typ
- časopisecké články MeSH
Ůvod: Korálová aorta (coral reef aorta – CRA) je vzácná klinická jednotka charakterizovaná vystupujícími kalcifikacemi v juxta- a suprarenální aortě, které způsobují hemodynamicky významné stenózy aorty a jejích větví. Prezentujeme kazuistiku 65leté pacientky s oboustrannými 30metrovými klaudikacemi dolních končetin a klinicky významnou stenózou levé renální tepny. Kazuistika: Vstupní vyšetření počítačovou tomografickou angiografií (CTAG) břišní aorty a dolních končetin u pacientky prokázalo významnou cirkulární kalcifikaci břišní aorty s propagací do oblasti větvení renálních tepen, způsobující hemodynamicky významnou stenózu aorty a levé renální tepny. U pacientky byl indikován elektivní chirurgický výkon. Z levého retroperitoneálního přístupu byla vypreparovaná abdominální aorta vč. obou renálních tepen. Cévní svorky byly nasazeny na obě renální tepny, subrenální aortu a suprarenální aortu, těsně pod odstupem horní mezenterické tepny. Proximálně byla provedena přímá endarterektomie aorty vč. plátů zasahujících do levé renální tepny; distálně byla endarterktomie ukončena v oblasti ústí obou společných ilických tepen. Výsledek: Pacientka byla dimitována domů 8. pooperační den s fyziologickými renálními parametry, normální perfuzí obou ledvin a po krátké pooperační rehabilitaci i bez limitujících klaudikací obou dolních končetin. V současné době máme s pacientem 12měsíční sledování. Závěr: CRA je vzácnou klinickou jednotkou. Ideální způsob intervence zatím stanoven není. V současné době se jako zlatý standard léčby CRA jeví chirurgická endarterektomie.
Introduction: Coral reef aorta (CRA) is a rare clinical entity characterised by hard, protruding calcifications in the juxta and supra-renal aorta, which cause haemodynamically significant stenosis of the aorta and its branches. We are presenting a case report of a 65-year-old female patient with bilateral 30-meter claudication on both lower extremities and a haemodynamically significant stenosis of the left renal artery. Case report: The patient underwent computed tomography angiography (CTAG) of the abdominal aorta and lower extremities. CTAG revealed severe abdominal aortic wall calcification with circular atherosclerotic calcification in the area of the renal arteries branch off, causing haemodynamically significant stenosis of the aorta and the left renal artery. The patient was scheduled for an elective open surgery. The left retroperitoneal approach dissects the abdominal aorta, including both renal arteries. Cross-clamps were placed on both renal arteries, the subrenal aorta and the suprarenal aorta, just below the superior mesenteric artery. Circular aortic calcifications protruded through the aortotomy, and aortal endarterectomy was performed. The calcific plaques extending to the left renal artery were dissected similarly. Identically, an endarterectomy of both common iliac arteries orifice was performed. Result: The patient was discharged on the 8th postoperative day with excellent renal parameters, normal left kidney perfusion, and without limiting claudications on both lower extremities. Currently, we have a 12-month follow-up with the patient. Conclusion: CRA is a rare clinical entity. The optimal treatment has yet to be established. Up-to-date, the gold standard treatment for CRA is surgical endarterectomy.
