Research progress on invasive cervical resorption / 口腔疾病防治

@#Tooth absorption can be divided into physiological absorption and pathological absorption. Root absorption of mature deciduous teeth is physiological absorption. Pathological absorption includes internal absorption and external absorption. Internal absorption, also known as intramedullary absorption, includes inflammatory absorption and alternative absorption. External tooth absorption originates from the outer surface of the root or the neck of the tooth and can be divided into inflammatory absorption, alternative absorption, pressure resorption and invasive cervical resorption. Invasive cervical resorption (ICR) is pathological damage caused by many factors, which usually begins in the cemento-enamel junction and extends peripherally or horizontally in the dentin. It hardly invades the pulp. Orthodontic devices, trauma, bleaching, systemic diseases, and the use of certain medications can all lead to invasive cervical resorption. The clinical manifestations of ICR are usually asymptomatic or not obvious, and most of which are found in imaging examinations. Because caries and internal absorption are often misdiagnosed through plain apical radiography, cone beam computed tomography (CBCT) can help to better understand the situation of invasive cervical resorption. Because the pathogenesis and etiology of invasive cervical resorption are not fully understood, clinical negligence and inadequate treatment of invasive cervical resorption can even cause unnecessary tooth loss. This article reviews the latest research progress on the histopathologic features, pathogenic mechanism, susceptibility factors, diagnosis and treatment of ICR, with special emphasis on susceptibility factors and their mechanisms.

Research progress on ankylosis of primary molars / 口腔疾病防治

@#Ankylosis of primary molars is a kind of eruption abnormality of the teeth, where the periodontal membrane disappears, owing to a bony union between bone and root. Studies have shown that the common proportion of ankylosed primary molars is 1.3%~8.9% with an equal occurrence. In the primary dentition, the mandibular first primary molar is the most commonly affected tooth, while in the middle mixed dentition stage of development, the second primary molar is more affected. Its etiology may be related to genetics, signaling pathways of mineralization metabolism of local alveolar bone or cementum, cytokines secreted by epithelial rest cells of Malassez, and enhanced inflammatory reactions during physiological absorption of roots. Ankylosis of primary molars can be diagnosed by clinical symptoms and imaging and is classified as mild, moderate and severe according to the degree of infraocclusion. As it may cause a series of complications, such as occlusal disturbances, delayed exfoliation and incomplete alveolar process development, multidisciplinary treatment, including in the departments of pediatric dentistry, orthodontics, periodontics and prosthodontics, should be adopted, and long-term treatment is determined based on the patient's age, severity of infraocclusion, and presence of permanent teeth. This review summarizes the etiology, diagnosis, complications and treatment of ankylosed primary molars to provide a reference for the clinical diagnosis and treatment of decidual molar fixation.

Exploration on the experience of long-term external normothermic machine perfusion of discarded human kidney for the first time in China / 中华肾脏病杂志

Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.

Clinical experience of different switching schemes of tacrolimus slow-release dosage forms after kidney transplantation: a report of 101 cases / 中华器官移植杂志

