Strong impact of acute kidney injury on survival after liver transplantation

Acute kidney injury (AKI) is a major complication in orthotopic liver transplantation (OLT). In an evaluation of Acute Kidney Injury Network (AKIN) criteria in liver transplanted patients, we retrospectively analyzed the usefulness of these criteria to predict survival of 193 consecutive patients at a single center who underwent primary OLT for clinical parameters and peak AKI. Postoperative AKI according to AKIN occurred in 60.1% of the patients, namely, stages 1, 2, and 3 in 30%, 13% and 17.1% respectively. Using multivariate logistic regression, AKIN stage 1 and 2 AKI were independently associated with the pre-OLT Model for End-Stage Liver Disease (MELD) score and age, while stage 3 AKI was independently associated with MELD and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. The 28-day and 1-year mortality post-OLT of AKI patients were 15.5% and 25.9% respectively compared with 0% and 3.9% among non-AKI patients (P < .05 for both). The survival rates of non-AKI and stages 1, 2, and 3 AKI subjects were 96%, 85.5%, 84%, and 45.3%, respectively. Cox regression analysis showed independent risk factors for mortality during the first year after transplantation to include post-OLT AKI (12.1; P < .05), post-OLT infection (HR 4.7; P < .01), pre-OLT hypertension (HR 4.4; P < .01) hazard ratio [HR] and post-OLT APACHE II ≥10 (HR 3.6; P < .05). We concluded that AKI as defined by the AKIN criteria is a major complication of OLT linked to a poor outcomes. It remains to be evaluated whether aggressive perioperative therapy to prevent AKI can improve survival among OLT patients.     

Detection of renal allograft dysfunction with characteristic protein fingerprint by serum proteomic analysis

This study aimed to diagnose renal allograft dysfunction with specific biomarkers by serum proteomic analysis. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) and bioinformatics (support vector machine and leave-one cross validation) were used to analyze serum proteome. Enrolled patients included 38 biopsy-proved acute rejection (BPAR), 10 acute tubular necrosis (ATN), 24 subclinical rejection (SCR) and 29 stable control recipients verified by protocol biopsy. A characteristic protein profile can be detected in each renal allograft dysfunction group. BPAR patients were differentiated from stable patients with markers of 9710.1, 4971, 6675.5, 8563.8, 6709.2, 9319 and 4476.7 Da with high sensitivity and specificity. ATN can be clearly distinguished from BPAR and stable control. Subclinical rejection differentiated from stable control with markers of 9193.1, 2759.1, 8464.6 Da. The independent blind test yielded with high specificity and sensitivity for each group. Serum proteome analysis by SELDI-TOF MS combined with bioinformatics in renal allograft dysfunction is valuable and promising. Specific markers were detected in each group. Identification of these proteins may prove useful as diagnostic markers for allograft dysfunction and better to elucidate the mechanism of acute rejection.     

Population Pharmacokinetic Analysis of Mizoribine in Chinese Renal Transplant Recipients

Background

We calculated the population pharmacokinetics of mizoribine in adult Chinese patients and compared the parameters with those of Japanese patients to determine whether there are any ethnic differences in blood concentration transition between these 2 populations.

Incidence and risk factors for pulmonary mycosis in kidney transplantation

IntroductionPulmonary mycosis, a severe complication following kidney transplantation, is associated with a high rate of mortality. The incidence of and independent risk factors for its development have not been well studied.MethodsWe retrospectively reviewed 2573 kidney transplant recipients. Patients were divided into case and control groups based on a diagnosis of pulmonary mycosis. The recipient baseline characteristics, posttransplant complications, immunosuppressive regimens and antibiotic usages were analyzed to identify independent risk factors.ResultsThe total incidence of pulmonary mycosis among kidney recipients was 2.1%. Upon univariate analysis, patients in the case group differed significantly from the controls based upon: older age, higher retransplantation rate, longer dialysis time, induction with ATG or anti-CD25 monoclonal antibodies, maintenance treatment with FK506 or MMF, broad-spectrum antibiotics, higher incidences of acute rejection episodes, DGF, impaired liver function, leukopenia, cytomegalovirus infection, and delayed incisional healing (P < .05). Multivariate analysis showed that older age, retransplantation, ATG induction, FK506/MMF, broad-spectrum antibiotics, leukopenia, and delayed incisional healing were independent risk factors for pulmonary mycosis.ConclusionsThe use of more potent immunosuppressive regimens seems to increase the rate of pulmonary mycosis. Patients who have five or more independent risk factors are at high risk for developing pulmonary mycosis.     

