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Objective:To evaluate the effect of scalp acupuncture combined with repeated transcranial magnetic stimulation (rTMS) on dysphagia after ischemic stroke.Methods:Prospective cohort study. A total of 94 patients with dysphagia after ischemic stroke in our hospital who met the inclusion criteria from December 2020 to February 2022 were randomly divided into two groups with 47 patients in each group. The control group was treated with rTMS and conventional acupuncture, while the scalp acupuncture group was treated with rTMS and scalp acupuncture (scalp acupuncture+seven points at the skull base). Both groups were treated for 4 weeks. Before and after treatment, Traditional Chinese Medicine (TCM) symptoms were scored, and the morphology, movement and food swallowing process of the patient's swallowing anatomy were observed with fiber optic endoscopy (FEES), and assessed by the leakage aspiration scale (PAS). The Yilang Fujishima swallowing efficacy evaluation and standard swallowing assessment (SSA) were used to evaluate swallowing function. The dysphagia quality of life scale (SWAL-QOL) were used to evaluate patients' quality of life. Magnetic resonance diffusion tensor imaging (DTI) scanning was performed to observe the anisotropy fraction (FA value) of the selected region of interest (ROI).Results:During the treatment period, each group dropped off 1 patient, and 92 patients entered the statistics. After treatment, the scores of salivation, food retention, eating and drinking cough in the scalp acupuncture group were significantly lower than those in the control group ( t values were 6.87, 4.90, 5.01, respectively, P<0.01), and the PAS grading was significantly better than that in the control group ( χ2=7.80, P=0.025), the swallowing efficacy evaluation and SWAL-QOL score of Yilang Fujishima were significantly higher than those of the control group ( t=6.81, 5.98, P<0.01), and the SSA score was significantly lower than that of the control group ( t=5.68, P<0.01). The FA values of parieto occipital cortex (0.47 ± 0.06 vs. 0.42 ± 0.04, t=3.16), insular cortex (0.44 ± 0.07 vs. 0.40 ± 0.05, t=3.00) and posterior limb of internal capsule (0.58 ± 0.04 vs. 0.54 ± 0.05, t=2.80) of ROI in the head acupuncture group after treatment were significantly higher than those in the control group ( P<0.05). Conclusion:The scalp acupuncture combined with rTMS can improve the swallowing function of patients with dysphagia after ischemic stroke and improve their quality of life.
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Objective:We aimed to evaluate the predictive value of pre-implantation biopsy combined with Lifeport for the short-term prognosis of kidney allograft from donation after citizen death (DCD).Methods:Data from a total of 34 patients who had undergone kidney transplantation in Jinling Hospital from December 2017 to December 2019 were retrospectively analyzed. Histopathological data from pre-implantation biopsy , Lifeport parameters and recipient kidney transplant function at 3 months post-surgery were collected. The performances of histopathological indexes , and Lifeport parameters to predict delayed graft function (DGF) and estimated glomerular filtration rate (eGFR) at 3 months post-surgery were observed evaluated.Results:13 cases of DGF occurred, accounting for 38.2%. Serum creatinine at death and resistance index (RI) at 0.5 h, 1 h, 2 h and 4 h after Lifeport hypothermic machine perfusion (HMP) in the DGF group was significantly higher than that in the non-DGF group. Histologically, the acute tubular injury (ATI) score of the DGF group was higher than that of the non-DGF group, whereas the Remuzzi score was not statistically different between the two groups. The eGFR at 3 months post-transplant was moderately correlated with the RI at 4 h HMP and the Remuzzi score (RI: r=-0.48, P<0.001; Remuzzi score: ρ=-0.42, P=0.01), but no correlated with ATI score of the donor kidney. Although Remuzzi score was not correlated with kidney allograft recovery time (ρ=-0.25, P=0.16), it was inversely correlated with eGFR at 3 months post-transplant (ρ=-0.42, P=0.01). Combined use of Lifeport HMP 4-hour RI and ATI score increased the sensitivity and specificity of predicting DGF to 100% (95% CI: 75.3%-100%) and 90.5% (95% CI: 69.6%-98.8%) respectively. Conclusions:The serum creatinine at death, Lifeport RI, and ATI score of the DGF group were significantly higher than those of the non-DGF group, and the eGFR at 3 months post-transplant was correlated with the Lifeport RI and Remuzzi score. Combined use of ATI score and RI at 4 hours of Lifeport perfusion improved the sensitivity and specificity of predicting DGF .
