Clinical pathology and prognosis of allograft IgA nephropathy / 中华肾脏病杂志

Objective:To investigate the cause of the allograft IgA nephropathy (IgAN) recurrence or de novo, and the risk factors for the graft-survival in allograft IgAN. Methods:Patients from the First Affiliated Hospital of Zhejiang University Medical College who were diagnosed as a transplanted kidney IgAN by allo-renal biopsy during November 2012 to December 2018 were selected. According to the increased levels of serum creatinine and the descent rate of estimated glomerular filtration rate (eGFR) on the last follow up, the patients were divided into the graft-function stable group (increased Scr<20 μmol/L, eGFR descent rate<10%), the graft-function inadequacy progressive group (Scr increased but less than doubling increase, 30%<eGFR descent rate<60%) and the graft-function lost group [double increase in serum creatinine and eGFR down to<15 ml·min -1· (1.73 m 2) -1 to chronic kidney disease stage V]. The clinical data and pathological characteristics were retrospectively analyzed and compared in the three groups. Taking the eGFR drop to<15 ml·min -1·(1.73 m 2) -1 to chronic kidney disease stage V as the end point event of follow-up, the effects of tacrolimus (FK506) concentration, the quantity of proteinuria and pathological changes of graft-renal on the survival rate of graft-renal were analyzed by Kaplan-Meier survival curve. Results:At the time of allograft biopsy, the urine protein/creatinine ratio (UP/Cr) was (2.00±2.38) g/g in the 38 cases, and the serum creatine increased in 17 cases (44.7%). Meanwhile, the blood concentration of FK506 was< 4 μg/L in 16 of 29 (55.2%) cases who taken FK506. With (23.2±22.2) months follow-up after renal biopsy, 11 cases (28.9%) progressed in renal insufficiency (graft-function inadequacy progressive group), and 7 cases (18.4%) lost their graft-function (graft-function lost group). The UP/Cr on the biopsy was significantly higher in graft-function lost group than that in graft-function stable group ( P=0.001), and the blood concentration of tacrolimus before biopsy was significantly lower in graft-function lost group than that in graft-function stable group [(3.05±0.71) μg/L vs (5.03±1.62) μg/L, P<0.010]. Kaplan-Meier survival analysis showed the kidney graft survival rate was significantly lower in the groups with a lower concentration of tacrolimus before the biopsy, with a large amount of proteinuria at the time of biopsy than that in the concentration of tacrolimus≥4.0 μg/L, and UP/Cr<2.3 g/g groups ( P=0.020, P=0.001, respectively), and with a infiltrated inflammatory cells in renal glomerular capillary loops and a co-deposition of C1q in mesangial region groups than that no infiltrated inflammatory cells in renal glomerular capillary loops and no co-deposition of C1q in mesangial region groups ( P=0.042, P=0.015, respectively). Conclusions:The low concentration of tacrolimus is the cause of the recurrence or de novo of allograft IgAN. A large amount of proteinuria, the inflammatory cells infiltration in glomerular capillary, the C1q deposition in mesangial region and the low concentration of tacrolimus are the factors that affect the survival rate of graft-renal IgAN.

Clinical analysis of persistent hypercalcemia with osteoporosis caused by tertiary hyperparathyroidism after kidney transplantation / 中华器官移植杂志

Objective To explore the clinical characteristics of tertiary hyperparathyroidism (THPT) after renal transplantation .Methods The levels of bone mineral density (BMD) , serum calcium , phosphates , alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH ) were retrospectively analyzed in 36 RTx recipients with persistent hypercalcemia and stable kidney function (eGFR 76 .71 ± 17 .44) ml/min/1 .73 m2 .Results Among them ,serum total calcium level increased (2 .97 ± 0 .20 ) mmol/L for 6 to 170 months ,blood phosphorus decreased (0 .59 ± 0 .19 ) mmol/L , serum alkaline phosphatase (ALP) increased to (295 .73 ± 194 .22)U/L and T-score of BMD decreased (T - 2 .78 ± 0 .84 in lumbar vertebrae and T - 2 .09 ± 0 .66 in hip joint) .And 11 /36 (30 .6％ ) cases had a complication of extraosseous calcification .Parathyroid hyperplasia was detected in 17 /36 cases (47 .2％ ) .iPTH was significantly higher at pre-operation and 1 week post-operation than that in control group (n= 45) (859 .50 ± 495 .44 vs 345 .56 ± 216 .55 pg/ml) , P = 0 .001 ,(759 .25 ± 907 .07 vs 197 .45 ± 249 .31 pg/ml) , P= 0 .001 .The value of iPTH at the last follow-up (198 .26 ± 155 .22) pg/ml was still higher than normal reference value (15 .0 - 65 .0 pg/ml) . Multivariate stepwise regression analysis showed the last iPTH was correlated with preoperative iPTH ,serum calcium and postoperative serum phosphor ,ALP and 25OHD3 (P= 0 .024 , P= 0 .002 , P = 0 .001 , P = 0 .037 , P = 0 .026 ) .Conclusions Renal recipients had a higher levels iPTH with persistent hypercalcemia , hypophosphatemia , osteoporosis and extraosseous calcification showing the features of tertiary hyperparathyroidism .

