Purpose: Isometric handgrip exercise (IHE) has a favorable cardiovascular effect and improves hemodynamic responses. Whether IHE attenuates stress-related hemodynamic reactivity assessed during a sympathetic challenge remains unexplored. We tested the hypothesis that an acute bout of IHE would improve carotid arterial function and attenuate cardiovascular vasoreactivity response to sympathetic stress in healthy adults. Methods: In a randomized cross-over design, sixteen healthy adults (aged 21.8±3.1 years) were enrolled. Participants completed two testing sessions, separated by 1 week. Trials were either a control trial or performed IHE for two sets of 2 minutes at 30% of maximal voluntary contraction for each hand. The participant’s hand was immersed in an ice water bath (4 ℃ ) up to the wrist for 2 minutes. Carotid artery diameter, β-stiffness index, and compliance using ultrasound machine and brachial blood pressure (BP), heart rate (HR) were measured as indices of vasoreactivity at baseline, during, and recovery from cold pressor testing (CPT). Results: The BP, HR, carotid artery diameter, and β-stiffness index increased similarly during CPT in both trials (p＜ 0.001), without any interaction effect. Compared with the IHE trial, arterial compliance decreased in the control groups at 120 seconds during recovery with a significant interaction effect (p=0.02). Conclusion These findings suggest that an acute IHE did not attenuate BP, HR, carotid artery diameter and β-stiffness index vasoreactivity, but improved carotid artery compliance to sympathetic activation in healthy young adults.

Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft's renal artery and the patient's common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90~180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient's common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient's common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.
Allografts ; Angioplasty ; Angioplasty, Balloon* ; Arterial Pressure ; Atherosclerosis ; Calcineurin ; Creatinine ; Cytomegalovirus Infections ; Humans ; Hypertension ; Iliac Artery ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Leukocytes ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Phenobarbital ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Survival Rate ; Tissue Donors ; Transplants

Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.
Anoxia ; Cough ; Dyspnea ; Fever ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Opportunistic Infections ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia ; Transplantation* ; Trimethoprim, Sulfamethoxazole Drug Combination