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BACKGROUND: Although desired cartilage repair has been realized via tissue engineering technology, these achievements mainly focus on small-size defect under a normal physical condition. However, cartilage defects are always accompanied by the underlying diseases in clinical practice, such as osteoarthritis and rheumatoid arthritis. Meanwhile, the location, scope, and depth of cartilage defects are uncertain, which brings a great challenge in cartilage tissue repair. OBJECTIVE: To summarize the methods of repairing articular cartilage defects at different locations and under inflammatory condition. METHODS: We searched PubMed and CNKI with the search terms “cartilage defect regeneration, osteochondral, growth plate, weight-bearing area, inflammatory” in Chiense and English to retrieve related papers published before March 2019. A total of 209 papers were retrieved and 86 were included in the final analysis according to inclusion and exclusion criteria. RESULTS AND CONCLUSION: For articular cartilage defects under different special conditions, the repair goals and strategies are different. For repair of full-layer cartilage defects and osteochondral structure defects, multi-layered scaffolds are often used to repair the unique stratified cartilage structure and subchondral bone structure, while avoiding the problem of heterotopic ossification in neonatal cartilage. To avoid deformity after long bone maturation, growth factors such as insulin-like growth factor and bone morphogenetic protein 7 should be added to continuously stimulate the repair of the growth plate and promote bone growth. For cartilage repair in the weight-bearing area, the scaffolds should have good mechanical property, which ensure not to undergo severe deformation and structural damage when loaded. In addition, the new cartilage tissue has sufficient mechanical strength to support sustained longitudinal pressure and wear. For cartilage defects in the inflammatory state, both inflammation management and cartilage defect repair should be considered, and introduction of mesenchymal stem cells can regulate immune function and promote tissue regeneration, such that articular cartilage defect can be completely repaired.
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Objective:To explore the long-term prognosis of chronic active antibody-mediated rejection(cABMR)and independent risk factors for prognosis.Methods:A single-center retrospective cohort with biopsy-proven cABMR was examined. Renal biopsies were scored according to the criteria of Banff 2017. The primary outcome was death-censored graft failure defined as resuming dialysis or estimated glomerular filtration rate(eGFR)decreased to <15 ml·(min·1.73m 2) -1. The prognostic significance of clinical and histopathologic parameters were determined by a Cox proportional hazard model. Results:Clinical data from 149 cases were available for analysis with a median follow-up of 28(15~51)months. In a multivariable model, ci + ct score(HR 3.0; 95 % CI 1.9~4.7), cg score(HR 1.9; 95 %CI 1.1~3.1), eGFR(HR 2.0; 95 % CI 1.3~3.2)and proteinuria(HR 2.0; 95 %CI 1.3~3.2)were independent predictors of primary outcome.Conclusions:eGFR, proteinuria, Banff ci + ct and Banff cg are independent risk factors for the prognosis of cABMR.
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Objective:To report for the first time the clinicopathologic characteristics of two patients with light chain deposition disease after renal transplantation.Methods:The clinicopathologic features were analyzed for two patients with light chain deposition disease and the related literature was reviewed.Case 1 was a 49-year-old male with unknown primary disease presenting with abnormal urine test and elevated serum creatinine at 24 months after kidney transplantation. Renal allograft biopsy hinted at light chain deposition disease. Case 2 was a 38-year-old male with light chain deposition disease in native kidneys presenting with proteinuria, microscopic hematuria and elevated serum creatinine at 15 months after kidney transplantation. Renal allograft biopsy supported recurrent light chain deposition disease.Results:1 case after bortezomib and dexamethasone dosing, serum creatinine decreased during follow-ups. 1 case received bortezomib and dexamethasone. However, sepsis and pulmonary infections developed and allograft function deteriorated.Conclusions:Light chain deposition disease after renal transplantation is a rare disorder with a rapid progression and a poor prognosis. Early detection of free light chain in blood and urine through immune fixed electrophoresis is conducive to an early diagnosis. The efficacy of bortezomib is to be furthered examined.