Objective:To conduct a retrospective analysis of efficacy and safety of different conversion schemes of tacrolimus to slow-release dosage forms for recipients in stable phase after renal transplantation to provide rationales for the conversion strategy of tacrolimus.Methods:From January 2020 to June 2020, clinical data were reviewed for 101 kidney transplant recipients converting from common tacrolimus dosage form to tacrolimus sustained-release dosage form during postoperative stable period.There were 62 males and 49 females with an age range of 19 to 69 years.They were divided into two groups according to iso-dose and incremental-dose switching schemes.The common dosage form of tacrolimus was converted into a sustained-release dosage form with different conversion doses, They were divided into two groups of 1∶1 conversion( n=55)and >1∶1 conversion( n=46). The clinical parameters of serum creatinine(Scr), blood urea nitrogen(BUN), alanine aminotransferase(ALT)and aspartate aminotransferase(AST), alkaline phosphatase(ALP), serum albumin(ALB), white blood cell count(WBC), urinary white blood cell(UWBC), hemoglobin(Hb)and fasting blood glucose(Glu)were compared between two groups after conversion. Results:Regarding numerical change trend after switching to tacrolimus sustained-release dosage form, drug dose/variation trend was smaller and blood drug concentration more stabilized.In two subgroups converted by 1∶1 and 1>1 initial dose, change trend of dose/blood concentration in 1∶1 conversion group appeared to be more stable.However, no inter-group difference existed in long-term parameters.Scr was lower at 1 week and 3 months after switching to extended-release dosage form( P<0.05)and BUN was lower at 2 weeks( P<0.05). In addition, at 5 months after conversion, ALT and AST significantly improved as compared with common dosage form( P<0.05). Significant differences existed in urinary WBC(UWBC)at 2/3 weeks( P<0.05). After switching for 2 weeks, hemoglobin significantly improved compared with common dosage form( P<0.05). No significant differences existed in ALP, ALB or Glu at other timepoints and pre-conversion( P>0.05). In 1∶1 switch group, renal function tended to improve.At 2 weeks, BUN was lower than pre-conversion; at 1/3 weeks, Scr was lower than pre-conversion( P<0.05). In addition, there was also a trend of improvement in liver function in 1∶1 conversion group.At 1 week and 5 months, ALT was lower than pre-conversion( P<0.05). However, no significant differences existed in AST, ALB, ALP, Glu, UWBC and serum WBC count at each timepoint between two different dose conversion groups( P>0.05). After conversion, intra-individual variability of tacrolimus trough concentration significantly improved( P<0.05). Conclusions:With the same safety and efficacy as common dosage form, sustained-release dosage form of tacrolimus may improve drug variability of individuals.When converting common dosage form into sustained-release dosage form, individual differences should be considered.While monitoring trough concentrations, proper doses should be adjusted on the basis of various clinical parameters.

Mapping Domain- and Age-Specific Functional Brain Activity for Children’s Cognitive and Affective Development / 神经科学通报·英文版

The human brain undergoes rapid development during childhood, with significant improvement in a wide spectrum of cognitive and affective functions. Mapping domain- and age-specific brain activity patterns has important implications for characterizing the development of children’s cognitive and affective functions. The current mainstay of brain templates is primarily derived from structural magnetic resonance imaging (MRI), and thus is not ideal for mapping children’s cognitive and affective brain development. By integrating task-dependent functional MRI data from a large sample of 250 children (aged 7 to 12) across multiple domains and the latest easy-to-use and transparent preprocessing workflow, we here created a set of age-specific brain functional activity maps across four domains: attention, executive function, emotion, and risky decision-making. Moreover, we developed a toolbox named Developmental Brain Functional Activity maps across multiple domains that enables researchers to visualize and download domain- and age-specific brain activity maps for various needs. This toolbox and maps have been released on the Neuroimaging Informatics Tools and Resources Clearinghouse website (http://www.nitrc.org/projects/dbfa). Our study provides domain- and age-specific brain activity maps for future developmental neuroimaging studies in both healthy and clinical populations.

Interactions between cells and biomaterials in tissue engineering: a review / 生物工程学报

Seed cells, biomaterials and growth factors are three important aspects in tissue engineering. Biomaterials mimic extra cellular matrix in vivo, providing a sound environment for cells to grow and attach, so as to maintain cell viability and function. The physicochemical properties and modification molecules of material surface mediate cell behaviors like cell adhesion, proliferation, migration and differentiation, which in turn affect cellular function and tissue regeneration efficacy. Furthermore, the modification molecules of material surface are the direct contact point for cell adhesion and growth. Therefore, the interactions between cells and surface modification molecules are the key to tissue engineering. This review summarizes the effects of surface modification molecules on cell phenotypes and functions.

Correlation of sleep disorders with serum Aβ 1-42 and P-Tau 181 in patients with Alzheimer's disease / 中华老年医学杂志

