Impact of donor-specific antibodies on the outcomes of kidney graft: Pathophysiology,clinical, therapy

Allo-antibodies, particularly when donor specific, are one of the most important factors that cause both early and late graft dysfunction. The authors review the current state of the art concerning this important issue in renal transplantation. Many antibodies have been recognized as mediators of renal injury. In particular donorspecific-Human Leukocyte Antigens antibodies appear to play a major role. New techniques, such as solid phase techniques and Luminex, have revealed these antibodies from patient sera. Other new techniques have uncovered alloantibodies and signs of complement activation in renal biopsy specimens. It has been acknowledged that the old concept of chronic renal injury caused by calcineurine inhibitors toxicity should be replaced in many cases by alloantibodies acting against the graft. In addition, the number of patients on waiting lists with preformed anti-human leukocyte antigens(HLA) antibodies is increasing, primarily from patients with a history of renal transplant failure already been sensitized. We should distinguish early and late acute antibody-mediated rejection from chronic antibody-mediated rejection. The latter often manifets late during the course of the posttransplant period and may be difficult to recognize if specific techniques are not applied. Different therapeutic strategies are used to control antibody-induced damage.These strategies may be applied prior to transplantation or, in the case of acute antibody-mediated rejection, after transplantation. Many new drugs are appearing at the horizon; however, these drugs are far from the clinic because they are in phase Ⅰ-Ⅱ of clinical trials. Thus the pipeline for the near future appears almost empty.     

Mycosis fungoides and Sézary syndrome: Role of chemokines and chemokine receptors

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma(CTCL), and is characterized by a clonal expansion of malignant CD4+ T lymphocytes with skinhoming properties. Clinically and pathologically, mycosis fungoides can be categorized into patch, plaque and tumor stages. The clinical course of mycosis fungoides is usually chronic and indolent, but a proportion of patients may develop progressive disease with peripheral blood, lymph node and visceral organ involvement. Sézarysyndrome is an aggressive leukemic form of CTCL characterized by a clonal population of malignant T cells in the peripheral blood. Various forms of skin-directed and systemic treatments are available for mycosis fungoides and Sézary syndrome. However, current treatments are generally not curative, and can only control the disease. Currently, the etiology and pathogenesis of mycosis fungoides and Sézary syndrome are not well defined. Proposed mechanisms include chronic antigenic stimulation by infectious agents, expression of specific adhesion molecules, altered cytokine production, mutations of oncogenes and tumor suppressor genes, and avoidance of apoptosis. In recent years, a number of chemokine receptors and their corresponding chemokine ligands have been found to contribute to the migration and survival of lymphoma cells in mycosis fungoides and Sézary syndrome, including CC chemokine receptor 4(CCR4), CCR10, C-X-C chemokine receptor type 4(CXCR4), CCR7, CCR3 and CXCR3. Since chemokines and chemokine receptors have been found to play important roles in the pathophysiology of mycosis fungoides and Sézary syndrome, they may be potentially useful targets for the development of new treatments for these diseases in the future.     

Nail Psoriasis: Treatment Options and Management Strategies in Special Patient Populations

Nail involvement is common in psoriasis and is considered a risk factor for and a predictor of the development of psoriatic arthritis. The treatment of nail psoriasis is challenging because of the unique anatomical structure of nails and the absence of standardized treatment protocols. Herein, we provide an up-to-date overview of the treatment options for nail psoriasis, including topical drugs and penetration enhancement strategies, traditional and novel oral drugs, and biologic agents. In addi...     