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Objective@#To evaluate the efficacy and safety of bortezomib in kidney transplant recipients with chronic active antibody-mediated rejection (cABMR).@*Methods@#A retrospective study wad conducted in patients(n=136)fulfilling the Banff 2017 criteria for cABMR from January 2004 to July 2017, including 29 patients bortezomib group and 97 patients in control group. Identified cABMR patients were dichotomized into bortezomib and control groups with a 1∶1 match using the propensity score matching method. The primary outcome was initiation of replacement therapy or an estimated glomerular filtration rate(eGFR)declined to <15 ml·min-1·(1.73m2)-1. The prognosis and adverse reactions of two groups were analyzed and evaluated.@*Results@#No significant inter-group differences existed in age, sex ratio, immunosuppressive regimen, allograft age, serum creatinine, eGFR, urine protein, serum albumin, hemoglobin or HCV positive rate(all P>0.05). There were no significant inter-group differences in Banff scores (g, i, t, v, ah, mm, ci, ct, cv, ptc, c4d, all P>0.05). The median survival for bortezomib group and control group was 40.7 months and 36.9 months respectively. No statistically significant difference in graft survival between the two groups was observed(P=0.83), even after propensity score adjustment(P=0.29). The incidence of nausea, diarrhea and thrombocytopenia in bortezomib group was higher than those in control group (P<0.05).@*Conclusions@#Bortezomib does not seem to improve the prognosis of cABMR while is associated with higher incidence of adverse reactions.
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Objective To evaluate the efficacy and safety of bortezomib in kidney transplant recipients with chronic active antibody-mediated rejection (cABMR) .Methods A retrospective study wad conducted in patients(n=136)fulfilling the Banff 2017 criteria for cABMR from January 2004 to July 2017 , including 29 patients bortezomib group and 97 patients in control group .Identified cABMR patients were dichotomized into bortezomib and control groups with a 1:1 match using the propensity score matching method .The primary outcome was initiation of replacement therapy or an estimated glomerular filtration rate (eGFR)declined to <15 ml·min-1·(1 .73m2 )-1 .The prognosis and adverse reactions of two groups were analyzed and evaluated .Results No significant inter-group differences existed in age ,sex ratio , immunosuppressive regimen ,allograft age ,serum creatinine ,eGFR ,urine protein ,serum albumin ,hemoglobin or HCV positive rate(all P>0 .05) .There were no significant inter-group differences in Banff scores (g ,i ,t , v ,ah ,mm ,ci ,ct ,cv ,ptc ,c4d ,all P>0 .05) .The median survival for bortezomib group and control group was 40 .7 months and 36 .9 months respectively .No statistically significant difference in graft survival between the two groups was observed (P=0 .83) ,even after propensity score adjustment (P=0 .29) .The incidence of nausea ,diarrhea and thrombocytopenia in bortezomib group was higher than those in control group (P<0 .05) .Conclusions Bortezomib does not seem to improve the prognosis of cABMR while is associated with higher incidence of adverse reactions .
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OBJECTIVE@#To investigate the long-term outcome of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer.@*METHODS@#Clinicopathological data of 29 patients with mid-low rectal cancer undergoing laparoscope-assisted taTME at Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou Medical University from May 2010 to December 2015 were collected for the retrospective case-series study. All the operations were performed with transabdominal and transanal procedure simultaneously or sequentially. Perioperative presentations, pathological examinations, and oncologic outcomes were retrospectively analyzed. Long-term recurrence, metastasis and survival were assessed during follow-up. Outpatient clinic and telephone survey were used for follow-up. The follow-up time ended in December 2018. The overall survival (OS) rate and disease-free survival (DFS) rate were calculated by the Kaplan-Meier method.@*RESULTS@#The average intra-operative blood loss was (75.9±9.5) ml (range,20 to 200). The average operating time was (223.6±4.1) minutes (range, 165 to 280). The average number of harvested lymph node was 22.3±2.0. The average length of pathological specimen was (13.1±0.6) cm. The average distal resection margin was (2.9±0.2) cm. 89.7% (26/29) of specimens was complete and 10.3% (3/29) near complete. Two cases (6.9%) had positive cutting circumferential margin. Median follow-up was 56 (range, 22 to 91) months. Local recurrence rate, distant metastasis rate, 3-year OS rate, 3-year DFS rate, 5-year OS rate, 5-year DFS rate were 10.3% (3/29), 20.7%(6/29), 96.6%, 83.2%, 87.6% and 79.6%, respectively. No incisional hernia or adhesive intestinal obstruction was found.@*CONCLUSION@#Long-term outcomes of mid-low rectal cancer patients undergoing laparoscope-assisted taTME are satisfactory.