Objective:To investigate the correlation of sleep disorders(SD)with serum levels of amyloid β-proteins(Aβ 1-42)and tau phosphorylated at threonine(P-Tau 181)in patients with Alzheimer's disease(AD). Methods:A total of 126 patients with mild and moderate AD who met the inclusion criteria in the memory clinic, sleep clinic and geriatrics department of Jianghan Oilfield General Hospital affiliated to Yangtze University from February 2017 to January 2020 were included.The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate sleep quality.Patients with PSQI scores ≥7 were included in the AD group with sleep disorders(AD-SD group), and patients with PSQI scores <7 were included in the AD group without sleep disorders(AD-NSD group). The Montreal Cognitive Assessment(MoCA), Global Deterioration Scale(GDS), Clinical Dementia Rating(CDR), Hamilton Rating Scale for Depression(HRSD)and Hamilton Anxiety Rating Scale(HAM-A)were used to evaluate cognitive and psychosocial symptoms.During the same time, biological markers such as serum Aβ 1-42, Aβ 1-40 and P-Tau 181 were detected by using enzyme-linked immunosorbent assays.Patients in the two groups received donepezil as an anti-dementia therapy, while the AD-SD group was treated additionally with a targeted sleep intervention.All patients underwent neuropsychological assessment and biochemical tests at enrollment and at the end of the 6th month, and results from all parameters at baseline and at the end of the 6th month were compared.At the end of the six-month treatment, patients in the AD-SD group were further divided into the recovery AD-SD sub-group and the no-recovery AD-SD sub-group based on the extent of sleep improvement. Results:Of the 126 AD patients, 93(73.8%)had sleep disorders.There was no statistically significant difference between the two groups in gender, age, onset age, educational level, course of disease, CDR, GDS, MoCA, Aβ 1-40 or Aβ 1-42/Aβ 1-40(all P>0.05). The scores of PSQI, HRSD and HAM-A and serum levels of Aβ 1-42 and p-Tau 181 showed statistically significant differences between the AD-ND and AD-NSD groups( P<0.05 or P<0.01). At the end of the 6th month, the scores of PSQI, GDS, HRSD and HAM-A and levels of Aβ 1-42, Aβ 1-40, and P-Tau 181 also showed statistically significant differences between the AD-ND and AD-NSD groups( P<0.05 or P<0.01). There was no statistically significant difference in results from other parameters( P>0.05). Spearman correlation analysis showed that PSQI was correlated with HRSD( r=0.271, P=0.009), HAM-A( r=0.479, P=0.000), Aβ 1-42( r=0.470, P=0.000), Aβ 1-42/ Aβ 1-40( r=0.479, P=0.000)and P-Tau 181( r=0.371, P=0.000)in the AD-SD group at baseline.Multivariate Logistic regression model showed that serum Aβ 1-42 and P-Tau 181 levels and HRSD had predictive effects on changes in sleep quality in AD patients( OR=1.897, 1.269 and 1.889, P=0.000, 0.003 and 0.000). The areas under the receiver operating characteristic(ROC)curves for Aβ 1-42, P-Tau 181 and HRSD were 0.926(95% CI: 0.860-0.991), 0.837(95% CI: 0.746-0.927)and 0.854(95% CI: 0.776-0.932), respectively. Conclusions:Sleep quality is correlated with serum Aβ 1-42and P-Tau 181 levels in AD patients.Elevated serum levels of Aβ 1-42 and P-Tau 181 and high HRSD scores are important predictors of SD in AD patients and may be used as indexes for clinical treatment efficacy.

Preliminary results of multicenter studies on ABO-incompatible kidney transplantation / 中华器官移植杂志

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Retrospective analysis of pediatric kidney transplantation: a report of 244 cases / 中华器官移植杂志

Objective:To explore the clinical characteristics and outcomes of pediatric kidney transplantations at a single center and discuss the related clinical issues.Methods:From January 1990 to October 2019, clinical data were analyzed retrospectively for 244 pediatric renal transplants. The youngest recipient was aged 1.8 years and the median age of pediatric recipients was 12.2 years. The major disease was primary or hereditary glomerulonephritis ( n=160, 69.0%), congenital anomalies of kidney and urinary tract (CAKUT), cystic renopathy and other hereditary nephropathies ( n=55, 23.7%). The donor sources included traditional deceased donor ( n=42, 17.2%), living-related donor ( n=19, 7.8%) and organ donation ( n=183, 75.0%). The median age of donors was 2 years (0-51) and the median weight 12.0(2.7-72.0) kg. From January 2013 to October 2019, 170 cases), the major induction immunosuppression regimen was anti-thymocyte globulin (ATG) ( n=110, 64.7%) or basiliximab ( n=58, 34.1%). The maintenance regimen was tacrolimus + mycophenolic acid (MPA) + glucocorticosteroids. Finally the outcomes and the complications were analyzed. Results:The survival rates of 244 kidney allograft recipients were 98.1%, 94.5% and 93.4% and the graft survival rates 92.6%, 84.2% and 82.0% at 1/3/5 years respectively. Ten recipients died of accident ( n=2, 20.0%), pneumonia after transplantation ( n=2, 20.0%) and intracranial hemorrhage ( n=2, 20.0%). Thirty-three recipients lost their allografts mainly due to intravascular thrombosis in graft ( n=5, 14.3%), acute rejection ( n=5, 14.3%) and death ( n=9, 25.7%). Besides, among 109 deceased donor allograft recipients, the postoperative outcomes were delayed graft function recovery (DGF) ( n=27, 24.8%), arterial thrombosis ( n=6, 5.5%), venous thrombosis ( n=1, 0.9%), graft perirenal hematoma ( n=6, 5.5%), raft artery stenosis ( n=10, 9.2%) and graft ureteral fistula ( n=1, 0.9%). The incidence of acute rejection was 17.5% and 23.2% at 1/3 year respectively. The recurrent rate of primary disease was 6.9%, including primary FSGS ( n=3, 42.9%) and IgA nephropathy ( n=2, 28.6%). At 1/3 year post-operation, the incidence of pulmonary infection was 16.9% and 22.4% and the incidence of urinary tract infection 26.9% and 31.7%. Excluding recipients with graft failure, the estimated glomerular filtration rate (eGFR) at 1/2/3 year postoperatively was (80.3±25.2), (81.4±27.8) and (71.8±27.6) ml/(min·1.73 m 2)respectively. Conclusions:The outcomes of pediatric renal transplantations are excellent at our center. Future efforts shall be devoted to optimizing the strategies of donor kidney selection and strengthening preoperative evaluations, perioperative and postoperative managements for improving the long-term outcomes of pediatric renal transplantations.