Acute management of symptomatic nephrolithiasis

Over half a million patients present to emergency departments and nearly 3 million patients visit healthcare providers annually due to problems associated with urolithiasis.Despite updated guidelines from the American Urological Association and European Association of Urology for the evaluation and management of nephrolithiasis,considerable variability still exists regarding treatment for acute symptomatic upper urinary tract stones.Therefore,this article will review the current evaluation and management of acute symptomatic nephrolithiasis.Initial management includes analgesia and antiemetics.Additionally,a urinalysis and creatinine are required laboratory evaluations.Acute imaging with a non-contrast computed tomography(CT)scan is the diagnostic imaging modality of choice.However,concerns over radiation exposure have led towards low-dose and even ultra-low-dose protocols for the detection of urinary calculi.Low-dose non-contrast CT scans are now standard of care for the initial diagnosis of renal colic in patients with a body mass index≤30.Medical expulsive therapy is recommended for patients with a ureteral calculus10 mm and no signs of infection.Emergency urinary decompression is mandatory for a specific subset of patients,especially those with infection.Although limited data exists,emergency ureteroscopy or even shock wave lithotripsy may also betherapeutic options.     

头皮糜烂性脓疱性皮病及其治疗

头皮糜烂性脓疱性皮病是一种少见的皮肤病.其临床特点为老年人头皮部红斑,无菌性脓疱,糜烂甚至溃疡,斑块结痂;伴疼痛为主;慢性病程易反复,最终可导致瘢痕性脱发,并可在瘢痕上发生鳞状细胞癌.其病因不明,目前认为相关的致病因素包括,头皮外伤、日光损伤及自身免疫性疾病.诊断为排除性,组织病理及微生物培养后排除其他疾病后方可诊断此病.已有文献报道多种治疗方法,其中以口服异维A酸疗效最佳.

Abstract：

Erosive pustular dermatosis of the scalp (EPDS ) is an uncommon and painful skin disease characterized by erythema,sterile pustules,erosion,ulceration,and crusted plaques of the scalp of elderly patients,which is often chronic and relapsing,and can eventually cause scarring alopecia and even squamous cell carcinoma.The etiology is unknown,but predisposing factors have been reported such as trauma,prolonged exposure to sunlight as well as coexistence of autoimmune diseases.EPDS is a diagnosis of exclusion based on histological examination and microbial cultures.Multiple therapies have been documented for the treatment of EPDS,and oral isotretinoin is supposed to be the most effective.     

Low T3 syndrome and long-term mortality in chronic hemodialysis patients

AIM:To investigate the predictive value of low free T3 for long-term mortality in chronic hemodialysis(HD) patients and explore a possible causative role of chronic inflammation.METHODS:One hundred fourteen HD patients(84 males) consecutively entered the study and were assessed for thyroid function and two established markers of inflammation,high sensitivity C-reactive protein(hs CRP) and interleukin-6(IL-6).Monthly blood samples were obtained from all patients for three consecutive months during the observation period for evaluation of thyroid function and measurement of inflammatory markers.The patients were then divided in two groups based on the cut-off value of 1.8 pg/m L for mean plasma free T3,and were prospectively studied for a mean of 50.3 ± 30.8 mo regarding cumulative survival.The prognostic power of low serum f T3 levels for mortality was assessed using the Kaplan-Meier method and univariate and multivariate regression analysis.RESULTS:Kaplan-Meier survival curve showed a negative predictive power for low free T3.In Cox regression analysis low free T3 remained a significant predictor of mortality after adjustment for age,diabetes mellitus,hypertension,hs CRP,serum creatinine and albumin.Regarding the possible association with inflammation,free T3 was correlated with hs CRP,but not IL-6,and only at the first month of the study.CONCLUSION:In chronic hemodialysis patients,low plasma free T3 is a significant predictor of all-cause mortality.Further studies are required to identify the underlying mechanisms of this association.     

Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms(LUTS). In this review, we summarise the conclusions from fourof the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life(Qo L) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and Qo L available to men with LUTS. Metaanalyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume 30 mL, PSA 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.     

‘Children Kidney Care Centers’:Rationale,requirements and recommendations for best facilities and better future

Specialized centers are needed for nephrology and urology care of children. The justifications are the specialized nature of care needed and the growing incidence and prevalence. Children with chronic kidney disease(CKD) are at risk of morbidity, mortality, and decreased quality of life. Current pediatric practice structures are apparently poorly suited for the increasing demands of chronic disease in children. Kidney diseases account for around 8%-10% of total outpatients and 12% of admissions ...     

