Plasmapheresis therapy in renal transplant patients: five-year experience

Introduction

Plasma exchange (PE) and double-filtration plasmapheresis (DFPP) have been used successfully in renal transplant patients as well as those with various other diseases over the last decade. In this retrospective study, we sought to explore the outcomes of plasmapheresis in renal transplant patients.

Patients and methods

We investigated 58 patients who received PE or DFPP therapy between 2005 and 2010. PE was performed using a Fresenius AS.TEC 204 device and DFPP, by an INFOMED HF 440 device. Indications for therapy, biopsy findings, number of PE/DFPP sessions, laboratory data, medications, complications as well as graft and patient survivals were recorded.

Results

Overall mean age of subjects was 34.1 ± 8.8 years and 55% were female. Sixteen patients underwent 95 DFPP sessions and 42 underwent 215 PE sessions. Indications for therapy were acute humoral rejection (n = 39), recurrent focal segmental glomerulosclerosis (FSGS; n = 8), thrombotic microangiopathy (n = 6), and chronic humoral rejection (n = 5). Responses to therapy were 24/39 for acute humoral rejection, 1/5 for chronic rejection, 4/8 for FSGS, and 3/6 for thrombotic microangiography. No complication was observed in any patient.

Conclusion

PE/DFPP is a safe and succesful method for treatment of acute humaral rejection as less so for recurrent FSGS and thrombotic microangiopathy. The outcomes among subjects with chronic humoral rejection were not satisfactory.     

Orthopedic protraction with skeletal anchorage in a patient with maxillary hypoplasia and hypodontia

Multipurpose titanium miniplates were placed on the lateral nasal wall of the maxilla as anchorage for face mask protraction in an 11-year-old girl presenting with severe maxillary hypoplasia and hypodontia. Applying orthopedic forces directly to the maxilla resulted in an eight mm maxillary advancement. Intraosseous titanium screws were also placed on the palatal bone, near the alveolar crests, to provide anchorage for the expansion appliance. The maxilla was expanded from the median palatal suture, and seven mm of expansion was achieved across the buccal segments. No other tooth support was used for the expansion or the protraction of the maxilla.     

Maxillary molar distalization with a bone-anchored pendulum appliance

To obtain an effective and compliance-free molar distalization without an anchorage loss, we designed the bone-anchored pendulum appliance (BAPA). The aim of this study was to evaluate the stability of the anchoring screw, distalization of the maxillary molars, and the movement of teeth anterior to maxillary first molars. The study group comprised 10 patients (mean age 13.5 +/- 1.8 years) with Class II molar relationship. A conventional pendulum appliance was modified to obtain anchorage from an intraosseous screw instead of the premolars. The screw was placed in the anterior paramedian region of the median palatal suture. Skeletal and dental changes were measured on cephalograms, and dental casts were obtained before and after distalization. A super Class I molar relationship was achieved in a mean period of 7.0 +/- 1.8 months. The maxillary first molars distalized an average of 6.4 +/- 1.3 mm in the region of the dental crown by tipping distally an average of 10.9 degrees +/- 2.8 degrees . Also, the maxillary second premolar and first premolar moved distally an average of 5.4 +/- 1.3 mm and 3.8 +/- 1.1 mm, respectively. The premolars tipped significantly distally. No anterior incisor movement was detected. The BAPA was found to be an effective, minimally invasive, and compliance-free intraoral distalization appliance for achieving both molar and premolar distalization without any anchorage loss.     

人参皂甙诱导的造血细胞内信号传递途径的研究

目的探讨人参皂甙（ＧＳ）刺激造血祖细胞增殖有关的细胞内信号传递途径。方法采用Ｎｏｒｔｈｅｒｎ印迹杂交法、电泳带移动阻滞实验、抗体胶结合移动实验和紫外放射交联实验。结果ＮｏｒｔｈｅｒｎＢｌｏｔ显示经ＧＳ诱导的人巨核细胞株ＣＨＲＦ２８８、Ｍｅｇ０１和ＭＯ７ｅ细胞的ＧＡＴＡ２ｍＲＮＡ水平增高,分别是未经处理细胞的１．８４,２．４３和１．５２倍。但ＧＡＴＡ１ｍＲＮＡ表达水平低,且ＧＳ处理前后也无明显变化。电泳带移动阻滞实验提示ＧＳ诱导的细胞核内ＧＡＴＡ转录调控蛋白与特定的ＤＮＡ序列结合的活性增高。抗体胶结合移动实验证实与ＤＮＡ结合的主要成分为ＧＡＴＡ２蛋白,紫外放射交联实验确定该复合物的相对分子质量约为５０×１０３,符合ＧＡＴＡ２转录调控蛋白。结论ＧＳ诱导细胞内的信号传递途径与转录因子ＧＡＴＡ２有关,ＧＡＴＡ２有介导ＧＳ刺激造血细胞增殖的作用。     

Alveolar cleft closure by distraction osteogenesis with skeletal anchorage during consolidation

Intraoral distraction osteogenesis (DO) has been widely used for the reconstruction of various dentoalveolar defects. However, its use in the management of alveolar clefts is relatively new. This method allows the closure of the cleft via the regeneration of new alveolar bone and attached gingiva through the distraction of a dento-osseous segment. It eliminates the need for a donor site for autogenous bone grafting and possible graft failure. However, the relatively long consolidation period required for the use of intraoral DO devices may result in soft tissue irritation that would compromise patient cooperation, especially in children. In the case presented, the intraoral DO technique was used for the treatment of a unilateral residual alveolar cleft and an implant was subsequently placed in the regenerated bone. A miniplate was also placed to serve as a skeletal anchor to enable the early removal of the distractor device. The distractor was removed before the beginning of the consolidation phase.