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Humans , Laparoscopes , Neoplasm Recurrence, Local , Rectal Neoplasms , General Surgery , Rectum , Retrospective Studies , Transanal Endoscopic SurgeryABSTRACT
Objective To preliminarily investigate the safety and feasibility of intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion. Methods From March 2016 to March 2018, consecutive acute ischemic stroke patients with large artery occlusion within 8 h after onset admitted to the Department of Neurology, the People's Hospital of Longhua District, Shenzhen and recanalized successfully after endovascular treatment were enrolled. After recanalization, cold saline was infused through the guiding catheter via the ipsilateral guilty vessel (10 ℃, 33 ml/min for 30 min). Results A total of 20 patients were enrolled, including 15 males. Their median age was 67 years (interquartile range, 53-80 years). Fifteen patients were treated with thrombolysis. A median onset-to-needle time was 300 min (interquartile range, 260-360 min). During the infusion of cold saline, the lowest rectal temperature was only decreased 0. 1 ℃, but within 5 min after completion of perfusion, it returned to the temperature before perfusion. Complications associated with intra-arterial hypothermia were not observed. The median National Institutes of Health Stroke Scale score was significantly decreased from 21 (interquartile range 15-55) before needle to 15 (interquartile range 10-16; Z = -4. 549, P < 0. 001) at discharge. Conclusion Selective intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion is safe and feasible.
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Objective To establish a cultivating method for obtaining a large number of P0 generation human placental chorionic-derived mesenchymal stem cells (hpcMSCs).Methods The hpcMSCs were isolated from human placental chorion.After primary culturing and culturing for seven days,the culture medium,the non-adherent tissue and the douching normal saline of the primary culture were centrifuged and re-cultured twice.Cell morphology was observed by an inverted microscope.CCK-8 was used to measure the cell growth curve.Flow cytometry was used to detect cell surface markers.Adipogenic and osteogenic differentiation kits were used to assess the cell differentiation potential.Results The obtained hpcMSCs were fibroblast-like adherent cells and (25.54±3.38)×106 cells were obtained per placenta.The total yield of the primary culture,secondary culture and tertiary culture were (11.73±2.09)×106,(11.12±1.42)×106 and (2.69±0.71)×106,respectively,and the incubation time were (12.00±0.64) d,(8.87±0.63) d and (12.33±0.80) d.There was significant differences in incubation time between the secondary culture and the primary culture as well as the tertiary culture (all P＜0.05),and there was no significant difference between the primary culture and the tertiary culture.However,the incubation time of the tertiary culture had an increasing trend (P＞0.05).The yield per culture flask of the primary culture,secondary culture and tertiary culture were (1.12±0.15) × 106,(2.10±0.16)×106 and (1.04±0.16)×106,respectively.There was significant differences in the yield per culture flask between the secondary culture and the primary culture as well as the tertiary culture (all P＜0.05),and there was no significant difference between the primary culture and the tertiary culture.However,the yield per culture flask of the tertiary culture had a decreasing trend (P＞0.05).There was no difference among the three cultures in the growth curve and the expression of surface markers,and the osteogenic and adipogenic differentiation were all positive.Conclusions The P0 generation hpcMSCs isolated from a choriocarcinoma sample can be doubled by the three cultures compared with the primary culture,which can provide plenty stem cell source for the regenerative medicine.