Role of β2-microglobulin in uremic patients may be greater than originally suspected

The role of beta2-microglobulin(β2M) in dialysisrelated amyloidosis as a specific amyloid precursor was defined in the 1980 s. Studies in those years were largely related to β2M amyloidosis. In 2005, for what was probably the first time in the available literature, we provided data about the association betweenβ2M and early-onset atherosclerosis in hemodialysis patients without co-morbidities. In recent years, the role of uremic toxins in uremic atherosclerosis and the interest in β2M as a marker of cardiovascular(CV) and/or mortality risk have grown. In the current literature,clinical studies suggest that β2M is an independent, significant predictor of mortality, not only in dialysis patients, but also in predialysis patients and in the highrisk portion of the general population, and it seems to be a factor strongly linked to the presence and severity of CV disease. It is still unknown whether β2M is only a uremic toxin marker or if it also has an active role in vascular damage, but data support that it may reflect an increased burden of systemic atherosclerosis in a setting of underlying chronic kidney disease. Thus, although there have been some inconsistencies among the various analyses relating to β2M, it promises to be a novel risk marker of kidney function in the awareness and detection of high-risk patients. However, more research is required to establish the pathophysiological relationships between retained uremic toxins and further biochemical modifications in the uremic milieu to get answers to the questions of why and how. In this review, the recent literature about the changing role of β2M in uremic patients will be examined.     

Preclinical therapy of benign prostatic hyperplasia with neuropeptide hormone antagonists

Benign prostatic hyperplasia(BPH)is a pathologic condition of the prostate described as a substantial increase in its number of epithelial and stromal cells.BPH may significantly reduce the quality of life due to the initiation of bladder outlet obstruction and lower urinary tract syndromes.Current medical therapies mostly consist of inhibitors of 5α-reductase orα1-adrenergic blockers;their efficacy is often insufficient.Antagonistic analogs of neuropeptide hormones are novel candidates for the management of BPH.At first,antagonists of luteinizing hormone-releasing hormone(LHRH)have been introduced to the therapy aimed to reduce serum testosterone levels.However,they have also been found to produce an inhibitory activity on local LHRH receptors in the prostate as well as impotence and other related side effects.Since then,several preclinical and clinical studies reported the favorable effects of LHRH antagonists in BPH.In contrast,antagonists of growth hormone-releasing hormone(GHRH)and gastrin-releasing peptide(GRP)have been tested only in preclinical settings and produce significant reduction in prostate size in experimental models of BPH.They act at least in part,by blocking the action of respective ligands produced locally on prostates through their respective receptors in the prostate,and by inhibition of autocrine insulin-like growth factors-Ⅰ/Ⅱand epidermal growth factor production.GHRH and LHRH antagonists were also tested in combination resulting in a cumulative effect that was greater than that of each alone.This article will review the numerous studies that demonstrate the beneficial effects of antagonistic analogs of LHRH,GHRH and GRP in BPH,as well as suggesting a potential role for somatostatin analogs in experimental therapies.     

Epidermolysis bullosa, pyloric atresia, and obstructive uropathy: a report of two case reports with molecular correlation and clinical management

The epidermolysis bullosa-pyloric atresia-obstructive uropathy (EB-PA-OU) association is a rare, but well-described multisystem disease. While the prognosis at this time is still poor, an increasing number of patients are surviving to adolescence with aggressive care. It is important to understand this syndrome in order to anticipate medical complications and offer preventive strategies where possible. Prompt and expectant management of obstructive uropathy is crucial in these patients. Evidence of ureterovesicular obstruction may require bowel diversion, as excision of the obstructed ureterovesicular junction with reimplantation is often associated with a high risk of reobstruction. Many newborns succumb to sepsis or dehydration and electrolyte imbalance. Those infants who survive need close monitoring for the development of obstructive uropathy, failure to thrive, protein-losing enteropathy, respiratory compromise, and increased susceptibility to invasive infections. Once a clinical diagnosis is made, mutational analysis can confirm it and facilitate genetic counseling, as recurrence risks are 25% for this autosomal recessive condition. Mutational analysis enables direct genetic testing and accurate prenatal diagnosis. As more patients are studied, genotype/phenotype correlations may be possible.     

