[Mid-term efficacy evaluation of ABO incompatible living relative kidney transplantation based on protocol biopsy].

Objective: To evaluate the mid-term efficacy of ABO incompatible living donor kidney transplantation (ABOi-KT) based on the results of routine renal biopsy for transplantation. Methods: Retrospective collection of clinical data from 23 pairs of ABOi-KT donors and recipients at the First Affiliated Hospital of Sun Yat-sen University from July 2015 to November 2021. ABOi-KT was performed on recipients after desensitization treatment, and the results of routine kidney transplant biopsy at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were analyzed. Combined with blood type antibody levels and renal function recovery, the mid-term efficacy of ABOi-KT was evaluated. Results: Among the 23 recipients, there were 19 males and 4 females; age range from 19 to 47 years old [(29.6±6.7) years old], all underwent ABOi-KT successfully after receiving desensitization treatment. The follow-up time was (44.6±22.4) months, of which 22 cases were followed up for more than 1 year. The incidence rates of rejection reactions at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were 15.0% (3/20), 11.1% (1/9), 7.7% (1/13), 25.0% (3/12), and 12.5% (1/8), respectively. For receptors with rejection reactions, targeted anti-rejection therapy was performed based on clinical symptoms and various indicators. Borderline T cell mediated rejection (TCMR) can be converted to mild tubular inflammation after anti-rejection treatment. The positive rate of complement C4d in peritubular capillaries was 95.0% (19/20) one week after surgery, and the positive rate of complement C4d was 100% at 3 and 12 months after surgery. The cumulative survival rates at 1, 3, 5, and 7 years after surgery were all 100%. The cumulative survival rates at 1, 3, 5, and 7 years after kidney transplantation were 100%, 93.3%, 84.0%, and 84.0%, respectively. Except for 2 recipients who underwent transplantation in 2017 and experienced kidney failure at 30 and 49 months after surgery, all other transplanted kidneys survived. Conclusions: The results of routine renal transplant biopsy show that ABOi-KT has a good mid-term therapeutic effect. The pathological changes of ABOi-KT can be dynamically observed through routine renal transplant biopsy and targeted treatment for rejection reactions can be provided accordingly.

[A survey of mental health status in armored vehicle crew].

OBJECTIVE: To investigate the mental health status in armored vehicle crew (commanders, gunners, and drivers) , to know the level of mental health in them, and to provide educational intervention. METHODS: In April 2009, 120 male armored vehicle crew with >2 driving years were enrolled as battle group, and 70 male persons within the same age group who were not engaged in armored vehicle operation were enrolled as control group. The Symptom Checklist-90 (SCL-90) was used to evaluate the mental status of the 180 subjects. RESULTS: Compared with the control group, the battle group showed significantly higher scores on the subscales of obsessive-compulsive symptom, interpersonal sensitivity, depression, anxiety, phobic anxiety, and paranoid ideation (t=2.323, 3.250, 3.158, 2.712, 2.391, and 2.137, all P<0.05) , as well as significantly higher total score, number of positive items, and average score of positive symptoms (t=4.128, 4.357, and 4.632, all P<0.05). In the battle group, the scores on the subscales of somatization, obsessive-compulsive symptom, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and additional items, total score, number of positive items, and average score of positive symptoms were significantly lower than the military reference values (t=4.364, 5.127, 5.280, 3.783, 7.012, 5.361, 4.369, 6.167, 6.476, 3.558, 6.357, 4.379, and 6.763, all P<0.05). CONCLUSION: A survey should be performed on the mental health status of armored vehicle crew, including obsessive-compulsive symptom, interpersonal sensitivity, depression, and anxiety. Mental health service for the crew should be enhanced to improve their psychological quality.

Enhanced myeloid differentiation factor 88 promotes tumor metastasis via induction of epithelial-mesenchymal transition in human hepatocellular carcinoma.

