Application progress in classification of puncture biopsy after kidney transplantation / 器官移植

Renal allograft biopsy (biopsy) remains the "gold standard" for the diagnosis of renal dysfunction after kidney transplantation. Puncture biopsy after kidney transplantation could be divided into indicative biopsy and protocol biopsy according to renal function of the patients. Indicative biopsy is mainly applied to diagnose postoperative complications of kidney transplantation, evaluate the severity of disease and guide subsequent treatment. Protocol biopsy is primarily employed to regular monitor renal allograft function of kidney transplant recipients and exclude subclinical rejection and other complications. Due to the willingness of patients and other reasons, protocol biopsy has not been widely applied in China. Currently, indicative biopsy is the main biopsy pattern. At present, the indications of puncture of indicative biopsy, the timing and necessity of puncture of protocol biopsy remain controversial. In this article, the classification of puncture biopsy after kidney transplantation and research progress on tissue biomarkers based on biopsy were reviewed, aiming to assist clinical diagnosis and targeted treatment of complications after kidney transplantation and provide reference for further improving the survival of renal allografts and recipients.

Application progress of ischemic preconditioning in ischemia-reperfusion injury of renal allografts / 器官移植

Kidney transplantation is more efficacious compared with other organ transplantations. Nevertheless, postoperative complications, such as renal ischemia-reperfusion injury (IRI), severely affect the survival rate and quality of life of recipients. How to mitigate the IRI of renal allografts has become one of the key topics in the field of kidney transplantation. At present, ischemic preconditioning enables renal allografts to adapt to ischemia, which is one of the effective methods to prevent the progression of IRI. However, the underlying mechanism remains elusive. In this article, the application of ischemic preconditioning in IRI, the regulation mechanism of ischemic preconditioning on the IRI of renal allografts at the cellular level and intracellular signaling pathway, and clinical application value and prospect of ischemic preconditioning were reviewed, aiming to provide reference for alleviating the IRI of renal allografts, enhancing the survival rate of the recipients and renal allografts and improving the quality of life of recipients.

Two clinical cases of Novel coronavirus pneumonia (NCP) in renal transplant recipients / 中华器官移植杂志

Objective@#To explore the clinical features, diagnosis and prognosis of renal transplant recipients with NCP.@*Method@#The clinical data of 2 cases of kidney transplant recipients with NCP were retrospectively analyzed. Based onclinical manifestations, blood routine, inflammatory factors, cell immunity, chest CT andtherapeutic effects, the diagnosis and treatment of NCP in kidney transplant recipients (5th edition) were compared to that ofordinary NCP patients. Both recipients developed onset of low andmoderate fever, with no cough or fatigue at the initial stage. Blood routine indicated a normal range of leukocytes,buta significant decrease in lymphocyte counts, increased C-reactive protein (CRP) , and slightly higher procalcitonin (PCT) . The cellular immunity was extremely low, and the chest CT showed multiple patchy ground glass shadows in both lungs.@*Result@#After 1 week of onset, both patients had significant disease progression. The pathogenesis and imaging changes were highly similar tothatreported in ordinary NCP patients.Two patients were givensymptomatic supportive treatment by antiviral agents, stop uses ofimmunosuppression agents, small amount of hormone maintenance, intravenous drip of gamma globulin andrespiratory support toavoid secondary infections. At present, the condition of both patients is obviously improved, and renal function is stable. One of them has recovered and was discharged.@*Conclusion@#The clinical manifestations of NCP in renal transplant recipients were generally consistent with that of ordinary NCP patients. Although there is no established method for the treatment of NCP, it is effective by stopping uses of immunosuppressive agents, maintaining small and medium doses of hormones, actively restoring immunity, and providing respiratory support in a timely manner.