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BACKGROUND:There are a lot of studies on isolation and culture methods of human placental chorionic-derived mesenchymal stem cells (hpcMSCs), but how to simply and efficiently harvest a large amount of primary MSCs has not been resolved. OBJECTIVE:To optimize the tissue explants method of isolating and culturing hpcMSCsin vitro. METHODS:Human placental chorionic villi were collected from full-term deliveries under aseptic condition and isolated by electric homogenizer. hpcMSCs were prepared by tissue explants method. The fluid and tissue of the primary culture flask and douching normal saline of the initial culture were centrifuged and prepared for secondary culture. RESULTS AND CONCLUSION: It saved time and effort to treat human placental chorionic villi with electric homogenizer, with good effects on tissue dispersion and removal of red blood cells. The average time of cell acquisition in initial culture and secondary culture was (17.73±1.14) and (10.03±1.30) days, respectively. The yields of primary cultured cells in initial culture and secondary culture were (6.97±0.98)×105 and (13.82±1.44)×105per Φ100 mm culture dish, respectively. The adherent cells showed fibroblast-cell-like shape, which were in parallel or circinate arrangement. Highly expressed CD73, CD105 and CD90 could be detected in the third generation of hpcMSCs, but CD34, CD45, CD14, CD19 and HLA-DR were negative. Following induction, alizarin red staining and oil red O staining produced a strong reaction in cells. In a word, the optimized method is a simple and efficient method for obtaining a large amount of primary hpcMSCs.
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Objective To characterize the clinicopathologic features,treatment efficacy and prognoses of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) in renal allografts.Methods Electronic medical records of Jinling Hospital were searched for PGNMID that was diagnosed during January 2008 to April 2017.Clinicopathologic features,treatment regimens and prognoses information were retrieved and analyzed.Results We identified 5 cases of PGNMID with clinical symptoms of proteinuria (5/5),serum creatinine elevation (4/5) or hematuria (4/5) 5 to 19 months after kidney transplantation.Various light microscopic features were observed,with predominantly membranoprolifeative pattern.Mild mesangial proliferation pattern could be observed in early stages of disease progression.Immunofluorescence revealed monoclonal IgG3κ in 3 patients and IgG3λ in another 2 cases.One case of PGNMID with normal light microscopy but monoclonal IgG deposits was verified by IgG and light-chain subtyping.In the 4 patients treated with rituximab or bortezomib,decreased proteinuria was achieved in all treated patients while the decreases in serum creatinine decrease were only observed in 2 patients At last follow-up,one patient was in dialysis and serum creatinine levels of other 2 patients were ＞265.2 μmol/L.Conclusion Membranoprolifeative pattern is the most frequently observed microscopic findings and IgG3 is the most frequent IgG subtype in PGNMID.PGNMID recurs shortly after kidney transplantation.Rituximab and/or bortezomib is conducive to decrease proteinuria while their efficacy to decrease serum creatinine is dubious.The most effective treatment protocol for PGNMID remains to be determined in larger samples.
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Objective To evaluate the efficacy and safety of single bolus high dose (SD group) ATG-Fresenius induction therapy in kidney transplantation vs.multiple low dose (MD group) administration.Methods A multiple center,prospective,randomized and controlled clinical study was performed on 280 de novo renal transplant recipients from 19 centers.Patients were randomized into 2 groups as follows:SD group,a single high dose (7-9 mg/kg) of ATG-F infused as an induction agent before the vessel anastomoses;MD group,2 mg/kg of ATG-F daily administrated in postoperative 4 days.All the patients accepted maintenance immunosuppressive protocol including tacrolimus,mycophenolate and prednisone.Patients were assessed and data were collected at regular schedule clinic visits on the day 1,3,7,14,30,90,180,270 and 365.The primary end point of efficacy was therapeutic failure rate [the number of death,grafts loss and acute rejection (AR)].The event first occurred should be used in the classification of patients.The non-inferiority evaluation of the two treatment regimens was done based on treatment failure rate.The secondary end points of efficacy were the incidence of AR,delayed graft function (DGF),1-year survival rate of patients and grafts,and serum creatinine at each visiting point.The indicators for safety evaluation included hemotologic variation and incidence of adverse events.Results The therapeutic failure rate in SD group was non-inferior to the MD group (17.24％ vs.23.08％).AR was the major cause of therapeutic failure and there was similar incidence of AR between SD gronp and MD group (12.07％ vs.21.37％).There was no significant difference in the incidence of DGF between SD group and MD group (12.07％ vs.6.84％,P =0.1721).The 1-year patient's survival rate and 1-year graft survival rate in SD group and MD group showed no significant difference (96.55％ vs.98.29％,P =0.6714;94.83％ vs 98.29％,P =0.2750).The serum creatinine level showed no significant differences between two groups at each visit point.There was also no significant difference in total incidence of adverse events between the two groups.In addition,there was also no statistically significant difference in the incidence of concerned and drug-related adverse events between the two groups,including infection,hemotologic abnormality,liver or renal dysfunction,gastrointestinal disorder,etc.After ATG--F administration,peripheral blood lymphocytes in the SD and the MD group immediately decreased but nearly restored to the normal level on the postoperative day 30 and 90 respectively.No severe granulocytopenia,erythropenia or thrombocytopenia occurred in both two groups.Conclusion The efficacy and safety of single high dose of ATG-F induction are non-inferior to multiple low dose ATG-F induction,moreover,single high dose of ATG-F induction is administered more conveniently and economically.