Clinical features of catch-up growth after kidney transplantation in children / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of catch-up growth of body height after kidney transplantation in children and related influencing factors.@*METHODS@#A retrospective analysis was performed from the chart review data of 15 children who underwent kidney transplantation in Guangzhou Women and Children's Medical Center from July 2017 to November 2019. According to whether the increase in height standard deviation score (ΔHtSDS) in the first year after kidney transplantation reached ≥0.5, the children were divided into a catch-up group with 8 children and a non-catch-up group with 7 children. According to whether final HtSDS was ≥-2, the children were divided into a standard group with 6 children and a non-standard group with 9 children. The features of catch-up growth of body height and related influencing factors were compared between groups.@*RESULTS@#The data showed that median ΔHtSDS was 0.8 in the first year after transplantation, which suggested catch-up growth of body height. There was a significant difference in HtSDS between the non-catch-up and catch-up groups (P<0.05). Baseline HtSDS before transplantation was positively correlated with HtSDS at the end of follow-up (r=0.622, P<0.05) and was negatively correlated with ∆HtSDS in the first year after transplantation (r=-0.705, P<0.05). Age of transplantation and mean dose of glucocorticoid (GC) per kg body weight were risk factors for catch-up growth after kidney transplantation (OR=1.23 and 1.74 respectively; P<0.05), while baseline HtSDS and use of antihypertensive drugs were independent protective factors for catch-up growth (OR=0.08 and 0.18 respectively; P<0.05); baseline HtSDS and ΔHtSDS in the first year after kidney transplantation were influencing factors for final HtSDS (β=0.984 and 1.271 respectively; P<0.05).@*CONCLUSIONS@#Kidney transplantation should be performed for children as early as possible, growth retardation before transplantation should be improved as far as possible, and multiple treatment methods (including the use of GC and antihypertensive drugs) should be optimized after surgery, in order to help these children achieve an ideal body height.

Clinicaland prognostic features of lipoprotein glomerulopathy in renal allografts / 中华器官移植杂志

Objective@#To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts.@*Methods@#Retrospective analysis was performed for two case of LPG in renal allografts. The onset time was 6 and 9 years after living transplantation respectively. Initial symptoms included proteinuria and hypoproteinemia. Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity. One patient had hyperlipemia and elevated apolipoprotein E (ApoE). Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs). Yet it had no effect on graft function. The definite diagnosis was made by graft biopsy. Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary, glomerular sclerosis, mesangial hypercellularity and tubular atrophy.@*Results@#During a follow-up period of 8 and 10 years post-transplantation, two cases eventually lost their grafts within 2 and 1 year after biopsy respectively. With long-term dietary control and drug therapy, regular dialysis continued and both awaited a second transplantation.@*Conclusions@#LPG is generally steroid-resistant and refractory in renal allografts. And routine biopsy is recommended for patients with a high risk of occurrence. Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed.

