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Noninvazív rejekció utánkövetése szolid szervek átültetését követően: a donoreredetű sejtmentes DNS vizsgálata
Noninvasive rejection surveillance after solid organ transplantations: analysis of the donor-derived cell-free DNA
Solid organ transplant rejection is a major etiological factor of graft dysfunction, hospitalisation, and death. Invasive biopsy is still considered the gold standard method of monitoring rejection; however, besides the need for hospitalisation, common concerns are its complications and the high interobserver variability. Thus, noninvasive methods for monitoring allograft injury are of paramount importance. Donor-derived cell-free DNA (dd-cfDNA) characterizes graft injury, and it can be isolated from the recipient’s sera. Elevated dd-cfDNA levels precede the diagnosis of rejection on biopsy and possess high negative predictive value. We aimed to analyze the role of dd-cfDNA testing after solid organ (kidney, liver, heart, lung, and pancreas) transplantation and to present the first Hungarian results with the dd-cfDNA-based routine heart allograft rejection surveillance programme. Since October 2022, dd-cfDNA testing has been performed on 264 occasions in 46 heart transplant recipients. The amount of dd-cfDNA is measured relative to the total amount of cell-free DNA derived from a plasma sample. A dd-cfDNA level of ≥0.20% indicates injury, while severe injury threshold is at ≥0.35%. 80% of dd-cfDNA data points were below the injury threshold. Meanwhile, elevated dd-cfDNA values indicated 20 for-cause endomyocardial biopsies (EMB). Six heart allograft rejection episodes were diagnosed. Based on the dd-cfDNA levels, 232 EMBs, i.e., 88% of routine surveillance biopsies that would have otherwise been performed over 16 months were safely avoided. Since it has the potential to detect early signs of graft injury, it opens the door to earlier and more personalized titration of immunosuppressive therapy, thus avoiding its toxicities, more severe allograft rejection, and irreversible graft dysfunction. Orv Hetil. 2024; 165(33): 1275–1285.
A poszt-COVID–19-szindróma (long-COVID) tünetei és a rehabilitáció lehetőségei
Symptoms and options in rehabilitation of post-COVID–19 syndrome (long-COVID)
Today we live in the age of epidemics. More and more serious epidemics are appearing. Coronavirus disease 2019 (COVID–19) is a highly contagious disease caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2). The virus probably spread from bats to humans. One virus of Rhinolophus sinicus showed 80% similarity, while the virus strain of Rhinolophus affinis showed 96% similarity with SARS-CoV-2. Human-to-human transmission of the COVID–19 infection has led to the isolation of patients. Due to globalized travel, it has spread worldwide, the World Health Organization (WHO) declared it a pandemic, and today it is considered a major public health problem. Besides the acute symptoms after infection, patients and society are also being challenged by long-term health complications associated with COVID–19 including the post-COVID–19 syndrome, also known as long-COVID. Within the post-acute COVID–19 syndrome, two stages are distinguished: subacute COVID–19 between 4 and 12 weeks after acute infection and post-COVID–19 syndrome characterized by symptoms that persist beyond 12 weeks. It is characterized by a wide range of symptoms that affect several organ systems. Treatment of complaints consists primarily of symptomatic treatment and multidisciplinary rehabilitation. Vaccination against COVID–19 is one of the most important means of mitigating the pandemic. Extensive research in recent years has confirmed the effectiveness of the COVID–19 vaccines. International studies have shown that the vaccine has proven to be a protective factor against long-lasting COVID symptoms. In this review, the symptoms, epidemiology, transmission, pathogenesis of COVID–19 as well as the effects of the post-COVID–19 syndrome on certain organ systems, its rehabilitation, and the effect of vaccines on the development of symptoms are highlighted. Orv Hetil. 2024; 165(33): 1266–1274.