Two clinical cases of novel coronavirus pneumonia (COVID-19) in renal transplant recipients / 中华器官移植杂志

Objective:To explore the clinical features, diagnosis and prognosis of renal transplant recipients with COVID-19.Methods:The clinical data were retrospectively analyzed for 2 kidney transplant recipients with COVID-19. Based upon clinical manifestations, blood routine, inflammatory factors, cell immunity, chest computed tomography(CT)and therapeutic efficacies, the diagnosis and treatment of COVID-19 in kidney transplant recipients(Interim Edition V)were compared to that of ordinary COVID-19 patients. Both recipients had an onset of low/moderate fever. There was no initial symptom of cough or fatigue. Blood routine indicated a normal count of leukocytes, a marked lymphocytopenia, elevated C-reactive protein(CRP)and slightly higher procalcitonin(PCT). Cellular immunity was extremely low and chest CT showed multiple patchy ground-glass opacities in both lungs.Results:After 1 week of onset, both patients had a marked disease progression. The pathogenesis and imaging changes were highly similar to those reported for ordinary COVID-19 patients. For preventing secondary infections, both received symptomatic supportive measures of antiviral agents, withdrawing immunosuppressants, tapering of hormone maintenance dose, intravenous drip of gamma globulin and respiratory supports. Currently the conditions of both patients obviously improved and renal function was stable. One case recovered and was discharged.Conclusions:The clinical manifestations of COVID-19 in renal transplant recipients are generally consistent with that of ordinary COVID-19 patients. Although there is no established treatment for COVID-19, withdrawing immunosuppressants, maintaining small and medium doses of hormones, actively restoring immunity and providing respiratory supports in a timely manner are effective.

Two case reports ofrecurrent focal segmental glomurular sclerosis after renal transplantation and preliminary application of risk grade assessment of circulating permeability factor panel / 中华器官移植杂志

Objective:To summarize the diagnosis, treatment and outcome of recurrent focal segmental glomurular sclerosis(FSGS)after kidney transplantation and explore the predictive value of risk grade assessment of peripheral circulating permeability factor for recurrent FSGS.Methods:Retrospective analysis was performed for pathological history, biopsy finding before and after transplantation, blood level of FSGS biomarkers of two patients with recurrent FSGS. Then the relationship was analyzed between the risk grade assessment of peripheral circulating permeability factor and recurrent FSGS.Results:Both patients belonged to primary FSGS with >10g/24h urine protein. The recurrence of FSGS after transplantation was confirmed by renal biopsy. After plasma exchange, rituximab and Tripterygium wilfordii, 24-hour urine protein content declined, general edema subsided significantly and renal function stabilized.Conclusions:After renal transplantation, plasma exchange and rituximab can effectively alleviate the symptoms of recurrent FSGS. And assessing risk level of peripheral circulating permeability factor panel may have value in predicting the recurrent risk of FSGS

How to identify the new technology and method of clinical nursing by editors of nursing journals / 中国实用护理杂志

Objective:To explore the methods to improve the ability of editors of nursing journals to recognize new clinical nursing techniques and methods.Methods:Aanalyzed the difficulties in the recognition of new nursing technology innovation points, and summarized the methods of improving the recognition ability of nursing journal editors.Results:It was difficult to identify the new technology of nursing that the presentation of innovation points was inappropriate, inaccurate and there were differences in the definition and application of new technology and new method in different levels of medical units. To improve the identification ability of new technology innovation, nursing editors must fully understand the new information and development trend of specialized field industry and specialized technology, and the application of clinical nursing technology in different levels of medical units.Conclusion:The editors of nursing journals should strive to overcome the difficulties in the identification of new nursing technology in the paper, improve the innovative appreciation ability of the paper, and assist the authors to enhance the innovative value of the paper.

Inspiration of selecting peer review experts for nursing sci-tech journals with the review of different peer review′s conclusion papers / 中国实用护理杂志

Objective:To discuss the method and strategy of selecting reviewers for nursing journals.Methods:Through the review practice of different review conclusions, this paper analyzed the reasons for the differences in review conclusions.Results:The methods and suggestions for selecting reviewers included more detailed research direction of reviewers and more comprehensive distribution of research direction; complementary "academic school" and "clinical school" in the same research direction; certain reserved candidates in hot research areas; full consideration of the energy and time of reviewers who hold concurrent administrative positions.Conclusion:The selection of reviewers of nursing journals should follow the characteristics of disciplines and fully consider the distribution of reviewers with different characteristics, so as to make the review process more professional and reliable.