- Klíčová slova
- coral reef aorta,
- MeSH
- aorta abdominalis chirurgie diagnostické zobrazování patologie MeSH
- aortální stenóza diagnostické zobrazování diagnóza etiologie MeSH
- arteria renalis chirurgie diagnostické zobrazování patologie MeSH
- ateroskleróza diagnóza komplikace MeSH
- endarterektomie * metody MeSH
- intermitentní klaudikace diagnóza etiologie MeSH
- lidé MeSH
- nemoci aorty * diagnostické zobrazování diagnóza klasifikace terapie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: Vascular access (VA) stenoses play a significant role in the morbidity of the haemodialysed population. Classifications for diagnosis, assessment and proposal of treatment strategies can be useful clinical and methodological tools. This review aims to present a comprehensive summary and propose further methodological approaches. DESIGN: A systematic review of the literature, evaluating classifications for dialysis-related VA stenosis. DATA SOURCES: Web of Science, Scopus, PubMed, Google Scholar and the ClinicalTrials.gov registry were searched from inception to 7 December 2024. ELIGIBILITY CRITERIA: All articles containing classifications regarding dialysis VA were eligible, with no restrictions on the study type or language of the full text. DATA EXTRACTION AND SYNTHESIS: Two independent researchers performed the search and initial screening. Four vascular surgeons assessed the included classifications using a modified Buchbinder's critical appraisal tool to evaluate quality. RESULTS: From 4771 screened papers, 59 full-text papers were retrieved and 24 articles contained classifications. Three classifications were dedicated to VA stenosis, all based on the anatomical location of lesions. According to the modified Buchbinder's appraisal, the classifications were assessed as moderate-to-good quality. The literature disposes of immense inconsistency in terms of the definition of significant stenosis indicated for treatment. CONCLUSIONS: VA significant stenosis and its classification is a non-uniformly understood issue with many different criteria and categorisations. This basic methodological problem leads to inconsistent results. We recommend the unification of the criteria and their validation in prospective studies.
- MeSH
- arteriovenózní zkrat * MeSH
- dialýza ledvin * metody MeSH
- lidé MeSH
- okluze cévního štěpu etiologie MeSH
- stenóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
V průběhu čtyřiceti let vývoje se transplantace pankreatu stala v České republice běžnou léčebnou metodou, která je zvláště vhodná pro pacienty současně podstupující transplantaci ledviny z důvodu dlouho trvajícího diabetu 1. typu. Oproti samostatné transplantaci ledviny zlepšuje kvalitu života i dlouhodobé přežití. Vede k téměř úplné normalizaci glykemií bez potřeby injekčního inzulinu a bez rizika hypoglykemií. Jako samostatný výkon suverénně léčí syndrom porušeného vnímání hypoglykemie u osob, u nichž edukace a použití dostupných technických prostředků nebyly dostatečně efektivní. V současné době existuje v České republice komplexní program, který dovoluje využít nabídku pankreatů od zemřelých dárců a různým typům příjemců s diabetem 1. a výjimečně i 2. typu poskytnout efektivní a relativně bezpečnou náhradu nefunkčních beta buněk s přihlédnutím k jejich celkovému zdravotnímu stavu, operačnímu riziku a také jejich volbě. Popisujeme dlouhodobé zkušenosti s transplantační léčbou diabetu v IKEM, na které se podílí odborníci z řad transplantačních chirurgů, diabetologů, nefrologů, imunologů a dalších specialistů.
During 40 years of development, pancreas transplantation has become a common treatment method in the Czech Republic, which is particularly suitable for patients undergoing simultaneous kidney transplantation due to long-standing type 1 diabetes. Compared to kidney transplantation alone, it improves quality of life and long-term survival. It leads to almost complete normalisation of glycaemia without the need for insulin injections and without the risk of hypoglycaemia. As a stand-alone procedure, it sovereigny treats the syndrome of impaired hypoglycaemia perception in people for whom education and the use of available technical means have not been sufficiently effective. Currently, there is a comprehensive program in the Czech Republic that allows to use the supply of pancreases from deceased donors and to provide various types of recipients with type 1 and, exceptionally, type 2 diabetes with an effective and relatively safe replacement of non-functioning beta cells, taking into account their overall health status, surgical risk and also their choice. We describe the long-term experience with transplantation treatment of diabetes at IKEM, involving experts from transplant surgeons, diabetologists, nephrologists, immunologists and other specialists.
- Klíčová slova
- IKEM,
- MeSH
- diabetes mellitus 1. typu chirurgie MeSH
- doba přežití bez progrese choroby MeSH
- lidé MeSH
- přežívání štěpu imunologie MeSH
- transplantace slinivky břišní * dějiny metody MeSH
- týmová péče o pacienty MeSH
- výběr pacientů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
On the basis of author's request the publisher of Physiological Research decided to change the license of the article to CC BY license.
- MeSH
- dospělí MeSH
- lidé MeSH
- trombóza * etiologie prevence a kontrola diagnóza MeSH
- uterus * transplantace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