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Objective Little research has been done on the risk factor analysis of BK virus(BKV) infection in renal transplant recipients in Chinese population.The article aimed to investigate BKV infection and analyze its risk factors in renal transplant recipients in China.Methods Renal transplant recipients who had received the detection of BKV DNA in urine and blood samples in Nanjing General Hospital from June 2015 to July 2016 were selected, while the patients with uremia hemodialysis and healthy living donors were included as control group.According to the detection results of BKV DNA in urine and blood samples, renal transplant recipients were divided into BKV DNA positive group(n=89, positive urine or blood and urine BKV DNA) and BKV DNA negative group(n=359, negative blood and urine BKV DNA).Analysis was made on BKV infection in renal transplant recipients in order to investigate the effects of factors including clinical condition, postoperative complications and immunosuppressive regimen on BKV infection.Results The positive rate of BKV DNA in urine samples of renal transplant recipients was 19.9%, which was higher than those of patients with dialysis and healthy living donors(6.3% and 4.2% respectively, P<0.001).Multivariate logistic regression analysis showed BKV infection was associated with pulmonary infection(OR[95%CI], 3.468[1.227-9.802];P=0.019) , acute rejection (OR[95%CI], 2.645[1.142-6.127];P=0.023), and FK506 (OR[95%CI], 2.408[1.104-5.254];P=0.027).Conclusion The incidence of BKV infection in renal transplant recipients increases significantly.Pulmonary infection, acute rejection and FK506-based immunosuppressive regimen are risk factors leading to BKV infection.
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Objective BK virus-associated nephropathy ( BKVAN) after kidney transplantation is a key factor that influence the prognosis of transplant kidney .To our knowledge , it is believed to be associated with immune suppression .We observed the cura-tive effect and influencing factorsof anti-rejection scheme that Leflunomide was administered instead of Mycophenolate Mofetil ( MMF) on transplant kidney BKVAN .. Methods This study included 15 kidney transplant recipients with pathologically confirmed BKVAN in Nanjing General Hospital of Nanjing Military Region form March 2007 to March 2013 .Leflunomide was administered instead of Myco-phenolate Mofetil ( MMF) .Serum creatinine level , renal allograft loss rate and side effects of leflunomide were monitored after medica-tion switch.The patients were divided into two groups , which were renal allograft loss group and renal allograft survival group , for fur-ther analyses . The differences between each groups in clinical characteristics as well as histochemical features of the transplanted kidneys were analyzed to determine the cause of renal allograft loss in patients with BKVAN . Results Six patients experienced renal al-lograft loss after switching to leflunomide and needed hemodialysis , and 9 patients had stable renal allograft function , renal allograft loss rate was 40.0%.Hyperuricemia occurred in 8 patients in the period before the medication switch and in 5 patients after the switch;a decrease in blood white cell orplateletcount was found in 2 patients during both periods;an increase in Alanine aminotransferase ( ALT) level occurred in one patient after the medication switch .There were no statistically significant differences in any of the above parame-ters before and after the medication switch.Compared to allograft survival group, serum creatinine level[(1.80 ±0.53)mg/dL vs (2.74 ±0.58)mg/dL, P=0.007], the number of B lymphocytes [(206.44 ±144.96) vs (439.67 ±267.77), P=0.047] and CD68[(588.44 ±271.80) vs (944.67 ±259.32), P=0.025] in renal allograft tissue were significantly higherin the allograft loss group. ConclusionLeflunomide is a safe and effective medication for BKVAN .Patients with significantly increased serum creatinine level might have a poorer prognosis .Significantly increased B lymphocytes and CD 68 cells in renal allograft tissue might indicate a poor prognosis.
