Immunoadsorption in Severe C4d-Positive Acute Kidney Allograft Rejection: A Randomized Controlled Trial

Antibody-mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d-positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, 'anti-cellular' treatment. All IA-treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis-dependent. With the exception of one patient who developed graft necrosis, non-responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.     

Pure isolated dorsal dislocation of the fifth carpometacarpal joint

Isolated pure dislocations of the fifth carpo-metacarpal joint are extremely rare injuries. The dorsal form was described in mere 12 cases. The diagnosis can be easily missed. The lesion is also often overlooked in the routine diagnostic X-ray. Lateral and oblique views are important for the recognition of the true extent of the lesion. Treatment of these injures is still controversial and both closed reduction with percutaneous pinning or open reduction with internal fixation are advocated. The goal of treatment is early reduction and fixation of the metacarpal. Early diagnosis is the key to success. The aim of this paper is to review literature and present two new cases.     

两种艾灸法对二肾一夹型高血压大鼠血压和血管内皮细胞内分泌功能的影响

目的:应用两种艾灸疗法治疗两肾一夹肾血管性高血压大鼠(2K1C-RHR),评价这两种艾灸疗法的降压作用,并对其降压机理作初步的探讨。方法:建立2K1C-RHR模型,并将其随机分为六组:灸法Ⅰ组(百会、神阙、足三里)、灸法Ⅱ组(关元、涌泉、足三里)、卡托普利组、灸法Ⅰ+卡托普利组、灸法Ⅱ+卡托普利组、高血压对照组,另设正常对照组。经过10天治疗后,测量血压,并测定血浆中内皮素(ET)、一氧化氮(NO)。结果:高血压对照组的收缩压(SBP)、舒张压(DBP)明显高于正常对照组,各治疗组的SBP、DBP明显低于高血压对照组(P<0.01),各治疗组间则没有明显差异(P>0.05)。血浆NO含量各组间没有明显差异(P>0.05)。各治疗组与正常对照组的血浆中ET含量明显低于高血压对照组(P<0.01)。各治疗组ET/NO比值接近正常对照组(P>0.05)且明显低于高血压对照组(P>0.05)。结论:两种艾灸疗法有良好的降压作用,其降压机理与及纠正ET与NO的失衡状态有关。     

肠易激综合征辨证分析

肠易激综合征（IBS）是一组持续存在或反复发作的临床症候群,主要症状有腹痛、腹胀、排便习惯改变和大便性状异常、黏液便等,经检查排除可引起这些症状的器质性疾病。临床分为肝木乘脾型腹泻、脾胃虚弱型腹泻、脾肾阳虚型腹泻、肝郁脾虚型便秘四型,根据临床辨证分别施以不同治法,不同方药治疗,有显著疗效。同时,教育患者平时养成良好的饮食卫生习惯,不饮生水,不食生冷瓜果,忌食辛辣、油腻、肥厚之品,保持心情舒畅,怡情悦志,注意保暖,可加强疗效,防止复发。     

Kidney Transplantation in Patients with Antibodies against Donor HLA Class II

The immunologic risk associated with donor-specific antibodies (DSA) against Class II human leukocyte antigens (HLA) in kidney transplant (KTx) recipients is unclear. The aim of this study was to determine the outcome of KTx when DSA was detected only against HLA Class II. To isolate the impact of anti-Class II DSA, we retrospectively analyzed 12 KTx recipients who at baseline had a positive B-cell flow cytometric crossmatch (FXM) and a negative T-cell FXM. Using alloantibody specification analysis, 58.3% (7/12) had DSA against donor Class II and 41.7% had no demonstrable DSA. Biopsy-proven AMR occurred in 57% (4/7) in the Class II(+) group and 0% in the Class II(-) group (p > 0.05). Peritubular capillaries stained positive for C4d in 86% (6/7) of the Class II(+) patients and in 40% (2/5) of the Class II(-) patients (p > 0.05). One patient in the Class II(+) group lost their graft at 3 months to accelerated transplant glomerulopathy, while all other grafts were functioning 3-37 months posttransplant despite the persistence of anti-Class II DSA. We conclude that KTx recipients with clearly defined anti-Class II DSA are at risk for humoral rejection suggesting that desensitization and/or close posttransplant monitoring may be needed to prevent AMR.     

新型双球囊导管经皮选择性隔离肝脏灌注化疗的效果研究

目的探讨自制双球囊导管经皮选择性隔离肝脏灌注化疗的隔离效果。方法12只成年猪随机分为两组：HAI组6头,进行常规经肝动脉灌注化疗;PSIHP组6头,利用自制双球囊导管经介入放射学方法行经皮选择性隔离肝脏灌注化疗结合血液灌流。化疗药物选用5-FU,分别检测肝静脉及外周血液中的血药浓度峰值,了解球囊隔离肝脏效果。结果HAI组肝静脉血和外周静脉血浓度峰值分别为4658.420±433.204mg/L和1676.140±226.933mg/L,PSIHP组为5321.711±517.318mg/L和65.735±6.425mg/L。两组外周静脉血浓度峰值有显著性差异（P〈0.01）。结论自制新型双球囊导管能有效隔离肝脏,是一种理想的隔离肝脏灌注化疗的球囊导管。     

Intravenous Iloprost: A New Therapeutic Option for Patients with Post-Transplant Distal Limb Syndrome (PTDLS)

The purpose of this study was to investigate the application of intravenous iloprost as a novel therapy for the treatment of post-transplant distal limb syndrome (PTDLS). PTDLS is a benign but disabling complication in the first year after renal transplantation. It is characterized by bilateral, often incapacitating pain in the feet and or knees on motion and a significant rise in alkaline phosphatase levels on laboratory evaluation. On MRI, bone marrow edema of the affected bone regions can be demonstrated. PTDLS differs from steroid induced osteonecrosis of the hip in terms of localization, an average cumulative steroid dosage within expected limits, and a benign outcome, as PTDLS does not progress to overt cell necrosis. From August 2003 to April 2005 we treated 10 patients with MRI-proven diagnosis of PTDLS following a standardized regimen of intravenous iloprost over 5 days. Iloprost led to prompt pain relief measured on a visual analogous scale (VAS) ranging from 1 to 10 (5.6 +/- 1.5 before vs. 2.1 +/- 1.3 after treatment, p = 0.0004). PTDLS represents a benign but disabling complication following renal transplantation. Intravenous iloprost might be a promising therapeutic concept leading to a quick relief of symptoms without relevant side effects.     

vWF及GPIb在慢性肾脏疾病中变化及作用

目的研究假性血管血友病因子（vWF）及血小板膜糖蛋白Ib（GPIb）在慢性肾脏疾病（CKD）不同阶段的变化及意义。方法87例患者按病因及CKD不同阶段分为5组，A组：CKD1期，肾小球肾炎组，17例；B组：CKD1期，原发性肾病综合征组，14例；C组：CKD1期，继发性肾病组，18例；D组：CKD2～4期，慢性肾衰组，18例；E组：CKD5期，慢性肾衰透析组，20例。酶联免疫吸附检测法测定GPIb、双抗体夹心固相酶免疫测定血浆vWF。结果vWF、GPIb在A、B、C、D、E组均明显增高，以B、C组尤为突出；与凝血状况正相关。结论vWF水平可同时反应内皮细胞受损及凝血状态，在肾小球疾病发展中可能有重要意义。