Pszichiátriai osztályon diagnosztizált, AIDS talaján kialakult progresszív multifokális leukoencephalopathia
Case report and literature review of AIDS-related progressive multifocal leukoencephalopathy diagnosed in a psychiatric department
Progressive multifocal leukoencephalopathy is caused by the reactivation of the John Cunningham virus, which occurs almost exclusively in immunocompromised patients. The symptoms of the disease are primarily determined by the localization of demyelinating lesions. In the early stages, the disease could be asymptomatic, and neurological symptoms appear later. Diagnostic methods primarily include imaging studies and the detection of viral DNA from cerebrospinal fluid. There is no specific therapy known; the goal is to restore immune system function. In our case study, we present the medical history of a patient observed in a psychiatric department, whose case was confirmed to be AIDS-related right hemispheric progressive multifocal leukoencephalopathy. Early differential diagnostic difficulties included pathological personality traits observed in the patient as well as a crisis state arising from situational difficulties and relationship loss. With this case, we aim to highlight the importance of psychiatric symptoms in immunocompromised patients. Orv Hetil. 2024; 165(33): 1295–1302.
Abstract
Background
Psychedelic use and its impact on well-being is garnering a lot of research attention, however, little has been done to understand the potential associations between multiple characteristics of the psychedelic experience and psychological flexibility (PF), which encompasses a conscious awareness of thoughts and behavior, allowing individuals to adapt to new experiences and perceive multiple explanations or solutions for life events.
Aims
The current study examines the psychedelic correlates of PF. It was hypothesized that intention, comfort and safety during the experience, decentering, mystical experiences, ego-dissolution, and insight would be significantly associated with greater reports of PF.
Methods
Data used for the regression analysis were from 114 participants who had used one of the classic psychedelics (LSD, Psilocybin, Mescaline, DMT, Ayahuasca, 5MeO-DMT) and were recruited from postings on Twitter (now X) and within psychedelic-based groups on Facebook and Reddit to fill out an online survey. Standard assessments used include the Experiences Questionnaire, Mystical Experience Questionnaire, Ego-Dissolution Inventory, Cognitive Flexibility Inventory, Psychological Insight Questionnaire, and Religious Salience Scale.
Results
After controlling for sociodemographics (age, income, religious salience, number of psychedelic experiences), self-perceived meaningful intention and decentering remained significantly associated with greater psychological flexibility.
Conclusions
These results expand upon existing literature on psychedelic use and its impact on well-being by exploring specific characteristics of the psychedelic experience. Understanding the importance of intention and decentering can provide a pathway by which psychedelic users, guides, and researchers can further understand the psychedelic experience and its effects.
Abstract
Background and aims
Cognitive control and reward-related abnormalities are centrally implicated in addiction. However, findings from longitudinal studies addressing neurocognitive predictors of addictive behaviors are mixed. Further, little work has been conducted predicting non-substance-related addictive behaviors. Our study aimed to assess predictors of substance and non-substance addictive behaviors in a community sample, systematically evaluating each neurocognitive function's independent influence on addictive behavior.
Methods
Australians (N = 294; 51.7% female; M[SD] age = 24.8[4.7] years) completed online neurocognitive tasks and surveys at baseline and 3-month follow-up. Self-report scales assessed problematic alcohol use, addictive eating (AE), problematic pornography use (PPU), and problematic internet use (PUI) at 3- and 6-month follow-ups. Linear regressions with bootstrapping assessed neurocognitive predictors for each addictive behavior across a 6-month period.
Results
Neurocognition at baseline did not predict AE or PUI severity at 6-month follow-up. Less delay discounting at baseline predicted higher PPU at 6-month follow-up (β = −0.16, p = 0.005). Poorer performance monitoring at baseline predicted higher AE at 3-month follow-up (β = −0.16, p = 0.004), and more reward-related attentional capture at 3-months predicted higher AE at 6-month follow-up (β = 0.14, p = 0.033). Less reward-related attentional capture (β = −0.14, p = 0.003) and less risk-taking under ambiguity (β = −0.11, p = 0.029) at baseline predicted higher PUI at 3-month follow-up. All findings were of small effect size. None of the neurocognitive variables predicted problematic alcohol use.
Discussion and conclusions
We were unable to identify a core set of specific neurocognitive functions that reliably predict multiple addictive behavior types. However, our findings indicate both cognitive control and reward-related functions predict non-substance addictive behaviors in different ways. Findings suggest that there may be partially distinct neurocognitive mechanisms contributing to addiction depending on the specific addictive behavior.
Abstract
Background and aims
Neurobiological models of addiction posit that addiction manifests through an amplified salience towards addiction-associated stimuli and a diminished responsiveness to non-addiction-related incentives. However, existing research on reward processing in individuals with problematic pornography use (PPU) has primarily been limited to sexual cue reactivity.