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Objective To discuss the clinicopathological characteristics and prognosis of the recurrence of IgA nephropathy (IgAN)after renal transplantation.Methods A total of 1 48 patients,pathologically diagnosed with IgAN which progressed into end-stage renal failure,undergoing renal transplantation in National Clinical Medical Research Center of Kidney Diseases,Nanjing General Hospital of Nanjing Military Command from January 1 996 to April 2009,were included in this study.According to whether IgAN recurred,all patients were assigned into recurrence (n =46)and non-recurrence groups (n =1 02).Urinary red blood cell (U-RBC)count,24 h urinary protein level,renal function including serum creatinine (Scr)and glomerular filtration rate (GFR)at 0,1 ,2,3 and 5 years after renal transplantation were statistically compared between two groups.The incidence of histopathological renal injury and survival rate of transplant kidneys was compared between two groups.Results In recurrence group,U-RBC count and 24 h urinary protein level were gradually elevated and renal function steadily declined.Compared with non-recurrence group,U-RBC count at 2-,3-and 5-year after renal transplantation significantly increased,and renal function was significantly aggravated at postoperative 5 years (all in P<0.01 -0.001 )in recurrence group.Renal pathological findings revealed that compared with non-recurrence group,the incidence of cellular crescent formation,glomerulus adhesion,mesangial cell proliferation,increased mesentery matrix, glomerulosclerosis,segmental glomerulosclerosis,glomerular dysfunction and tubulointerstitial fibrosis was significantly higher in recurrence group (all in P <0.001 ).After renal transplantation,chronic kidney injury index in recurrence group was 7.7 ±2.3,which was significantly higher than 4.6 ±1 .4 in non-recurrence group (P <0.01 ).Compared with non-recurrence group,the incidence of chronic rejection,glomerulopathy of transplant kidney (without IgAN)and positive C4d deposition was significantly higher in recurrence group (P <0.01 -0.001 ).At 1 -and 3-year after renal transplantation, survival rates of transplant kidney did not significantly differ between recurrence and non-recurrence groups (93.8% vs.86.7%,95.6% vs.88.3%,both in P >0.05).However,the survival rate at 5 years after transplantation was 51 .4% in recurrence group,significantly lower compared with 83.8% in non-recurrence group (P <0.001 ).In recurrence group,1 0 patients (22%)presented with renal failure after renal transplantation,and 9 patients (9%)in non-recurrence group.Conclusions After renal transplantation,the recurrence of IgAN characterized by asymptomatic microscopic hematuria, albuminuria and progressive aggravation of renal function reduce long-term survival rate of renal graft and indicate poor prognosis.
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Objective To study the correlation between TSH decrease and post‐stroke depression .Methods 101 patients with acute brain infarction in our hospital from October 2012 to July 2014 were collected as the study subjects and divided into the TSH decrease group and the TSH normal group according to whether serum TSH levels less than 0 .27 uIU/mL .The two groups were evaluated on admission by the National Institute of Health Stroke Scale (NIHSS) ,at 3 months after discharge by modifies Rankin′s Scale(mRS)and the Hamilton Depression Scale(HAMD)respectively .Results The HAMD scores at 3 months in the TSH decrease group were significantly higher than those in the TSH normal group (16 .04 ± 3 .34 vs .14 .03 ± 3 .47 ,P=0 .000)and the mRS scores NIHSS score were significantly higher than those in the TSH normal (3 .2 ± 1 .1 vs .2 .1 ± 1 .5 ,P<0 .05)) .The ra‐tio of poor prognosis in the TSH decrease group was higher than that in the TSH normal group (89 .3% vs .38 .4% ,P<0 .05) ,in‐dicating that the prognosis in the TSH decrease group was poor .Conclusion The correlation could exist between the decrease of TSH level with post‐stroke depression .In acute brain infarction ,the patient with low TSH level could have the poor prognosis .