Pneumatosis cystoides intestinalis in systemic sclerosis

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of multiple gas containing thin walled cysts in the intestinal wall and mesentery. It is sometimes associated with chronic obstructive pulmonary disease, but has been described most often in patients with gastrointestinal disorders including duodenal and gastric ulceration, small bowel obstruction, regional enteritis and gastrointestinal malignancy. Its association in the patient described below with severe systemic sclerosis is of particular interest. There have been occasional previous reports of this association which should be considered in any patient with systemic sclerosis who develops abdominal symptoms suggestive of acute or sub-acute intestinal obstruction, not readily explicable by other causes.     

Prostatic surgery associated acute kidney injury

Acute kidney injury (AKI) is associated with extended hospital stays, high risks of in-hospital and long-term mortality, and increased risk of incident and progressive chronic kidney disease. Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy, older age, and preexistent chronic kidney disease. Nonetheless, precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking. Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures. Whereas severe AKI after prostate surgery in general appears to be unusual, AKI associated with transurethral resection of the prostate (TURP) syndrome and with rhabdomyolysis (RM) after radical prostatectomy have been frequently described. The purpose of this review is to discuss the current knowledge regarding the epidemiology, risk factors, outcomes, prevention, and treatment of AKI associated with prostatic surgery. The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.     

Chronic pulmonary complications associated with toxic epidermal necrolysis: report of a severe case with anti-Ro/SS-A and a review of the published work

Patients with toxic epidermal necrolysis (TEN) have been known to have various complications. Though pulmonary complications are often observed, they usually show an acute form; however, chronic complications are quite rare and little is known about either their incidences or clinical manifestations. We herein report a 33‐year‐old man who presented with chronic pulmonary complications after a recovery from TEN. At the onset of TEN, he had severe respiratory failure and artificial ventilation was instituted. Despite being extubated successfully, respiratory failure reappeared 1 month later. A diagnosis of chronic bronchitis with severe obstructive ventilatory impairment and bronchiectasis was made and he was treated with steroids, bronchodilators and antibiotics, however, he died 1.5 years after the onset of TEN. There have been 13 reported cases of chronic pulmonary complications with TEN or Stevens–Johnson syndrome (SJS) in the English published work. Such cases are usually classified into chronic bronchitis/bronchiolitis with obstructive change (including bronchiolitis obliterans and bronchiolitis obliterans organizing pneumonia), respiratory tract obstruction and bronchiectasis. Approximately 40% of all such patients die while the surviving continue to suffer from these complications because no curative therapy yet exists. As a result, the prognosis seems to be poor. The relationship between TEN and these chronic pulmonary complications remains to be elucidated. Interestingly, our patient was asymptomatically anti‐Ro/SS‐A positive at the onset of TEN. In addition, eccrine gland involvement and an extremely high level of serum salivary amylase were observed at the onset of TEN, furthermore, Sjögren‐like symptoms occurred after recovery from TEN. These findings suggested that the Sjögren‐like autoimmune abnormalities induced by anti‐Ro/SS‐A correlated with the development of chronic pulmonary complications in our patient.     

Livedo reticularis de las piernas: Metodología de diagnóstico y tratamiento

The term livedo reticularis refers to a reddish-violet reticular discoloration of the skin that mainly affects the limbs. It is caused by an interruption of blood flow in the dermal arteries, either due to spasm, inflammation, or vascular obstruction, and is associated with diseases of varying etiology and severity. To establish the cause of livedo reticularis, it is essential to determine its course (chronic, acute, or fulminant), the presence of other cutaneous signs such as nodules, retiform purpura or necrosis, and the possible association of general symptoms or laboratory findings that suggest a particular systemic process. The aim of this review is to describe the diagnosis and treatment of the disease.     

