Myocarditis is an adverse event associated with coronavirus disease 2019 (COVID-19) mRNA vaccination. A 50-year-old man presented with dyspnea and resting chest pain after receiving the second dose of the COVID-19 mRNA vaccine and developed cardiogenic shock. Fulminant myocarditis was diagnosed by endomyocardial biopsy and treated with intravenous corticosteroids.
Background: Little is known about the mechanisms underlying recovery from hydronephrosis.Using a rat kidney model, we investigated the possible contribution of growth factors during regeneration after hydronephrosis. Methods: After the unilateral ureteral obstruction for 7 days, the obstruction was released by ureterocystostomy. Epidermal growth factor (EGF), hepatocyte growth factor (HGF) and transforming growth factor-b1 (TGF-b1) were studied using immunohistochemistry and semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR).
Results:The immunoreaction of EGF in the medulla of both obstructed and contralateral kidneys increased after releasing the obstruction. The release of ureteral obstruction brought further increased immunoreaction of HGF to both the cortex and the medulla of the contralateral kidney. The immunoreaction of TGF-b1 also increased in the interstitium especially around the blood vessels in the post-obstructed kidney. The expression of HGF and EGF mRNA in both kidneys and TGF-b1 mRNA in the obstructed kidney were increased after releasing the obstruction.
Conclusions:These results suggest that various growth factors may be involved in the postobstructive tubular recovery and interstitial damage in the rat kidney.
To clarify the clinico-pathological significance of protocol biopsy and clinically silent rejection in the management of renal graft recipients, we selected a total of 139 (23%) from 604 biopsy specimens according to the following criteria: 1) less than 1.4 mg/dL of serum creatinine and 2) more than 1,500 mL/d of urine volume at time of biopsy. Clinical indications for the biopsy were classified into five categories: i) protocol biopsy (73 specimens), including 69 cases at discharge post-transplantation; ii) slight increase in serum creatinine (32); iii) proteinuria (20); iv) evaluation of pulse-therapy (13); and v) fever elevation (1). Except for the last category, the specimens were histopathologically diagnosed as being normal in 50 (68%), 6 (17%), 1 (5%), and 5 (38%) specimens, respectively. Even borderline changes, and mild acute rejection, as well as drug-induced nephropathy were included, implying the existence of clinically silent rejection or drug-induced nephropathy. Obvious diversity in the histopathological diagnosis was noted in category iii) showing proteinuria, which was mainly caused by chronic rejection, drug-induced nephropathy and glomerulonephritis. The graft survival rate was no different among the four categories, except for category v). These results indicate that biopsies obtained from functionally sufficient renal grafts could provide useful information in the management of the recipients. The clinical significance of protocol biopsy awaits further clarification by the analysis of a large number of cases.
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