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Objective Sirolimus ( SRL) is a potent immunosuppressive drug used to prevent acute allograft rejection after re-nal transplantation.Nevertheless, the occurrence of proteinuria has recently been recognized among patients treated with SRL-based therapy.The aim of this study was to investigate the therapeutic effect of tripterygium wilfordii hook F ( T II) on proteinuria caused by SRL in renal transplant recipients who were treated by trilogy immunosuppressive therapy of sirolimus combined with mycophenolate and hormone. Methods 52 recipients were divided into 2 groups randomly:TⅡgroup (n=27) and valsartan group (n=25).The TⅡgroup was administered 1 mg/kg/d, and the valsartan group 80-160 mg/d for consecutive 12 months.Based on primary trilogy immu-nosuppressive therapy of sirolimus combined with mycophenolate and hormone, the dosage of sirolimus was adjusted according to the target concentration 6-10 ng/ml( ELASA approach) and mycophenolate was administered 750 mg twice per day, adjusting dosage ac-cording to the mycophenolate AUC 0-12 level(35-45 mg· h/L).The evaluation of therapeutic effect includes: complete remission, proteinuria decreased by>50%; partial remission, proteinuria decreased by 20% to 50%; ineffective, proteinuria decreased by<20%. Results During the 12 month follow-up, the total effective rates in the TⅡgroup and the valsartan group were 95.2%and 86.7%respectively, in which the TⅡ group decreased more significantly (P<0.01).The total cholesterol level and triglyceride level in TⅡgroup were obviously lower than those in valsartan group(P<0.01). The total cholesterol level and triglyceride level in valsartan group increased ([6.60±0.2]mmol/L vs [7.11±1.13]mmol/L, [2.47± 1.48]mmol/L vs [2.49±0.32] mmol/L).The serum protein level in TⅡ group was obviously higher than that in valsartan group ([41.1±1.2]g/L vs [37.9±4.2]g/L, P<0.05).At 3 month, 6 month and 12 month follow-up, the average serum creatinine levels in TⅡgroup were obviously lower than those in valsartan group ([1.5±0.4]mg/dl vs [1.6±0.3]mg/dl, P<0.05), ([1.3±0.3]mg/dl vs [1.8±0.5]mg/dl, P<0.05), ([1.1±0.4]mg/dl vs [2.1±0.5]mg/dl, P<0.05).The incidence rate of adverse reaction in valsartan group was obviously greater compared with TⅡgroup( P<0.05) . Conclusion Both tripterygium wilfordii multiglycosides and valsar-tan can reduce proteinuria caused by SRL in renal transplant patients,while the application of TⅡhas more remarkable effect.
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Objective To separate the CD133 + subpopulation in human hepatocellular carcinoma (HCC) and investigate the tumorigenicity.Methods The human liver cancer tissues were subcutaneously transplanted into nude mice to generate xenograft tumors which were then isolated to prepare single cell suspension.The expression of CD133 + subpopulation was further detected using flow cytometry.The CD133 + subpopulations were separated and depurated with magnetic-activated cell sorting system.Immunofluorescence was performed to identify the histological phenotype of CD133 + subpopulation.The in vitro and in vivo clone formation assay and in vivo xenograft formation assay were performed, respectively.Results Flow cytometry analysis revealed that a percentage of (4.1 ± 0.6) ％ CD133 + cells were detected in xenografts.Immunofluorescence studies showed that (86.8 ± 7.5) ％ of the isolated cells were CD133 +.Compared with CD133-population, CD133 + cells showed a higher capability to generate clone sphere in vitro and a higher tumorigenicity in nude mice (P ＜ 0.05).Conclusion The CD133 + subpopulation in human hepatocellular carcinoma had a potent tumorigenicity and was enriched in cancer stem cells.
ABSTRACT
Objective To verify whether the storage bag can reach the use requirement of cord blood freezing storage by conduc-ting a series of tests before staring use of new type cryopreservation bag for cord blood.Methods According to the standard opera-tion procedure,28 new type cryopreservation bags were extracted.The cord blood units were performed the cryostorage and thaw for rewarming according to the standard operating procedures.Then the physical integrity and various quality indicators of cord blood in bag were detected,including the nucleated cell viability,cell recovery rate,CD34-positive cell,colony-forming cultivation of stem cells,sterility test and verification of actual load volume.Results All the tested storage bags passed the integrity test,and the various testing indicators of the preserved cells conformed to the use requirements.Conclusion The new type storage bag has the same performance and effect to original bag,it is verified that the maximum loading volume of 50 mL(for 50 mL specification of storage bag)and 80mL(for 250mL specification of storage bag)is safe.