Methods
In this event-related potential (ERP) study, we employed a risky decision-making task involving 30 individuals with PPU and 33 healthy controls (HCs) to examine the effects of PPU on non-pornographic (money) reward valuation.
Results
Compared to HCs, individuals with PPU exhibited compromised sensitivity to monetary rewards. Specifically, while the HC group demonstrated a differential response in late positive potential (LPP) amplitude to various expected value (EV) levels, this pattern was absent in the PPU group. This impairment was associated with poorer adaptive decision-making, as evidenced by PPU participants' inability to adjust risk choices based on changes in EV, leading to a propensity for riskier decisions in disadvantageous situations.
Discussion and conclusions
The findings of impaired monetary evaluation in individuals with PPU may potentially explain why they continually pursue pornographic rewards while showing insensitivity to other rewards in daily life. Consequently, treatment development strategies may prioritize improving sensitivity to non-pornographic rewards within this population.
Abstract
Background
Although family history of psychiatric disorders has often been considered potentially useful in understanding clinical presentations in patients, it is less clear what a positive gambling family history means for people with gambling disorder. We sought to understand the clinical impact of having a first-degree relative with gambling disorder in a sample of adults with gambling disorder.
Methods
Data from 455 participants (aged 18–65 years) who had participated in previous pharmacological and psychotherapeutic clinical trials for gambling disorder were pooled in a secondary analysis. Demographic and clinical variables were compared between those who did versus did not have one or more first-degree relative(s) with gambling disorder. Additionally, we examined whether a family history of gambling disorder was associated with treatment outcome.
Results
223 (49.0%) participants had at least one first-degree family member(s) with gambling disorder. In terms of clinical variables, family history of gambling disorder was significantly associated with being female, having an earlier age of gambling onset, longer duration of untreated gambling illness, a greater likelihood of developing legal problems secondary to gambling, and higher rates of alcohol use disorder in family members. Family history of gambling disorder was also associated with a greater gambling symptom improvement from pharmacotherapy.
Conclusions
These results indicate that gamblers with a first-degree family member with a gambling disorder may have a unique clinical presentation and better response to treatment interventions.
Abstract
There are increasing number of clinical cases with physician-modified endograft (PMEG) endograft for urgent reconstruction of large pararenal aneurysms to reduce the perioperative complication risks of fragile patients, but the risk of spinal cord ischemia due to the coverage of longer segment of thoracic aorta is relatively high.
We demonstrate an expedited endovascular treatment of an 88 mm pararenal aneurysm by performing a 4-vessel fenestrated endovascular aortic repair. A prominent Adamkiewicz artery, ectatic supraceliac aortic segment, median arcuate ligament compression of the celiac artery and severe tortuosity of the common iliac arteries made the endovascular repair more challenging. A PMEG was implanted with simultaneous deployment technique to achieve a short proximal landing zone to preserve the Adamkiewicz artery.
The proper risk assessment and preparation of the patient based on the clinical evaluation and procedure planning is essential for the clinical success of PMEG in urgent indication.
Abstract
Objective
Corpus luteum is a transient structure which plays an important role by producing crucial hormones required for conception and pregnancy maintenance. The objective of this study was to compare grey scale morphological appearances and Doppler indices of corpus luteum in normal and abnormal pregnancies during first trimester.
Methodology
A comparative study was carried out after getting approval from Institutional Research Ethical Committee. A total of 156 pregnant women, 78 with normal and abnormal pregnancies each, with gestational age between 5 and 8 weeks were included in the study. Out of the abnormal pregnancies 52 (66.66%) were cases of threatened while 26 (33.33%) had missed abortion. Transvaginal ultrasound was used to assess the corpus luteum on gray scale and Doppler ultrasound.
Results
There was no significant difference between gray-scale sonographic appearances of normal and cases of missed and threatened abortion on Chi-square test. However, PI, RI and SD ratio showed significant difference between normal and cases of missed and threatened abortion on Kruskal- Wallis test.
Conclusion
Doppler indices recorded from the vasculature of corpus luteum can serve as an important indicator of the pregnancy outcome during early pregnancy.
