Validation of the Maryland Aggregate Pathology Index (MAPI), a pre‐implantation scoring system that predicts graft outcome

Predicting graft outcome after renal transplantation based on donor histological features has remained elusive and is subject to institutional variability. We have shown in a retrospective study that the Maryland Aggregate Pathology Index score reliably predicts graft outcome. We sought to validate the scoring system in our center and a second transplant center. We analyzed 140 deceased donor kidneys pre‐implantation biopsies from center 1 and 65 from center 2. The patients had a mean follow‐up of 695 ± 424 and 656 ± 305 d respectively. Although MAPI scores were similar, there were significant differences in donor and recipient parameters between both centers. Despite this, MAPI was predictive of graft outcome for both centers by Cox univariate, multivariate and time dependent ROC analysis. For center 1 and 2, three yr graft survival within each MAPI group was statistically equivalent. The three‐yr graft survival at center 1 for low, intermediate, and high MAPI groups were 84.3%, 56.5%, and 50.0%, respectively, p ≤ 0.0001, and at center 2 were 83.3%, 33.3%, and 33.3%, p = 0.006. MAPI, which is based on a pre‐implantation biopsy, demonstrated similar predictive and outcome results from both centers. As expanded criteria donors (ECD) criteria have redefined marginal kidneys, MAPI has the potential to further define ECD kidneys, increase utilization, and ultimately improve outcomes.     

Valganciclovir is an effective prophylaxis for cytomegalovirus disease in liver transplant recipients

Objectives:

Cytomegalovirus (CMV) infection is responsible for significant morbidity and mortality among solid organ transplant recipients. Prophylaxis using valganciclovir (VGCV) in orthotopic liver transplant (OLT) recipients is not approved by the Food and Drug Administration and its use is controversial. This study aimed to evaluate the effectiveness of VGCV in CMV prophylaxis in OLT recipients.

Methods:

We carried out a retrospective, single-centre study including all OLT procedures performed during 2005–2008. Patients with early death (at ≤30 days), without CMV serology or prophylaxis, or with follow-up of <1 year were excluded.

Results:

The overall incidence of CMV disease was 6% (n = 9). The ganciclovir (GCV) and VGCV groups had similar incidences of CMV disease (4.6% vs. 7.0%; P = 0.4) and similar distributions of disease presentation (CMV syndrome vs. tissue-invasive CMV; P = 0.4). Incidences of CMV infection, as well as disease presentation, were similar between the high-risk (CMV D+/R−) and non-high-risk groups (P = 0.16). Although acute cellular rejection occurred more frequently in patients who developed CMV disease (P = 0.005), overall survival in these patients did not differ from that in patients who did not develop CMV infection (P = 0.5).

Conclusions:

Valganciclovir is an effective antiviral for the prevention of CMV disease in liver transplant recipients. Our data support its use in high-risk OLT patients.     

Antioxidant and Cytotoxicity Activities of Karamunting (Melastoma malabathricum L.) Fruit Ethanolic Extract and Quercetin

Melastoma malabathricum L. is a type of plant naturally grows in Kalimantan that has medicinal properties.Ethanolic extract of M. malabathricum L. flower has quercetin and kaempferol contents that have antioxidant andanticancer activities. But the antioxidant and cytotoxicity activities of M. malabathricum L. fruit ethanolic extract werenot known. This study measured the quercetin and kaempferol level in M. malabathricum L. fruit ethanolic extractusing HPLC MS/MS, antioxidant activity using DPPH method, and cytotoxicity activity using Brine Shrimp LethalityTest (BSLT) method. Results showed the level of quercetin and kaempferol from M. malabathricum L fruit ethanolicextract are 67.78 μg/g and 43.52 μg/g, respectively. Beside, the antioxidant activity with by IC50 was 16.82±0.24 ppmand 7.38±0.41 ppm. The cytotoxicity activities of M. malabathricum L. fruit ethanolic extract and quercetin are shownby the LC50 of 313.44 ppm (95%CI 283.97-344.43) and 37.24 ppm, respectively.     

自体骨髓单个核细胞移植治疗老年冠状动脉粥样硬化性心脏病的临床观察

2003-06/2007-11河南省人民医院心内科收治的老年心肌梗死患者76例,行骨髓干细胞移植患者46例,男34例,女12例,除常规治疗外,将骨髓单个核细胞悬液在冠状动脉造影时经导管注入冠状动脉内;未行骨髓干细胞移植患者30例为对照组,男22例,女8例,仅采用常规治疗。随访1年,经胸超声心动图显示,骨髓干细胞移植组和对照组左室射血分数分别由治疗前(43.1±5.6)%、(44.9±7.5)%增加到(54.8±4.6)%、(50.1±7.1)%;骨髓干细胞移植组和对照组脑钠肽水平由治疗前(696±102)、(680±93)ng/L下降至(303±89)、(396±88)ng/L;单光子放射计算机断层显像术显示,骨髓干细胞移植组和对照组心肌灌注缺损面积分别由(25.8±8.5)%、(26.2±6.4)%降低至(14.8±4.6)%、(20.4±7.3)%。骨髓干细胞移植组在移植过程中和移植后均无并发症发生。表明经皮冠状动脉内移植骨髓干细胞治疗老年心肌梗死患者安全可行,移植后能改善左室收缩功能及心肌血流灌注。     