输卵管再通术、中药联合用于输卵管梗阻性不孕患者治疗对其梗阻程度、妊娠情况的影响

目的 探讨输卵管再通术联合中药治疗输卵管梗阻性不孕患者的临床效果.方法 选取2018年3月至2019年3月西安市第四医院诊治的72例输卵管梗阻性不孕患者作为研究对象.按照随机数字表法分为观察组(n=36)和对照组(n=36).对照组行输卵管再通术治疗,观察组在对照组基础上加服中药治疗.观察并比较两组输卵管梗阻程度改善、...     

Chronic external iliac vein obstruction as a cause of leg ulceration

Chronic venous leg ulceration, which tends to recur, is difficult to treat and therefore needs special diagnostic and therapeutic care. We recently treated a 45-year-old patient with an obstruction of the left external iliac vein, caused by deep venous thrombosis. We would like to propose that, although rare, the existence of pelvic vein thrombosis and obstruction can cause venous leg ulcers. This case clearly pointed out that in patients with crural leg ulceration, showing no other signs of chronic venous insufficiency and where duplex ultrasound is normal, additional diagnostic evaluation should be performed. Because standard duplex ultrasound investigation can fail to demonstrate the obstruction, phlebography should be used in suspected cases as a secondary test to check both the superficial and the deep venous system for pathology, applying the endovascular therapeutic stent-placement technique.     

阴部神经痛综合征的发病学研究

阴部神经疼痛征合征,亦称睾丸神经痛综合征、生殖神经痛综合征,临床发病率较高,发病机因尚不明确.我们按临床表现将其归纳为气血失调、脉络不畅;寒邪客脉、经络痹瘀;厥阴蕴滞、络脉受阻.现代医学认为,本证多因感染所致急慢性睾丸炎、睾丸结核、精索炎、前列腺炎及睾丸肿瘤、外伤、或精索静脉曲张精索鞘膜积液等原因所致.     

磁共振诊断前列腺炎并发梗阻性无精子症患者射精管梗阻情况的效用研究

目的:分析磁共振检查(MR)在青年前列腺炎并发射精管梗阻性无精子症患者的检查特征,为临床青年前列腺炎患者并发射精管梗阻性无精子症患者的临床诊断提供参考。方法:回顾性分析我院2014年1月至2015年12月收治的青年慢性Ⅲ型前列腺炎患者并发射精管梗阻性无精子症患者33例,所有患者均行MR检查梗阻数量,患者均行手术治疗,详细记录术中所见射精管梗阻数量,将MR检查与术中所见结果进行比较,计算MR诊断青年前列腺炎并发射精管梗阻性无精子症结果的准确性、特异性和灵敏度,比较MR和术中所见的kappa一致性系数。分析前列腺炎并发射精管梗阻性无精子症患者的MR特征,及MR对青年前列腺炎并发射精管梗阻性无精子症患者的临床价值。结果:MR术前诊断射精管粘连情况:射精管单点粘连23例,两点粘连5例,多点粘连5例。术中所见:射精管单点粘连21例,两点粘连6例,多点粘连6例,MR诊断与手术中所见的kappa一致性系数为0.814,该方法和手术中所见具有高度的一致性。MR法的敏感度为93.55%、准确度为90.91%、特异度为50.00%。前列腺炎并发射精管梗阻性无精子症MR特征为:前列腺以弥漫性炎症为主,其次为局灶性,射精管以单点粘连为主,射精管增强扫描31例出现管壁强化。结论:青年慢性Ⅲ型前列腺炎患者较易并发射精管梗阻性无精子症,MR检查可明确病变特征,为青年前列腺炎合并射精管梗阻性无精子症患者的手术方案的制定提供准确信息,具有较高的临床价值。