Influence of adaptive statistical iterative reconstruction-V on image quality and radiation dose of abdominal CT in phantom / 中国医学影像技术

Objective To evaluate the influence of preset adaptive statistical iterative reconstruction-V (ASIR-V) techniques on image quality and radiation dose reduction of abdominal CT in phantom,and to investigate the optimal ASIR-V level.Methods Abdominal anthropomorphic phantom was scanned using Revolution CT,when noise index (NI) were set as 6,8,10,12 and 14,respectively.Then 0-100％ ASIR-V and conventional scan was performed and 55 sets of images were obtained.CT value,noise,subjective score and radiation dose were recorded,and the optimal ASIR-V was obtained.Subjective scores of images in each group were compared using rank sum test,and CT value,noise and radiation dose were compared with one way ANOVA and paired t test.Results The image subjective score unchanged when NI was 6,8 or 10,slightly increased when NI was 12 and 14 with 0-40％ ASIR-V,and decreased above 50％ ASIR-V at all NI.When NI was 6,8 or 10,more than 70％ ASIR-V image subjective score fell below 3 points.When NI was 12 or 14 group,more than 60％ ASIR V subjective score fell below 3 points.The image quality score of conventional scan had no difference with 40％ ASIR-V when NI was 6,8 or 10,respectively (P=0.626,0.915,0.514),and inferior to 40％ ASIR-V when NI was 12 or 14 (P=0.041,0.036),while in all NI group,image quality score of conventional scan was superior to 60％ ASIR-V (P=0.021,0.012,0.015,0.014,0.007).CT values and image noises had no significant differences in different parts in all NI groups (all P＞0.05).CT dose index volume (CTDIvol) continuing decreased with ASIR-V.Compared with that of conventional scan,at 40％,50％ and 60％ ASIR-V,CTDIvol reduced by 49.82％,62.51％ and 71.63％,respectively.Conclusion Preset ASIR-V can reduce radiation dose obviously while maintaining the overall image quality,and 40％-60％ ASIR-V can be recommended for abdominal CT in clinical application.

Correlation of polymorphism of glial high-affinity glutamate transporter (SLC1A3) gene and non-suicidal self-injury in adolescents / 中华行为医学与脑科学杂志

Objective To explore the correlation between polymorphisms (SNPs) of locus rs2269272 of glial high-affinity glutamate transporter (SLC1A3) gene and suicide attempt among Chinese adolescents.Methods iMLDRTM genotyping technology was used to detect the polymorphism of rs2269272 SLC1A3 gene loci in 55 suicide attempters and 112 healthy controls,and survival analysis was applied to analyze the relationship between allele (T) and the age of suicide attempt.Results The differences of rs2269272 locus allele distribution between two groups were statistically significant(x2=4.208,P=0.040),but genotype distribution of two groups had no significantly differences(x2 =4.011,P=0.135).Non-suicidal self-injury adolescents with locus rs2269272 (15.6 ± 0.4) were younger than adolescents without locus rs2269272(16.4±0.7),but the difference was not statistically significant.Conclusion Preliminary findings suggest that rs2269272 SLC1 A3 may be relevant to non-suicidal self-injury acts,and rs2269272 locus allele is not related to earlier suicide attempt.

