Current trend of induction and maintenance treatment in positive panel-reactive antibody patients: a report on OPTN/UNOS kidney transplant registry data / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The status of sensitization in kidney transplant recipients in the last 10 years and the trend of induction and maintenance therapy in patients of different panel-reactive antibody (PRA) levels have not been analyzed. The aim of this study was to investigate the current status of pre-transplant sensitization and its association with graft outcome.</p><p><b>METHODS</b>A total of 155 570 kidney transplants reported to United Network for Organ Sharing (UNOS) during 2000 - 2009 were included in this study. We investigated the current status of pre-transplant sensitization and its association with graft outcome, and also compared the usage trend of 16 induction agents and 7 maintenance immunosuppressants in patients at different PRA levels. The difference of distributions of categorical variables between groups was investigated using the chi-square test. Unpaired t test or one-way analysis of variance (ANOVA) were used for numerical variables. The survival rates of transplant recipients were estimated using Kaplan-Meier methods and significance was determined by Log-rank test. Two-side P value < 0.05 was considered statistically significant. All statistical analyses were performed using STATA 10 with all available updates as of March 2010 (StataCorp LP, College Station, Texas 77845, USA).</p><p><b>RESULTS</b>Despite the fact of the decreased percentages of kidney transplant recipients with presensitization history, the mean PRA levels of all kidney recipients has been increasing in the last 7 years, which was possibly due to the introduction of more sensitive antibody testing techniques. The percentage of patients with treated rejection episodes within one year post-transplant were significantly higher in sensitized patients (PRA = 50% - 100%:14.3% and PRA = 1% - 49%:13.9%) than in non-sensitized patients (12.4%). Both 1- and 5-year graft survival rates improved in the last 10 years; this was more significant in high PRA patients. Thymoglobulin was the most commonly used induction agent in last 10 years. Its users increased from 10% to 46% in non-sensitized patients, from 12% to 57% in PRA 1% - 49% patients, and from 19% to 63% in PRA 50% - 100% patients. The users of Campath, intravenous immunoglobulin (IVIG), and Rituximab have been increasing and reached 16%, 20%, and 11% in highly sensitized patients. In the last 5 years, steroid-free patients were 33% - 36%, 30% - 37%, and 10% - 25% for PRA 0, 1% - 49%, and 50% - 100% respectively. Almost 90% of patients were on Prograf at discharge. It seems that Myfortic users have been increasing since 2005 and it may soon replace mycophenolate mofetil (MMF) if long-term follow-up study conforms its safety and efficacy.</p><p><b>CONCLUSIONS</b>Application of sensitive antibody testing techniques increased the mean PRA levels of transplant recipients in spite of a decreased percentage of sensitized recipients. Induction and maintenance therapy differed in patients at different PRA levels.</p>

Role of proteasome inhibition in sensitized transplant candidates / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review this efficacy and safety of bortezomib, a proteasome inhibitor, in the setting of the sensitized transplant candidate.</p><p><b>DATA SOURCES</b>The data used in this review were from articles published (PubMed) between 2000 to 2010. Additionally abstracts from medical meetings related to transplant were also used.</p><p><b>STUDY SELECTION</b>Articles were selected if they were trial results or case studies for the use of bortezomib in the sensitized patient population.</p><p><b>RESULTS</b>The early data using bortezomib as a part of desensitization regimens has shown success. Although one cycle (4 doses) of bortezomib seems to have affect on many patients, it also seems likely that to provide complete desensitization multiple cycles will be required. Regarding safety, bortezomib has been shown to have minimal side effects. The most common side effects reported are those of thrombocytopenia and anemia. These side effects are dose related and self limiting upon discontinuation of the treatment.</p><p><b>CONCLUSIONS</b>Bortezomib with plasmapheresis is a promising new alternative to desensitization protocols that use either high dose intravenous immune globulin (IVIG) or low dose IVIG and plasmapheresis. The efficacy on antibody reduction looks to be batter that that of the IVIG based regimens without significant addition toxicity. The results of ongoing prospective trials are positive and their complete results are greatly anticipated.</p>

Clinical Effectiveness of Urinary Human Chorionic Gonadotropin Related Protein (hCGRP) Quantification for Diagnosis of Ectopic Pregnancy

