Whether the coexistence of anti-A/B antibody and donor specific anti-HLA antibody (HLA-DSA) has a synergistic impact on the development of acute antibody-mediated rejection (AAMR) in kidney transplant recipients (KTRs) is unclear. This study includes 92 KTRs who received a kidney from an ABO-incompatible (ABOi) donor or were presensitized to donor HLA (HLAs) and 292 controls (CONT). HLAs was defined as a crossmatch positivity or the presence of HLA-DSA. We compared the incidence of AAMR among ABOi (n = 58), ABOi+HLAs (n = 12), HLAs (n = 22), and CONT (n = 292) groups and evaluated the risk factors and antibody type (anti-A/B vs. HLA-DSA) responsible for AAMR. AAMR developed less frequently in ABOi and CONT than in the ABOi+HLAs or HLAs (P < 0.05 for all); however, there was no difference between the ABOi+HLAs and HLAs groups. AAMR developed more frequently with strong HLA-DSA at baseline; however, high baseline anti-A/B titer did not affect AAMR development. Strong baseline HLA-DSA was an independent predictor for AAMR, however the baseline anti-A/B titer was not. All four AAMR episodes in ABOi+HLAs were positive to HLA-DSA but not to anti-A/B. In conclusion, ABO incompatibility does not increase the risk for AAMR in HLAs KTRs.

To date, few studies have carried out a simultaneous determination of multiple pro- and anti-angiogenic factors during liver diseases progression. This study investigated the dynamic change in circulating angiogenic factors in multi-step carcinogenesis and hepatocellular carcinoma (HCC) progression. Serum levels of major pro-angiogenic [Vascular endothelial growth factor (VEGF), Basic fibroblast growth factor (b-FGF)] and anti-angiogenic [Thrombospondin-1 (TSP-1), Endostatin] factors were identified by enzyme-linked immunosorbent assay and correlated with liver diseases progression and outcomes of HCC patients undergoing transarterial chemo-embolization. A total of 240 patients (156 HCC, 37 cirrhosis and 47 chronic hepatitis) were enrolled in this study. While progressing from chronic hepatitis, cirrhosis to HCC, VEGF and b-FGF levels showed a significant change. Particularly, b-FGF yielded the highest AUROC value for a diagnosis of HCC and its distinction from other disease groups. A trend towards increasing VEGF levels was observed from Child-Pugh class A, B to C. VEGF and TSP-1 levels increased with the advance of cancer stage, with a remarkable increase in TSP-1 at an intermediate stage. Pretreatment levels of VEGF, TSP-1, and endostatin independently predicted the overall survival of patients. VEGF and TSP-1 levels correlated with progression-free survival. Our study demonstrated the dynamic angiogenic switch and the roles that individual pro- and anti-angiogenic factors contribute to carcinogenesis and HCC progression during the course of multi-step liver diseases. These imply the future possibility of testing pro- and anti-angiogenic panels as a diagnostic marker and a guide in decision-making about upcoming targeted therapies.

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxygenation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.

Background/Aims: There have been few studies regarding the prognosis of intestinal Behçet's disease (iBD) patients according to consensus-based diagnostic categories, which reflects the typicality of intestinal ulcers, the presence of oral ulcers, and the accompanying systemic manifestations. Methods:The medical records of patients who had ileocolonic ulcers with a clinical impression of iBD were reviewed. The patients were categorized according to the diagnostic algorithm at the time of diagnosis. Adverse events were defined as major surgery or admission related to iBD deterioration.Results: A total of 163 patients were included in the study. The male-to-female ratio was 1:1.2, and the mean age at the time of diagnosis was 48.9±15.9 years. The numbers of patients who met the definite, probable, suspected, and nondiagnostic iBD criteria were 19 (11.7%), 61 (37.4%), 38 (23.3%), and 45 (27.6%), respectively. The event-free survival of patients with definite, probable, and suspected iBD was significantly shorter than that of patients with nondiagnostic iBD (p=0.026), while there was no significant difference among the definite iBD, probable iBD, and suspected iBD groups (p=0.596). After excluding patients with nondiagnostic iBD, multivariate analysis showed that anemia, fever, colonic involvement other than the ileocecum, and accompanying hematologic disorders at the time of diagnosis were significantly associated with the development of adverse events. Conclusions:The clinical course of patients with definite, probable, and suspected iBD is distinguished from that of patients with nondiagnostic iBD, but patients with definite, probable, and suspected iBD share similar clinical courses.

Background Since the consensus-based diagnostic algorithm for intestinal Behcet’s disease (iBD) was proposed by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases, there were few studies regarding the prognosis of iBD according to the diagnostic algorithm. Methods We reviewed the medical records of patients who had ileocecal ulcers with clinical impression of iBD from March 1986 to August 2019 in Seoul St. Mary’s Hospital and evaluated factors at the time of diagnosis which were related with adverse events (AEs, major operation or admission from iBD) and disease-free survival (DFS). Results Among 204 eligible patients, a total of 163 were included in the study after exclusion of 41 patients with ileocecal ulcers from other disorders. The male-to-female ratio was 1:1 and the mean age at the time of diagnosis was 48.9 ± 15.9. The number of definite, probable, suspected, and non-diagnostic iBD was 18 (11.0%), 64 (39.3%), 37 (22.7%), and 44 (27.0%), respectively. Patients with definite, probable, and suspected iBD developed more AEs compared with patients with non-diagnostic iBD (p = 0.026). After exclusion of patients with non-diagnostic iBD, univariate analysis showed accompanying haematologic disorders, haemoglobin &lt;10 g/dl, fever, colonic involvement, and hypoalbuminemia (&lt;3.0 g/dl) were significantly related to the development of AEs (all p &lt; 0.05). Multivariate analysis revealed accompanying haematologic disorders, haemoglobin &lt;10 g/dl, fever, and colonic involvement were significantly associated with development of AE (all p &lt; 0.05). Poor DFS was significantly associated with accompanying with haematologic disorders, haemoglobin &lt;10 g/dl, and colonic involvement (p &lt; 0.001, p = 0.022, and p = 0.034) in univariate analysis. Only haemoglobin &lt;10 g/dl was significant in multivariate analysis. Conclusion Patients with definite, probable, and suspected iBD have a poor prognosis compared with patients with non-diagnostic iBD. Accompanying with haematologic disorders, anaemia, fever, and colonic involvement at the time of diagnosis are poor prognostic factors in patients with iBD.