Metastasis is the leading cause of death in patients with hepatocellular carcinoma (HCC) after curative resection. Therefore, it is critical to understand the mechanisms underlying tumor metastasis in HCC. We have previously shown that elevated expression of myeloid differentiation factor 88 (MyD88) may promote tumor growth and metastasis in HCC. In this study, we reported that enhanced expression of MyD88 promoted epithelial-mesenchymal transition (EMT) properties and tumor-initiating capabilities in HCC cells. MyD88 was found to be able to interact with p85, a regulatory subunit of phosphoinositide 3-kinase (PI3-K), independent of TLR/IL-1R-mediated response and caused PI3-K/v-akt murine thymoma viral oncogene homolog (Akt) activation, which resulted in subsequent phosphorylation of glycogen synthase kinase-3ß and stabilization of Snail, a critical EMT mediator. Consistently, we observed a significant correlation between MyD88 expression and p-Akt levels in a cohort of HCC patients, and found that the combination of these two parameters have better prognostic value for HCC patients. Taken together, these results suggest that elevated MyD88 may facilitate HCC metastasis by promoting EMT properties and tumor-initiating capabilities via PI3-K/Akt pathway.

Adjuvant therapy options following curative treatment of hepatocellular carcinoma: a systematic review of randomized trials.

AIMS: Numerous postoperative therapies for preventing recurrence of hepatocellular carcinoma (HCC) have been reported, but their efficacy remains controversial and knowledge about adverse effects is limited. A systematic review of randomized controlled trials (RCTs) was performed to gain a comprehensive picture of the efficacy and risks of these therapies. METHODS: MEDLINE, EMBASE and the Cochrane Library were systematically searched through July 2011. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 2989 patients from 28 RCTs involving 10 postoperative therapies were included. For interferon therapy, the estimated RR for the 2-year recurrence rate was 0.84 (95% CI 0.73-0.97, P = 0.02) and the overall survival (OS) was 1.15 (95% CI 1.07-1.22, P < 0.001). Postoperative therapy with the vitamin K2 analog did not lead to a significant reduction in the 1-year recurrence rate, with a pooled RR of 0.60 (95% CI 0.28-1.27, P = 0.18). However, it did slightly improve the 1-year OS, with a pooled RR of 1.03 (95% CI 1.00-1.05, P = 0.03). Transarterial chemotherapy with or without embolization, adoptive immunotherapy and heparanase inhibitor PI-88 therapy may delay tumor recurrence. The effects of acyclic retinoid, lipiodol-iodine-131 and tumor vaccine treatment were promising but require further study. All postoperative therapies except interferon administered intramuscularly were well tolerated by the majority of patients. CONCLUSIONS: Use of adjuvant interferon is definitely associated with an increase in OS. Postoperative therapies involving acyclic retinoid, lipidol-iodine-131, or tumor vaccine may improve the OS of patients with HCC after curative treatment.

High susceptibility to hypoxia of afferent synaptic transmission in the goldfish sacculus.

1. The effect of hypoxia on synaptic transmission between hair cells and afferent fibers was examined in the sacculus of goldfish. For this, we recorded potentials, intracellularly, from large afferent fibers. Anoxia was introduced by perfusing the gill with water deprived of oxygen or by halting the water flow to the gill. 2. The ear of the goldfish is most sensitive to hypoxia. Sound-evoked afferent activities were profoundly depressed within several minutes after the introduction of hypoxia. 3. The depressed afferent activity was attributed to a reduction in the amplitude of sound-evoked excitatory postsynaptic potentials (EPSPs) generated at afferent fiber terminals, since no significant change was detected in the resting and action potentials of afferent fibers or in intensity of the threshold current required to set up an action potential. Also, there was no marked change in the electrical activity of hair cells, determined by the finding that the amplitude of intramacularly recorded microphonic potentials and that of the coupling potentials was not altered. 4. A statistical analysis of the amplitude of sound-evoked EPSPs revealed that the binomial parameter n decreased during hypoxia, in parallel with a reduction in the amplitude of EPSPs, while the binomial parameter p either remained unaltered or was augmented. No change was found in the quantal size, thereby indicating that the sensitivity of the postsynaptic membrane remained unchanged. These results indicate that presynaptic mechanisms within hair cells, especially those playing a role in transmitter release or in replenishment of the latter, are suppressed during hypoxia.