Clinicaland prognostic features of lipoprotein glomerulopathy in renal allografts / 中华器官移植杂志

Objective To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts .Methods Retrospective analysis was performed for two case of LPG in renal allografts . The onset time was 6 and 9 years after living transplantation respectively . Initial symptoms included proteinuria and hypoproteinemia .Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity .One patient had hyperlipemia and elevated apolipoprotein E (ApoE) . Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs) . Yet it had no effect on graft function .The definite diagnosis was made by graft biopsy .Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary ,glomerular sclerosis , mesangial hypercellularity and tubular atrophy .Results During a follow-up period of 8 and 10 years post-transplantation , two cases eventually lost their grafts within 2 and 1 year after biopsy respectively .With long-term dietary control and drug therapy , regular dialysis continued and both awaited a second transplantation .Conclusions LPG is generally steroid-resistant and refractory in renal allografts .And routine biopsy is recommended for patients with a high risk of occurrence .Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed .

Desensitization strategies for ABO-incompatible living related kidney transplantation / 中华器官移植杂志

Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation .Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018 .The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared .Results After desensitization treatment , 14 recipients successfully underwent ABOi-kidney transplantation . Within 2 weeks post-transplantation , blood group antibody rebounded to 1:64 in only 1 recipient .Within 1 week post-transplantation ,the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients .Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment . Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy . Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year .Thirteen cases (92 .6％ ) demonstrated varying degrees of peritubular capillary deposition of C 4d .One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment . During an early stage , the incidence of postoperative infection was 57 .14％ and declined to 14 .29％ after optimized desensitization .The expenditure of early desensitization treatment was (27004 .86 ± 10719 .85) yuan and (10612 .29 ± 8143 .05) yuan after optimization .And the expenditure of optimized desensitization was significantly lowered (P<0 .05) . During follow-ups ,renal allograft function of 14 recipients remained decent .And the survival rate of recipient/allograft was 100％ up to the statistical cut-off point .Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent .The expenditure of desensitization treatment is significantly lowered after optimization .

Analysis of 11 cases of ABO incompatible living kidney transplantation / 器官移植

Objective To evaluate the clinical efficacy and safety of ABO incompatible living kidney transplantation(ABOi-KT). Methods Clinical data of 11 donors and recipients with ABOi-KT were retrospectively analyzed. All the recipients were treated with desensitization before operation. The recovery condition of renal function and blood type antibody titer of the ABOi-KT recipients were monitored after operation. The incidence of complications and clinical prognosis of ABOi-KT recipients were observed. Results The serum creatinine (Scr) of 11 recipients were well recovered after ABOi-KT. No delay in recovery of graft renal function. Among them, 2 recipients experienced a significant increase in the Scr level at postoperative 14 and 45 d respectively, 1 recipient showed criticality cellular rejection after operation and 1 recipient presented with elevated Scr level at postoperative 33 d, accompanied by an increase in blood type antibody titer. The condition became stable after corresponding treatment. The remaining 7 recipients obtained normal graft renal function and postoperative blood type antibody titer did not rebound. During postoperative follow-up until November 2018, no recipient died or graft renal failure occurred. The survival rate of the recipient and graft renal was 100%. Among them, 3 patients suffered from postoperative complications, including pulmonary infection, BK viruria and granulocytopenia, which were cured after symptomatic treatment. Conclusions ABOi-KT is safe, feasible and yields high long-term clinical efficacy, which can increase the source of living donor kidney and relieve the shortage of donor kidney.

Prognosis of BK polyomavirus nephropathy: 10-year analysis of 133 renal transplant recipients at a single center / 中华医学杂志(英文版)