γδ T cells and cancer immunotherapy / 中国医师进修杂志

γδ T cells have been well recognized as a unique cell population that is actively involved in both innate and adoptive immunity of bodies. The features of γδ T cells, such as their major histocompatibility complex independent antigen recognition and their cytotoxic effects to tumor cells, make them as promising candidates used for cancer immunotherapy. There is a strong interest in developing γδ T cell-based immunotherapy for clinical application in treating cancer patients. This review discusses the progress of recent studies related to the γδ T cells and cancer immunotherapy, with an emphasis on the main characteristics of γδ T cells in several types of gynecologic tumors.

Selection of appropriate period and mode of blood purification for treatment of patients with severe acute pancreatitis / 中国中西医结合急救杂志

Objective To approach the selection of appropriate period and mode of blood purification for treatment of patients with severe acute pancreatitis(SAP)based on acute physiology and chronic health evaluationⅡ(APACHEⅡ)score. Methods The clinical data of 89 patients with SAP were retrospectively analyzed. They were assigned into two groups:the hemoperfusion(HP)and short continuous veno-venous hemodiafiltration(SCVVHDF) group(HP+SCVVHDF,49 cases)and the HP and hemodiafiltration(HDF)group(HP+HDF,40 cases). All the patients were evaluated by APACHEⅡscore. In the HP+HDF group,26 cases with APACHEⅡ0.05),while the APACHEⅡ score,PaO2/FiO2,CRP, SCr and ALT were improved more significantly in group C than those in group B(P<0.05 or P<0.01). The mortality rate of those SAP patients with APACHEⅡscore<15 was lower than those in cases with APACHEⅡscore 15-20〔6.82%(3/44)vs. 24.44%(11/45),P<0.05〕. Conclusions Blood purification is an effective measure to save patients with SAP. The APACHEⅡ score used to select the mode of blood purification in appropriate period for treatment of SAP has guiding significance. Currently the modes of blood purification have limited value and cannot cure all SAP patients.

Preparation and purification of advanced oxidation protein products / 中国组织工程研究

BACKGROUND: Advanced oxidation protein products (AOPPs) are a crucial pathogenic link to such long-term uremic complications in hemodialysis patients as immune system dysregulation, accelerated atherosclerosis, dialysis-related amyloldosis and so on. However, basic studies on AOPPs are relatively few, and one of the main reasons is the fact that it is difficult to obtain AOPPs with high pudty and biological activity.OBJECTIVE: To prepare, pudfy and indentify AOPPs, with the hope of searching for a method of preparing AOPPs with high purity and biological activity.DESIGN, TIME AND SETTING: A single sample observation was completed in the Clinical Biochemistry Section of Ecsomatics Department, Third Military Medical University of Chinese PLA from September to November in 2008. MATERIALS: Human serum albumin (HSA) was provided by Chengdu Rongsheng Company Ltd. Hitrap 26/60 sephacryl S-300 was purchased from GE Healthcare.METHODS: Hypochloric acid was used in the oxidation of purified HSA to prepare in vitro the AOPPs-modified HSA (AOPPs-HSA), which was then isolated by Hitrap 26/60 sephacryl S-300. Relative molecular mass was determined by sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE), native polyacrylamide gel electrophoresis (PAGE) and molecular weight standards. Structural features and biological activities were identified in the experiment of tumor necrosis factor α (TNF-α) release from monocytes.MAIN OUTCOME MEASURES: ①The purification and gel electrophoresis results of HSA. ②The purification and gel electrophoresis results of AOPPs. ③The dose-effect relationship between AOPPs-HSA and TNF-α release from monocytes. RESULTS: The relative molecular mass of AOPPs-HSA was 670 000 according to SDS-PAGE, native PAGE and molecular weight standards. Moreover, AOPPs-HSA could encourage the release of TNF-α from monocytes. The time effects showed that TNF-α release volume significantly increased after 6 hours of stimulation by AOPPs-HSA (1 g/L) and reached a peak at hour 12. CONCLUSION: Highly purified and bioactive AOPPs can be successfully prepared by the above-mentioned method, which builds a basis for further study on AOPPs.