We detected pregnancy related new molecule, human chorionic gonadotropin related protein (hCGRP) in the urine of a pregnant women by using a monoclonal antibody against the human chorionic gonadotropin (hCG). This study examined the effectiveness of urinary hCGRP quantification in diagnosing ectopic pregnancy. This study included 40 normal pregnant women and 25 patients with ectopic pregnancy. Patients' serum and urinary intact whole hCG (i-hCG) and hCGRP concentrations were measured using sandwich ELISA and the ratio of hCGRP to i-hCG was calculated. Statistical analysis was performed using statistical package for social sciences (SPSS) 10.0. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off value to discriminate ectopic pregnancies from normal intrauterine pregnancies. Urinary hCGRP and hCGRP/i-hCG ratio in ectopic pregnancy group (14 +/- 6.6 ng/mL, 4.6 +/- 1.9%, respectively) were significantly lower than those of normal pregnancy group (149 +/- 10.2 ng/mL, 29.7 +/- 1.9%, respectively; p<0.001). Based on ROC curve analysis, a cut-off point of urinary hCGRP/i-hCG ratio <16.2% discriminated between ectopic pregnancy and normal pregnancy with a sensitivity, specificity, positive predictive value and negative predictive value of 92.0%, 90.0%, 32.6%, and 99.5%, respectively. Urinary hCGRP/i-hCG ratio measurement may be effective in diagnosing ectopic pregnancy.

Correlation of central corneal thickness and Goldmann applanation tonometry among Filipinos

Methods: A prospective cross-sectional study was performed among Filipino patients consulting at the General Ophthalmology Clinic of the Philippine General Hospital. They underwent a comprehensive eye examination. CCT obtained by ultrasonic pachymetry and IOP by Goldmann applanation tonometry were correlated using linear regression analysis. Factors affecting CCT measurements were analyzed by ANOVA. Results: Two hundred twenty two eyes of 112 patients were included in the study. CCT ranged from 451.0 mm to 653.6 mm with a mean of 531.5 mm +/- 33.8 mm. There was a significant linear correlation between CCT and IOP (r=0.63). The IOP was noted to rise by 4.3 mm Hg/100 mm CCT. Conclusion: The CCT among Filipinos is normally distributed and is comparable to the distribution obtained by metaanalysis of worldwide data. The study also found a direct correlation between CCT and IOP among Filipinos.

Intestinal helminth infections among school children in Visakhapatnam.

A study was carried out between 1993-1994 to determine the prevalence and intensity of intestinal helminth infections among 217 primary school children in Relliveedhi, a slum area in Visakhapatnam. The children were between 7 to 13 years of age and belonged to lower socio-economic status. Stool samples collected were processed by modified formalin-ethyl acetate sedimentation technique to determine ova counts (EPG). One hundred and seventy seven children were infected with one or more of the intestinal parasites viz. Ascaris lumbricoides, Trichuris trichiura and hookworm. The overall prevalence of infection was eighty two per cent. Ascaris lumbricoides was the most common infection with a prevalence of 75% followed by T. trichiura (66%) and hookworm (9%). All infected children received a single dose of albendazole (400 mg/child). Single stool samples were examined over a period of nine months to study reinfection dynamics.

Quantitative assessment of Ascaris lumbricoides infection in school children from a slum in Visakhapatnam, south India.

An epidemiological study was conducted on 217 school children aged between 7-13 years, from Relliveedhi a slum in Visakhapatnam, Andhra Pradesh, south India, during August 1993 to August 1994. The children belonged to a socioeconomically backward community-parental occupation being fishing or waged labor. Intensity and prevalence estimations for Ascaris lumbricoides were done indirectly by formalin-ethyl-acetate sedimentation technic and directly by worm expulsions following albendazole administration at a single oral dose of 400 mg/child. Prevalence rate was 73% while the intensity of infection ranged between low to moderate. Boys had severe infection than girls due to their outdoor activities and behavioral habits. Nine year old children had the highest prevalence rates. Mean Ascaris worm intensity was 2.2 (+/-1.91) with an over-dispersed distribution of the parasite in the host population. Reinfection study over a period of nine month showed that the prevalence rates exceeded the pre-intervention level but the intensity of infection was very low. Dual species intensity correlation between Ascaris and Trichuris was consistently strong.

Re-infection estimation of soil-transmitted helminths among slum school children in Visakhapatnam, Andhra Pradesh.

Prevalence and intensity study of soil-transmitted helminths was carried out in a primary municipal corporation school in Relliveedhi, Visakhapatnam, Andhra Pradesh. All subjects (n = 217) belonged to low socio-economic status with an age distribution of 7-13 years. Reinfection study was estimated over a nine month period following treatment with albendazole administered at a single oral dose of 400 mg/child. Parasites identified were Ascaris lumbricoides, Trichuris trichiura and hookworm. Post-treatment prevalence reached pre-intervention level but the intensity of infection remained appreciably low (p < 0.05).