BACKGROUND@#BK virus-associated nephropathy (BKVN) is an important cause of chronic allograft dysfunction. The objective of our study was to evaluate the prognosis of BKVN.@*METHODS@#We retrospectively reviewed the data of 133 renal transplant recipients with BKVN treated at the First Affiliated Hospital of Sun Yat-Sen University between July 2007 and July 2017. BK viral loads, graft function, and pathologic indexes were compared between initial diagnosis and last follow-up.@*RESULTS@#After a mean follow-up period of 14.4 (range, 0.3-109.6) months after diagnosis of BKVN, BK viruria, and BK viremia become negative in 19.5% and 90.2% of patients, respectively. The mean estimated glomerular filtration rate (eGFR) at last follow-up was lower than at diagnosis of BKVN (18.3 ± 9.2 vs. 32.8 ± 20.6 mL·min·1.73 m, t = 7.426, P < 0.001). Eight (6.0%) patients developed acute rejection after reducing immunosuppression. At last follow-up, the eGFR was significantly lower in patients with subsequent rejection than those without (21.6 ± 9.8 vs. 33.5 ± 20.9 mL·min·1.73 m, t = 3.034, P = 0.011). In 65 repeat biopsies, SV40-T antigen staining remained positive in 40 patients and became negative in the other 20 patients. The eGFR (42.6 ± 14.3 vs. 26.5 ± 12.3 mL·min·1.73 m), urine viral loads (median, 1.3 × 10vs. 1.4 × 10 copies/mL), and plasma viral load (median, 0 vs. 0 copies/mL) were all significantly lower in patients with negative SV40-T antigen staining than those with persistent BK involvement (all, P < 0.05). Five (3.8%) recipients lost their graft at diagnosis of BKVN, and 13 (9.8%) lost their graft during the follow-up period. The 1-, 3-, and 5-year graft survival rates after diagnosis of BKVN were 99.2%, 90.7%, and 85.7%, respectively. Higher pathologic stage correlated with lower allograft survival rate (χ = 6.341, P = 0.042).@*CONCLUSION@#Secondary rejection and persistent histologic infection in BKVN lead to poor prognosis.

Personality and depression: A review of theory model and behavior and neural mechanism / 生理学报

The analysis of the relationship between personality and depression can facilitate the development of subclinical preventive measures and clinical treatment schemes. Moreover, the personality is associated with a variety of mental diseases, and there is substantial comorbidity between depression and some other mental diseases. So, to reveal pathological relationships between personality and depression is helpful to understand the etiology of the comorbidity between depression and multiple mental disorders. In this review, we first summarize the empirical researches on the relationship between personality and depression from the aspects of behavior and neural mechanisms, and then discuss the hypothetical model to explain the relationship between personality and depression. In a word, high neuroticism, low extroversion and conscientiousness, and other related traits (rumination, self-criticism, dependency, etc.) have a moderate to strong correlation with depression. Among them, neuroticism is the most concerned. To a certain extent, it can predict the onset of depression and affect the duration and treatment outcome of depression. Other traits, such as positive emotionality/ extroversion and effortful control/responsibility, can moderate the relationship between negative emotionality/neuroticism and depression. And after the onset of depression, the neuroticism may change, but the extroversion does not seem to change.

Efficacy and safety of initial-dose mizoribine plus tacrolimus and corticosteroids in living-related renal transplant recipients / 中华器官移植杂志

Objective To assess the efficacy and safety of mizoribine (MZR) in initial immunosuppression in living-related renal transplant recipients.Methods From October 2015 to October 2017,twenty-two patients undergoing initial living-related renal transplantation received MZR (3-4 mg/kg/d) plus tacrolimus and corticosteroid.During a follow-up period of 12 months,patient/graft survival,incidence of acute rejection and adverse events were observed.Results There was no onset of graft loss and death and acute rejection rate was 22.7％.Renal allograft function remained stable.The incidence rate of cytomegaloviral infection was 4.5％ and no CMV disease occurred.The incidence of BKV viruria was 36.4％ and the infection rate was 18.2％.Digestive symptoms occurred (n =3,13.6％).The major side effect of hyperuricemia could be controlled without reduction or withdrawal of MZR.Conclusions Excellent graft survival can be achieved when using MZR as initial immunosuppression in living-donor renal transplant recipients,yet the incidence of acute rejection remains high.Further study is required for determining the effect of MZR in the prevention of BK viral infection during renal transplantation.

Clinical analysis and outcome of 524 cases of kidney transplantation / 中华器官移植杂志

Objective To explore the clinical outcome of renal transplantation and analyze the risk factors influencing the kidney allograft survival after transplantation.Methods The clinical data of 524 cases of renal transplantation between January 2007 and December 2015 were retrospectively analyzed.Serum creatinine was determined,and glomerular filtration rate(GFR) was estimated.The 1-,2-and 3-year patient and graft survival after transplantation was calculated.Adverse events were recorded.Results The median follow-up time was 17.2 months.The 1-,2-and 3-year graft survival rate after transplantation was 97％,95.8％ and 95.3％,respectively.The 1-,2-and 3-year patient survival rate after transplantation was 97.8％,97％ and 97％,respectively.The eGFR was (67.6 ± 24.1),(68.9±24.2) and (72.7 ± 26.2) ml·min-1 ·1.73 m-2 at 1st,2nd and 3rd year after transplantation.The incidence of delayed graft function(DGF) was 20.6％ (108/524).Multivariate analysis revealed donor type (P =0.005) and the terminal creatinine (P＜0.001) were the independent risk factors of DGF.Elder recipients (P =0.004),recipients with diabetes(P =0.031),preoperative positivity of panel reactive antibody(PRA) (P =0.023),and donor with hypertension (P =0.046) were risk factors influencing the kidney allograft survival.Conclusion Kidney transplantation showed good outcomes at 3rd year after transplantation.The recipient age,recipient's history of diabetes,preoperative PRA and donor's history of hypertension are independent risk factors for renal graft survival.