Renal damage due to rupture of atherosclerotic plaque of renal artery in ApoE-/- mice / 中华肾脏病杂志

Objective To investigate the mechanism of renal damage due to rupture of atheroselerotic plaque of renal artery in apolipoprotein E (ApoE) knock-out mice. Methods The model for atherosclerotie renal artery stenosis (ARAS) was established by using ApoE knockout mice. The model mice with renal artery stenosis <50% were divided into the plaque rupture group and the non-plaque rupture group. Wild-type C57BL/6J mice were used as the control group. All the mice were raised under the same conditions. The renal arteries and kidneys were collected for the following analysis. Nuclear factor-kappa-Bp65 (NF-kBp65), intercellular adhesion molecule 1 (ICAM-1) and P-selectin (P-sel) were determined by Western blotting. The expression of interleukin 6 (IL-6) mRNA was detected by RT-PCR. Immunohistochemistry was performed by using serial sections to detect F4/80-related macrophages. Urine n-acetyl-β-d-glucosaminidase (NAG) activity was determined by direct enzyme-substrate coloration. Results In comparison with the nonplaque rupture group and the control group, the expression of NF-kBp65 protein in the blood, renal artery and kidney increased significantly in the plaque rupture group (P<0.05). The expression of F4/80, ICAM-1, P-sel, and IL-6 mRNA were increased significantly in the plaque rupture group (P<0.05), as compared with the non-plaque rupture group and the control group. The Ser and the activity of urine NAG in the plaque rupture group were higher than those in the non-plaque rapture group. The expression of NF-KBp65 protein differed insignificantly between the control group and the non-plaque rupture group (P>O.05). The group differences in the expression of F4/80, ICAM-1, P-sel, and IL-6 mRNA were similar to those in the expression of NF-KBp65 protein. The group differences in the activity of urine NAG and the Scr were similar to those in the expression of NF-kBp65 protein. Conclusion Rupture of atherosclerotic plaque of renal artery causes renal pathology change and renal function damage, which is mediated by inflammation.

Delivering programmed death-1 inhibitory signal suppresses lupus-like syndrome in autoimmune BXSB mice / 中华风湿病学杂志

Objective To explore the role of delivering programmed death (PD)-1 negative costimulation pathways in the prevention of murine BXSB lupus. Methods A recombinant adenovims containing the full-length mouse PD-L1 gene (AdPD-L1) was constructed and was introduced to the BXSB mice. The effect of immunoinhibitory receptor PD-1 on activated lymphocytes was investigated to evaluate its effect on prevention of lupus nephritis in BXSB mice. Results This intervention dramatically delayed the onset of proteinuria, effectively inhibited IgG autoantibody production, and significantly reduced hypercellularity and deposition of IgG in glomeruli, resulting in almost complete amelioration of lupus nephritis in these animals.Conclusion Our results suggest that simultaneous stimulation of PD-1-mediated pathway can potentially revent human lupus nephritis.

Experimental study of heme oxygenase-1 gene transfer prevents chronic allograft nephropathy / 中华泌尿外科杂志

Objective To investigate the effects of HO-1 on renal allografts after HO-1 gene transfection in rat chronic allograft nephropathy model. Methods Twenty F344 and twenty-six Lewis rats were included in this experiment. They were divided into 3 groups at random. Six Lewis rats were in pseudo-operation group, 10 Lewis were in empty carrier group (transfected with adenovirus) and 10 Lewis were in the gene transfection group (transfected with Ad-HO-1 adenovirus). The expression of HO-1 protein was detected by WB at the 1st ,2nd,3rd and 4th week. The content of creatinine in blood was assayed at the 4th,8th, 12th and the 16th week. The weight of rat, the value of patholiogical changes and the expression of ?-SMA,TGF-?1 and PDGF-B were analysized at the 16th week. Results The weight of rats in 3 groups had not any changes at 16th week. The content of creatinine in blood of gene transfection group were lower than those in the empty carrier group. The expression of HO-1 protein were very high in the 1st and 2nd week and decreased at 3rd and 4th week. The Banff value of kidney in the gene transfer group was better than that of the empty carrier group at the 16th week. The level of ?-SMA, TGF-?1 and PDGF-B in the gene transfection group were significantly lower than those in the empty carrier group. Conclusions Ad-HO-1 could efficiently transfer HO-1 gene into rat donor kidney. The prevention of chronic allograft nephropathy may have relationship with the decreasing expression of ?-SMA, TGF-?and PDGF-B.