Diagnosis of solitary pulmonary nodule by one-step spectral and perfusion imaging / 实用放射学杂志

Objective To observe the value of one-step spectral imaging and perfusion imaging in diagnosis of solitary pulmonary nodule(SPN).Methods Forty-seven patients with SPN proved by pathology underwent perfusion scan with gemstone spectral ima-ging mode,who were divided into malignant group in 28 patients and benign one in 1 9.The parameters of CT perfusion including blood volume (BV),blood flow (BF),mean transit time (MTT)and permeability surface (PS)were analyzed.Iodine concentration (IC),normalized iodine concentration (NIC)and slope rate of spectral curve in both arterial phase and venous phase were measured and calculated.The independent sample t test was performed to compare quantitative parameters between malignant and benign SPN.Results BF,BV and PS of malignant SPN were higher than those of benign ones (P 0.05).IC,NIC and slope rate of spectral curve in malignant SPN were higher than those in benign ones in both phases (P <0.05).Conclusion One-step spectral imaging and perfusion imaging can provide more parameters,which is helpful for the diagnosis of SPN.

Metal stent implantation in treatment of portal vein cavernous transformation / 实用放射学杂志

Objective To explore the efficacy and safety of percutaneous transhepatic portal vein or transjugular intrahepatic portosystemie shunt (TIPS)to implant the portal vein metallic stent in treatment of cavernous transformation of portal vein (CTPV).Methods Clinical and imaging data of 8 patients with CTPV were retrospectively analyzed who were treated in our hospital.All patients were treated with metallic stent implantation in portal vein including 3 patients by TIPS and 5 by percutaneous transhepatic portal vein.Results All patients were successful in the stent implantation without any occurrence of serious complications such as intra-abdominal hemorrhage and so on.Intraoperative angiography showed blood circulated freely in these stents.1 day-2 weeks later,the patients symptoms of abdominal pain and gastrointestinal bleeding were obviously relieved or disappeared.Follow up 1 month-3 years,1 patient with stent occlusion after one year of operation,the blood flow recovery after stent reimplantation,and the remaining patients,color doppler ultrasound reflected patency of blood flows in their stents.No one suffered from gastrointestinal bleeding or abdominal pain again.Conclusion Implantation of portal vein metallic stent via percutaneous transhepatic portal vein or via TIPS in treatment of cavernous transformation of portal vein is safe and effective.

Computed tomography pulmonary angiography with low dose contrast medium optimization research in dual-source CT / 实用放射学杂志

Objective To explore the feasibility of high-pitch CT pulmonary angiography (CTPA)with low dose contrast medium optimization in dual-source CT.Methods Eighty patients with high risk of pulmonary embolism who underwent CTPA on a dual-source CT were divided into two groups randomly:Group A,40 patients,50 mL contrast medium per patient,with conventional bolus tracing scanning;Group B,40 patients,contrast medium=body weight×0.3 mL/kg,with test bolus of small dose contrast agent. Pulmonary artery CT value,the differences of CT values in the paired PA and PV,SNR,CNR,radiation dose of two Groups were compared by two sample t-test.The positive rate of pulmonary embolism and the subjective indexes for assessing CT image quality were compared byχ2 test.Results There were no difference of the positive rate of PE between two Groups (P =0.655),and no sta-tistical difference for image quality scores between two Groups(P =0.1 74).The MPA CT value and the differences of CT values in the paired PA and PV in L-SⅢ of Group B were higher than those in Group A (P =0.001).However,no significant differences in CNR and SNR in MPA were observed between the two Groups(P =0.250,0.203,respectively).The ED of Group B was lower than that of Group A (P =0.001).Conclusion High-pitch CTPA in dual-source CT with lower dose contrast medium optimization can minimize the amount of contrast agent while meeting the clinical requirements.

Radiologic features of intestinal duplications in children / 实用放射学杂志

Objective To analyze the radiologic features of intestinal duplications in children and improve the diagnostic rate of this disease presurgical resection.Methods The clinical presentation and imaging data of eight cases confirmed surgically and patho-logically with intestinal duplications were retrospectively analyzed,as well as reviewed based on literature review.Results 8 cases were given ultrasonography,7 of them had positive performance.7 csaes were given CT scan and 6 of them had positive performance. 6 cases had ECT examination and 4 of them were positive.Their positive rates were 87.5%,85.7%,66.7% respectively.The posi-tive rates were all 100% combining ultrasonography with CT or CT with ECT.Conclusion Ultrasonography,CT and ECT is helpful to diagnose of intestinal duplications in children,their results are the no-specificity.Choosing a suitable imaging examination is useful to offer a pre-operative diagnosis.