慢性乙型肝炎治疗的研究进展

慢性乙型病毒性肝炎是一个严重威胁人类健康的疾病,呈世界性流行。抗病毒治疗是减少肝硬化、肝癌等严重肝病发生的关键治疗,目前公认有效的抗病毒药物包括干扰素和核苷(酸)类似物。抗病毒药物治疗的持续应答率仅有20%-30%,病毒耐药率高,且停药后容易反弹或复发。那么对CHB的抗病毒治疗时机的把握、药物的选择、治疗的目标、治疗效果的评价及终点的界定就显得尤为重要。     

癫痫发作1h后延髓内脏带区域内反应神经元与星形胶质细胞功能单位的分布特征:激光共聚焦显微镜研究

背景传统观点认为癫痫是大脑不同区域内神经元出现异常兴奋引起的复杂神经行为紊乱现象.而对星形胶质细胞在癫痫发病中的作用目前研究较少.目的研究戊四氮诱导大鼠癫痫发作后延髓内脏带内神经元和星形胶质细胞的反应.设计随机对照的实验研究.地点和材料实验在南方医科大学珠江医院神经外科实验室和解放军第四军医大学全军神经科学研究所完成.成年健康SD大鼠14只,体质量180～220 g,清洁级,由解放军第四军医大学实验动物中心提供.干预用抗Fos蛋白、抗酪氨酸羟化酶和抗胶质原纤维酸性蛋白的三重免疫荧光组织化学方法结合激光共聚焦显微镜技术,显示癫痫发作1 h后延髓内脏带内反应性神经元与星形胶质细胞的分布.主要观察指标对延髓内脏带内Fos,胶质原纤维酸性蛋白和抗酪氨酸羟化酶阳性细胞的分布及胶质原纤维酸性蛋白阳性星形胶质细胞与神经元的关系进行观察.结果延髓内脏带内的Fos阳性神经元和胶质原纤维酸性蛋白阳性星形胶质细胞明显增多,三重免疫组化方法显示反应性神经元(Fos阳性)与反应性星形胶质细胞(胶质原纤维酸性蛋白阳性)关系密切,发现3种不同标记的"神经元-星形胶质细胞复合体"即抗酪氨酸羟化酶+/Fos+/胶质原纤维酸性蛋白+三标记复合体、抗酪氨酸羟化酶+/胶质原纤维酸性蛋白+/Fos-和Fos+/胶质原纤维酸性蛋白+/抗酪氨酸羟化酶-二标记复合体.结论延髓内脏带内的神经元和星形胶质细胞在癫痫发作时反应强烈,可能以神经元-星形胶质细胞复合体作为功能单位参与癫痫发病的调节.     

Effects of Scalp Acupuncture on Focal Cerebral Ischemia in Rats

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High uptake of home-based, district-wide, HIV counseling and testing in Uganda

More than 80% of the people infected with HIV in low-income countries of sub-Saharan Africa do not know their HIV serostatus. Innovative measures of increasing access to HIV counseling and testing (HCT) are urgently needed so as to improve care and prevention. We implemented a home-based HCT program in Bushenyi District from September 2004 to March 2007, in Uganda where approximately 90% of people aged older than 14 years had never tested for HIV to gauge whether it was acceptable and increased uptake of HCT. Twenty-nine teams comprising a counselor and a laboratory assistant systematically visited homes offering HCT for all people older than 14 years of age and at-risk children (mother deceased or HIV infected) using a rapid HIV testing three-test algorithm. HIV-infected people received cotrimoxazole prophylaxis, were supplied with long-lasting insecticide-treated bed nets and equipment for treatment of drinking water at home, and were referred for assessment for antiretroviral therapy. The program reached 92,984 (63%) of all the homes in the district. Of these, 32,3621 people were eligible for HCT, and 28,2857 (87%) were present at home and were offered pretest counseling. A total of 264,966 (94%) accepted testing and received their results, of whom 11,359 (4.3%) were HIV-infected. Ninety percent of those testing had never tested before. The cost of testing was $7.83 per previously untested client. Ninety-seven percent of HIV-infected people initiated cotrimoxazole prophylaxis, 74% received bed nets, 70% received water treatment equipment, and 11% began antiretroviral therapy. Forty-four percent of people who were in an HIV-discordant relationship were infected. These results demonstrate that home-based HCT was well-accepted, feasible, and effective in identifying HIV-infected individuals who did not know their HIV status in rural Uganda.