Building immune microsphere against tumor necrosis factor-alpha (TNF-alpha) / 生物医学工程学杂志

We have constructed the immune microsphere against tumor necrosis factor-alpha (TNF-alpha) prospectively, hoping to establish the experiment groundwork in more researches which could be used in specific elimination of the TNF-alpha by blood purification method for the future. The recombinant human tumor necrosis factor-alpha monoclonal antibody (rHTNF-alpha McAb) was wrapped on the polystyrene microsphere (PSM) carrier connecting poly-L-lysine (PLL) beforehand. They were earmarked by the fluorescein isothiocyanate (FITC) respectively. The packing conditions were examined using the inversted and fluorescence microscopes and the spectrophotometer. The results showed that the best conditions for wrapping were 20 degrees C, pH9.5 and 60 minutes. The PLL content was not changed in the washing fluid after coating, which indicated the wrapping was quite firm. At the same temperature and same coating time, the rHTNF-alpha McAb coated on the PLL was obviously substantial when the concentration of glutaraldehyde solution was 0.2%. The findings demonstrated that the built immune microsphers can be used as a novel adsorption material. This method is simple and economic, and it offers a new approach to the related studies.

Expression and significance of programmed death-ligand 1 and programmed death-1 in acute allograft rejection / 中华器官移植杂志

Objective To investigate the expression of programmed death-ligand 1 (PD-L1) and programmed death-1(PD-1) in the kidney tissue of acute allograft rejection (AR) and the correlation between PD-L1 expression and PD-1 expression and the degree of tubulointerstitial lesions.Methods Immunohistochemistry and in situ hybridization were used to detect the expression of PD-L1 and PD-1 in renal tissue of normal control and AR confirmed by biopsy.Results Both PD-L1 and PD-1 expression were significantly higher in AR than in the normal renal tissue (P

Fibrosis of middle-small arteries and veins in early-stage uremic patients / 第三军医大学学报

Objective To explore the pathological changes of the middle-small arteries and veins of uremic patients in early stage.Methods Forty patients with chronic kidney disease at Ⅴ stage were randomly subjected in our study.Radial artery and cephalic vein about 0.5 to 1 cm in length were obtained by arteriovenous fistula operations.Cephalic veins from 4 trauma patients were taken as control group.Immunohistochemisty with anti-?-SMA(smooth muscle actin-alpha),BMP-2(bone morphology protein-2) and BMP-7(bone morphology protein-7) antibodies,alizarin Bordeaux staining,HE staining and Masson trichrome staining were carried out to investigate calcification and fibrosis.Results Compared with control group,the expressions of ?-SMA and BMP-2 were up-regulated obviously.Masson trichrome staining indicated fibrosis in the vein from uremic patients.Conclusion Fibrosis may be one of the early pathologic changes in the vein from uremic patients,suggesting the venous alterations may be related to cardiovascular disease of uremic patients.

Impact of transplant nephrectomy on panel reactive antibodies / 第三军医大学学报

Objective To observe the impact of transplant nephrectomy on panel reactive antibodies and a secondary renal transplantation.Methods Panel reactive antibodies in 15 patients with a failed renal transplant admitted in our hospital between 2004 to 2007 were measured before transplantation,before and 1 month,6 months,12 months after transplant nephrectomy,and the pathological changes were observed after transplant nephrectomy.Results Panel reactive antibodies was increasing after renal transplantation,and reached the highest level one month after transplant nephrectomy,then grandually got down.New HLA allosensitization sites were discovered after transplant nephrectomy.Large amount of C4d was stained in failed transplant.Conclusion Serum PRA increased after transplant nephrectomy.New HLA allosensitization sites were found,which may be useful in HLA matching.

