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Objective:To evaluate the safety of pregnancy after kidney transplantation and summarize the optimal timing of pregnancy and the experience in the management during pregnancy and peripartum.Methods:A total of 25 kidney transplant recipients were pregnant during March 2013 to February 2020. A matched cohort of 75 general pregnant women wasincluded as control.Results:Twenty-five women successfully delivered healthy babies in the transplant group. The mean age at kidney transplantationwas (25.6 ±3.2) years old, and the mean interval between transplantation and conception was (54.0±23.1) months. 92% (23 / 25) of recipients had cesarean surgery and all infants were singletons.During pregnancy, the incidence of preeclampsia was significantly higher in the transplant group(20.0%VS. 1.3%, P=0.001)compared with matched control. Compared with pre-pregnancy, the serum creatinine levels of the recipients decreased in the second trimester( P<0.001)and increased in the third trimester( P=0.019), which was similar with the control group. In the third trimester, 40%(10/25)of recipients in the transplant group had proteinuria, which decreased to negative(5/10) or 1+ (4/10) within 6 months after delivery. No rejection occurred in all patients during pregnancy and 6 months after delivery. A higher dose of tacrolimus was needed to maintain the normal trough level after pregnancy, which returned to routine dose postpartum. Conclusions:Although the risk of pregnancy was higher in kidney transplant recipients than that in non-transplant women, the overall risk was acceptable. Strict screening of patients preparing for pregnancy, adjustment of immunosuppressive drugs, and multi-disciplinary collaboration are important for safe pregnancy and delivery.
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Objective:To explore the efficacy and safety of pretreating with oral immunosuppressants alone for ABO-incompatible (ABOi) renal transplant recipients with an initial isoagglutinin titer <1: 8.Methods:From September 2014 to October 2019, 16 cases of ABOi renal transplantation pretreated with oral immunosuppressants alone and 32 cases of ABO-compatible (ABOc) renal transplantation were recruited for comparing the inter-group incidence of graft function, acute rejection, infection and recipient and allograft survival.Results:The 16 ABOi renal transplantations were AB-to-A(n=4), AB-to-B(n=3), A-to-B(n=1), B-to-A(n=4), A-to-O(n=2) and B-to-O(n=2). The initial isoagglutinin titer (IgM & IgG) and that on the date of transplantation were both ≤1∶8. The median follow-up period was 495(90-1696) days. One patient in ABOi group underwent allograft nephrectomy due to hyperacute rejection. The graft survival rates were 93.75%(15/16) and 100%(32/32) in ABOi and ABOc groups respectively. No recipient died. No significant inter-group difference existed in postoperative renal function after 6 months (serum creatinine μmol/L: 114.30±28.13 vs. 106.08±23.80, P=0.38; eGFR ml/min/1.73 m 2: 64.93±19.60 vs. 82.34±22.58, P=0.13). In ABOi group, there were 3 episodes of postoperative infection, 2 episodes of acute rejection within 2 weeks (including 1 episode of hyperacute rejection) and 1 episode of acute rejection after 2 weeks; 5 episodes of postoperative infection, no acute rejection within 2 weeks and 5 episodes of acute rejection after 2 weeks in ABOc group. No significant inter-group difference existed in the incidence of infection or rejection ( P>0.05). Conclusions:Using oral immunosuppressant alone is both safe and feasible for ABOi renal transplantation recipients with an initial isoagglutinin titer ≤1∶8. It may greatly simplify the pretreatment scheme for those with a low initial isoagglutinin titer and lower the incidence of complications.
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Objective To compare the clinical efficacy of hollow screws and "L" type plate for the treatment of middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture.Methods A retrospective case control study was performed on the clinical data of 73 patients with middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture treated from January 2010to January 2017.There were 47 males and 26 females,with the mean age of 38.5 years (range,23-70 years).According to the posterior malleolus fixation method,38 cases adopted the internal fixation with three hollow screws (screw group),and 35 cases with" L" type plate fixation (plate group).The middle and lower 1/3 spiral fracture of tibia were treated with medial anatomical plate internal fixation.The intraoperative blood loss,operation time,infection,fracture healing time,and complications were recorded.The Baird-Jackson score was used to evaluate the ankle joint function.Results There were no significant differences in the blood loss and operation time between the two groups (P ＞ 0.05).A total of 71 patients were followed up for 6-18 months (mean,15.8 months).Two cases in the screw group were lost to follow up.The wounds healed well after operation in two groups,and no signs of wound infection were found.All fractures healed well without delayed union or nonunion.There was no significant difference in fracture healing time between the two groups (P ＞ 0.05).No obvious reduction loss in posterior ankle fracture was found during follow-up.In the plate group,one patient was seen vertical shape toe deformity after operation,which might be related to muscle spasm of flexor hallucis longus,and the condition was not improved after removing the plate.At the last follow up,ankle joint function was evaluated according to the Baird-Jackson scoring system:in the screw group,18 cases were excellent,13 cases were good,four cases were allowed to pass,and one case was poor,with the excellent and good rate of 82％;in the plate group,17 cases were excellent,13 cases were good,four cases were allowed to pass,and one case was poor,with the excellent and good rate of 86％ (P ＞ 0.05).Conclusion The clinical efficacy of hollow screws and "L" type plate is not significantly different,both of which can provide rigid fixation,reduce the incidence of hip dysfunction and improve quality of life of patients with middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture.
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BACKGROUND:Different weaving methods of autologous tendon lead to various treatment efficacies on cruciate ligament rupture, but the preferred method is stil controversial. OBJECTIVE:To comparatively analyze the clinical efficacy of single-bundle and double-bundle autografts on anterior cruciate ligament reconstruction. METHODS:A retrospective analysis of 48 cases of anterior cruciate ligament rupture was performed. According to the composition of graft beam, these 48 patients were divided into two groups:double-bundle group (n=24) and single-bundle group (n=24). Al surgical patients underwent autologous anterior cruciate ligament reconstruction by arthroscopy, and were fol owed up for at least 6 months. The function of knee joint after operation was comprehensively analyzed through IKDC and Lysholm scores. RESULTS AND CONCLUSION:Al of the patients (n=48) exhibited no joint complications postoperatively, such as intra-articular infection, joint effusion and incision inflammation. The IKDC scores and Lysholm scores in the double-bundle group were better than those in the single-bundle group, but there was no statistical y significant difference (P>0.05). This study demonstrated that single-bundle and double-bundle autografts both have good curative effects on anterior cruciate ligament reconstruction by arthroscopy. But in contrast, the curative effects of double-bundle autografts are better.
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The production of mature functional T cells requires many signals from the thymus such as Wnt,Notch and Hedgehog,et al.The Hedgehog protein family signals for development,patterning and organogenesis of many tissues during mammalian embryogenesis.In recent years,more and more research groups focus their attention on it because of its relationship between tumors.Abnormal differentiation and development of T cells may cause various immunological diseases and tumors.Illuminating the roles of Hedgehog signaling in T cell differentiation and development can provide a theoretical guide in the treatment of tumor.