Application of iterative model reconstruction technique in CT pulmonary angiography with lower radiation dose and lower contrast medium / 实用放射学杂志

Objective To observe the value of iterative model reconstruction(IMR)technique in CT pulmonary angiography (CTPA)with lower radiation dose and lower contrast medium.Methods 60 patients with clinical suspicion of pulmonary embolism underwent 256-slice CTPA were prospectively enrolled.The raw data of test group(n=30)were reconstructed by filtered back projection (FBP)(group A)and IMR technique (group B).And the raw data of control group(n=30)were reconstructed by FBP(group C).The values of volume CT dose index(CTDIvol),effective radiation dose (ED)were recorded and calculated.The image quality parameters:CT value,image noise,signal-to-noise (SNR),contrast-to-noise ratio (CNR)and subjective image score(from one to five)were measured and compared between group A and B,B and C.Results The BMI was no statistically significant difierenee between two groups(P=0.001).The CTDIvol, ED on test group were respectively lower than that on control(P<0.001).The CT value was no statistically significant difierenee between group A and B(P=0.999).The CT valueon group B was higher than that on group C(P=0.005).The image noise on group B was lower than that on group A(P<0.001),but which was higher than that on group C(P<0.096).The SNR,CNR on group B were higher than that on group A(P<0.001).The SNR,CNR did not differ significantly between B and C(P=0.831,P=0.958).The diagnosable rate and good quality rate on group B were higher than that on group A(P<0.001),and there were no significantly diferent between B and C(P=1.000).Conclusion The application of optimized IMR technique can improve image quality at lower radiation dose and lower contrast medium for CTPA.

Effect of switch from cyclosporine to FK506 on renal graft outcome in patients after initial acute rejection / 中华肾脏病杂志

Objective To investigate the effect of swifch from cyclosporine to FK506 on renal allograft outcome after initial acute rejection. Methods Clinical outcome of patients who experienced first acute rejection episode were retrospectively analyzed. After initial acute rejection, 23 patients were switched to FK506-based immunosuppression, and 63 patients continued CsA-based immunosuppression. Demographic data, lipid, serum creatinine, uric acid, incidence of recurrent acute rejection and graft survival were analyzed and compared. Results During one year after anti-rejection therapy, incidence of biopsy-proved recurrent rejection events was significantly lower with FK506 therapy (1/23, 4.35%) compared with CsA therapy (16/63, 25.40%)(P=0.033). 5-year graft survival rate of FK506-based immunosuppression group was higher than that of CsA-based immunosuppression group (100.0% vs 81.4%). Serum uric acid level of FK506-based immunosuppression group from 24 months to 36 months after initial rejection were significantly lower than that of CsA-based immunosuppression group [(265.5 ±147.9) μmol/L, (245.8±88.9) μmol/L vs (428.5±119.3) μmol/L, (441.2±125.3) μmol/L, P<0.01, respectively]. Conclusion Conversion to FK506 therapy can significantly reduce recurrent rejection episode, and decreasing serum uric acid level provides long-term benefits to graft survival.

Clinical analysis of 2520 renal transplantations in one center / 中华器官移植杂志

Objective To evaluate the effects of different strategies on short-and long-term clinical outcomes of renal transplantation in Chinese subjects.Methods 2520 renal transplantations were retrospectively evaluated,including 2490 first renal transplantations and 30 second renal transplantations.Triple-immunosuppressant including cyclosporine A,azathioprine or myeophenolate mofetil(MMF)and prednisone(Pred)was adopted.Patients receiving kidney transplantation were given low dose immunosuppressants since 2000.Immunosuppressants including tacrolimus,MMF and Pred were adopted in some patients since 2000.Risk factors leading to graft loss and patients'death were analyzed.Results Until the cut date of June 30,2009,135 patients lost follow-up,and the follow-up rate was 94.6%.Incidence of acute(within 6 months post-transplantation) rejection was 18% among 2520 patients.Incidence of acute rejection (within 6 months post-transplantation) was 25.7% in panel reactive antibody (PRA) positive patients,significantly higher than 17.0% in PRA negative patients(P<0.05).Incidence of acute rejection within 6 months post-transplantation was 16.9% in HLA mismatches<4 patients,significantly lower than 23.7% in HLA≥4 patients (P<0.01).Total patient/death censored graft 1-,3-,5- and 1O-year survivals were 94.5%/96.0%,91.6%/93.1%,88.5%/90.1% and 81.7%/80.6%,respectively.Acute rejection and immunosuppressant regimen were independent risks for allograft loss.1mmunosuppressant regiment,pulmonary infection,cardio-brain-vessel accident, hepatic failure and tumor were independent risks for patients' death.Conclusion Renal allograft and patient survival appeared to be improved by optimal immunosuppressant regimen,strict HLA match and efficient post-transplant complication prophylaxis.

Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome.

BACKGROUND: Treatment of adults with steroid-dependent minimal change nephrotic syndrome (SD-MCNS) can be a significant challenge. Cyclophosphamide (CYC) and cyclosporin (CYA) are often effective steroid-sparing agents. Tacrolimus (TAC) may be another treatment option. METHODS: This open, prospective cohort study enrolled Chinese adults with SD-MCNS. At the start of the study, we administered TAC or intravenous CYC together with prednisone (0.5 mg/kg/day), the dose of which was tapered off throughout the study. The TAC cohort received oral TAC (target trough blood level of 4-8 ng/ml) for 24 weeks and the CYC cohort received intravenous CYC (750 mg/m(2) body surface) once every 4 weeks for 24 weeks. RESULTS: Twenty-six patients met the criteria for enrollment (14 patients in the CYC group and 12 patients in the TAC group). One patient from each group discontinued treatment because of a drug-related side effect. Complete remission (CR) after the 24-week therapeutic period was 76.9% (10/13) in the CYC group and 90.9% (10/11) in the TAC group. The mean time required for CR in the TAC group was significantly less than in the CYC group (P = 0.031). Eight of 13 (61.5%) patients in the CYC group and 8 of 11 (72.7%) patients in the TAC group successfully stopped steroids and changed their status from steroid dependence. Sixty percent (6/10) of the CYC patients and 50% (5/10) of the TAC patients who achieved CR maintained remission during the follow-up period of 23.0 +/- 10.1 months. Four (40%) CYC patients and five (50%) TAC patients experienced relapses, and two CYC patients experienced frequent relapses. CONCLUSION: A 24-week course of TAC is a favorable steroid-sparing agent for treatment of Chinese adults with SD-MCNS. Therapy with TAC accompanied by a tapering dose of prednisolone appears to yield quicker remission than treatment with CYC together with prednisone.

Impact of acute rejection episodes on long-term renal allograft survival / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the impact of the number, and time of acute rejection (AR) and outcome of anti-rejection therapy on the long-term survival of renal allografts and the relative risk factors.</p><p><b>METHODS</b>The Kaplan-Meier analysis and log-rank test were used to calculate the survival rates of patients and grafts in no acute rejection group (NAR, 895 patients), 1 rejection episode group (1AR, 183), 2 and more than 2 rejection episodes group (2AR, 17), acute rejection group [AR (1AR + 2AR), 200], early acute rejection group (within 90 days after transplantation, EAR, 125), late acute rejection group (91 days later, LAR, 58), completely AR reversed group (CAR, 105), and incompletely AR reversed group (IAR, 68). The relative risk factors were analyzed by the Cox proportional hazards regression.</p><p><b>RESULTS</b>The 5- and 10-year survival rates of renal allografts were 75.4% and 17.1% in AR and 93.2% and 86.5% in the NAR group (P < 0.0001). The long-term graft survival was much lower in the 2AR group than in the NAR or 1AR groups (P < 0.0001 and P = 0.002, respectively). It was similar in either the NAR or CAR groups (P = 0.31), but it was significantly lower (P < 0.0001) in the IAR group. Multivariate Cox regression analysis revealed that the outcome of anti-rejection therapy is an important risk factor affecting the long-term survival of allografts.</p><p><b>CONCLUSIONS</b>AR is significantly associated with poor long-term survival of renal allografts. But the long-term graft survival of patients with one acute rejection but completely reversed is not significantly different from that of patients without acute rejection.</p>