Endothelial progenitor cells transplantation ameliorates the progression of progressive focal segmental glomerular sclerosis / 第三军医大学学报

Objective To investigate the therapeutic effect of endothelial progenitor cells(EPCs) in ameliorating rat progressive focal segmental glomerular sclerosis(FSGS) model induced by adriamycin.Methods Bone marrow mononuclear cells from male SD rats,after cultured by adherence method,were identified as EPCs.Female SD rats were divided into normal control group,adriamycin induced renal disease(ADR) group,EPCs transplantation group.ADR group and EPCs group underwent unilateral nephrectomy and received 5,3 mg/kg of adriamycin via tail vein 1 week and 2 weeks after operation,while the control group underwent sham operation and received 0.9% sodium chloride solution of equal volume.The whole body irradiation by 5 Gy X ray was done 1 week after the 2nd injection of adriamycin,then immediately 1?106 EPCs were transplanted via tail vein.The rats in control group and ADR group were only injected with 0.9% sodium chloride solution after whole body irradiation.The body weight and urine protein were measured before operation(0 week) and 4(1 week after EPCs transplantation),8,12 and 16 weeks after nephrectomy.Y chromatosome incorporation was detected with in situ hybridization at the 4th and 16th week.The histological and ultrastructural changes of kidney were evaluated at the 16th week.Results At the 4th and 16th weeks,Y chromatosome positive cells could be found incorporation in the area of glomerular and tubular epithelial cells.Since the 4th week,the weight of rats in both ADR group and EPC group became significantly less than that in control group and since the 8th week that in ADR group became less than that in EPC group(P

Inhibiting tubular epithelial myofibroblast transdifferentiation by transgene of antisense vascular smooth muscle alpha actin in vitro / 第三军医大学学报

Objective To evaluate the inhibiting effect of antisense vascular smooth muscle alpha adenovirus vector on tubular epithelial myofibroblast transdifferentiation induced by TGF-?1.Methods The pAdanti-?-SMA was constructed and identified.The ?-SMA expression in tubular epithelial cells(TEC) was detected by immunofluorescence and Western blot.Five groups were designed as control(A),TEC transfected by 2 ?l pAdanti-?-SMA(B),TEC induced by TGF-?1(C),TEC induced by TGF-?1 and transfected by 2 ?l pAdanti-?-SMA(D),TEC induced by TGF-?1 and transfected by 10 ?l pAdanti-?-SMA(E).Results The pAdanti-?-SMA was successfully constructed.The expression of ?-SMA in TEC induced by TGF-?1 was inhibited by pAdanti-?-SMA.Conclusion Tubular epithelial myofibroblast transdifferentiation can be inhibited by pAdanti-?-SMA.

Transfection of Ad-HO-1 on renal tubular epithelial cell HK-2 and its effect on PBMC proliferation / 第三军医大学学报

Objective To observe the cytotoxicity of Ad-HO-1 and its capacity of mediating the expression of HO-1 in cultured HK-2 cells. Methods The HK-2 cells were infected by Ad-HO-1 with 100, 200 and 400 MOI for 3 h, followed by the green fluorescence observation 2 days later. The live cells ratio was detected 2 and 4 days later. The expression of HO-1 and GFP in HK-2 were detected under laser scan confocal microscope. The expression of HO-1 was detectee by Western blot analysis. 3H-TdR was used to assay the ability of HO-2 cells infected with Ad-HO-1 to inhibit the PBMC proliferation. Results Over 90% HK-2 cells expressed green fluorescence after infected by Ad-HO-1 (MOI 200) for 2 days. The live cell ratio at 2 and 4 days had not any difference from those of the control group. The expressions of HO-1 and GFP in the Ad-HO-1 transfected HK-2 cells were determined under laser scan confocal microscope. The locations of these two proteins were the same. HK-2 cells infected by Ad-HO-1 had protein immune blot strap combined with HO-1 antibody. When the MOI of Adv-HO-1 was 0.01, 0.1, 1 and 10, the proliferative capacity of PBMC was inhibited significantly. Conclusion The stable expression of HO-1 mediated by Ad-HO-1 in cultured tubular epithelial cells can inhibit the cell proliferation of PBMC.