Spigelius'line incision as a successful route to extract the kidney during retroperitoneal laparoscopic live-donor nephrectomy / 中华泌尿外科杂志

Objective To introduce the advantages,incision designing methods and surgical procedures of spigelius' line incision in retroperitoneal laparoscopic living donor nephrectomy.Methods Among the 114 donors,39 were obtained by spigeliu'line incision (13 males and 26 females),with an average age of 35 years,35 left kidneys and 4 right kidneys.Gibson incision was performed in 75 patients (28 males and 47 females),with an average age of 31 years,73 left kidneys and 2 right kidneys.The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively.The operation was performed by laparoscopic surgery to separate the ureter,renal vessels and perirenal fat.Finally,the renal vessels were removed and the kidneys were removed with hand-assistant.75 cases were taken out of the kidney through the inguinal parallel incision (Gibson incision),while the other 39 cases used the spigelius' line incision (Through the linea pararectalis,the anterior sheath is cut opened at the margin of the rectus sheath (spigelius' line) and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space).The intraoperative data were collected.Results All the operations were not converted to open surgery.The incision length of the spigelius' line incision group was (6.8 ± 0.6) cm,and the incision length of the Gibson incision group was (7.0 ± 0.4) cm,P =0.02.The blood loss of the operation of the spigelius' line incision group was (59.2 ± 33.4) ml,while the Gibson incision group was (80.7 ± 32.8) ml,P =0.002.The warm ischemia time of the spigelius'line incision group was (2.8 ± 1.1) min,while the Gibson incision group was (3.1 ± 1.7) min,P =0.31.The operation time of the spigelius' line incision group was (160.8 ± 30.7) min,while the Gibson incision group was (162.5 ± 28.1) min,P =0.77.There was no significant difference between the two groups in the warm ischemia time and the operation time.No incisional hernia was found in these two groups.Conclusions Compared with Gibson incision,the spigelius' line incision is safe.It can completely avoid to cut the abdominal muscles,and effectively avoid the abdominal nerves injury.Without damaging the integrity of the peritoneum,it can avoid abdominal organ injury.

Antibody monitoring and graft biopsy after renal transplantation contribute to early diagnosis of antibody mediated rejection / 器官移植

Objective To analyze the necessity of anti-human leukocyte antigen (HLA)antibody monitoring and graft biopsy on early diagnosis of antibody-mediated rejection (AMR). Methods Fifty-one recipients with de novo donor specific antibody (dnDSA)were screened and chosen. Donor specific antibody (DSA)and its ability to bind with C1 q were evaluated. Pathological biopsy of the kidney graft was performed. The recipients diagnosed with AMR were divided into the unstable and stable kidney function groups. Type of DSA,binding ability of the complement and Banff score were statistically compared between two groups. Kaplan-Meier survival analysis of the kidney graft in the recipients from non-rejection, unstable and stable kidney function groups was performed. Results Type of HLA antibody,mean fluorescent intensity (MFI)of DSA,C1 q binding ability and C4d deposition in peritubular capillary did not significantly differ between the unstable and stable groups (all P>0. 05 ). Histomorphologically,the Banff score of microvasculitis,endarteritis,renal tubule-interstitial nephritis,transplantation glomerulopathy and renal tubular atrophy-stroma fibrosis did not significantly differ between two groups (all P>0. 05 ). In the unstable group,the accumulated survival rate of the kidney graft was significantly lower compared with that in the stable group,which was significantly lower than that of their counterparts who were ineligible for pathological diagnosis (P=0. 002). Conclusions It is necessary to perform regular anti-HLA antibody monitoring and pathological puncture examination after renal transplantation,which contributes to early detection and diagnosis of AMR.