Y形软骨闭合与否对青少年特发性脊柱侧凸患者矫形疗效及并发症的影响

目的 探讨作为评估脊柱生长潜能指标的Y形软骨是否闭合对女性青少年特发性脊柱侧凸(AIS)患者单纯后路矫形内固定融合手术疗效及并发症的影响.方法 选取2003年6月至2007年10月行单纯后路矫形内固定融合术的女性胸弯AIS患者40例,其中手术时Y形软骨开放者16例(OTRC组),平均年龄11.8岁,冠状面主弯Cobb角平均53.3°,矢状面后凸平均27.7°;Y形软骨闭合者24例(CTRC组),平均年龄13.7岁,冠状面主弯Cobb角平均49.6°,矢状面后凸Cobb角平均27.8°.所有患者均于全身麻醉下行单纯后路矫形内固定融合术.对两组患者的术后及末次随访时冠状面胸主弯Cobb角、矢状面后凸Cobb角及并发症进行分析.结果 OTRC组和CTRC组术后平均随访27和26个月(P=0.74).两组患者术后平均Cobb角分别为22.2°和20.7°(P＝0.34),平均矫正率分别为58.3%和57.7%(P=0.83),末次随访时平均Cobb角为24.8°和21.1°(P＝0.05),平均矫正丢失率分别为5.3%和1.0%(P=0.01).矢状面上两组患者术后平均后凸Cobb角分别为22.5°和23.9°(P=0.49),平均矫正5.2°和3.9°(P=0.63),末次随访平均后凸Cobb角20.8°和24.7°(P＝0.04),平均丢失-1.7°和0.8°(P=0.01).OTRC组患者随访过程中出现冠状面Cobb角矫正丢失和矢状面后凸Cobb角减小.OTRC组2例实施选择性胸弯融合术的Lenke I型患者出现远端"附加现象",而CTRC组无远端"附加现象"发生.结论 Y形软骨是否闭合对女性AIS患者行单纯后路矫形内固定融合术短期疗效无明显影响,但OTRC组容易矫正丢失.OTRC或许是远端"附加现象"的危险因素.

Abstract：

Objective To investigate the effect of potential spinal growth on the posterior-only spinal instrumentation of adolescent idiopathic scoliosis (AIS) . Methods From June 2003 to October 2007 ,40 patients received posterior-only spinal instrumentation. Croup of open triradiate cartilage (Croup A) included 16 female AIS patients with mean age of 11. 8, and group of closed triradiate cartilages (Croup B)covered 24 female AIS patients with mean age of 13. 7. The mean preoperative Cobb angles of Croup A and B were S3. 3° and 49. 6° respectively, and the mean kyphosis in the sagittal plane was 27. 7° and 27. 8° respectively. Results The post-operative Cobb angles were 22. 2° (Group A) vs. 20. 7° (Group B) (P =0. 34) with correction rate of 58. 3% (Group A) vs. 57. 7% (Group B) (P = 0. 83). The mean Cobb angles at final follow-up were 24. 8°(Group A) vs. 21. l°(Group B) (P=0. 05) with the correction loss of 5.3% (Group A) vs. 1.0% (Group B) (P=0. 01). In the sagittal plane, the average post-operative kyphosis was 22. 5° (Group A) vs. 23. 9° (Group B) (P = 0.49) with correction of 5. 2° (Group A) vs.3.9°(GroupB) (P = 0.63). The mean kyphosis at final follow-up was 20. 8° (Group A) vs. 24.7°(Group B) (P=0.04) with the correction loss of - 1. 7°(Group A) vs. 0.8°(Group B)(P=0.01). Group A showed obvious correction loss in the coronal plane and decrease of kyphosis in the sagittal plane. Adding on phenomenon was found in 2 cases with Lenke type I with selected fusion in Group A, but not in Group B. Conclusions Although similar post-operative correction is found in AIS patients with OTRC or CTRC, the loss of correction and "adding on phenomenon" are more likely to happen in patients with OTRC.     

高强度聚焦超声系统治疗局限性前列腺癌（附26例报告）

目的探讨高强度聚焦超声系统(HIFU)治疗局限性前列腺癌的有效性及安全性。方法使用Sonablate-500聚焦超声系统对26例局限性前列腺癌患者进行治疗,观察术后3、6、12个月时的血清前列腺特异性抗原(PSA)、直肠指诊及经直肠B超情况。结果平均手术操作时间48min(28～86min),平均术后住院时间3.2d(2～9d)。治疗后3、6、12个月PSA与治疗前相比有显著降低(P<0.05),直肠指诊发现结节消失或减小的占73.3%(11/15),B超提示:低回声结节消失或缩小的占76.9%(20/26)。治疗后3、6、12个月各项检查结果经统计学检验无显著性差异。结论HIFU可以安全、有效杀死前列腺癌细胞,在治疗局限性前列腺癌方面具有美好的应用前景。     

人类皮层肌动蛋白基因siRNA干预结肠癌细胞侵袭能力的研究

目的 探讨通过慢病毒载体介导的人类皮层肌动蛋白基因( EMSl) siRNA沉默皮层肌动蛋白( Cortactin)的表达对结肠癌细胞侵袭能力的影响.方法 构建针对Cortactin的编码基因EMS1的siRNA慢病毒载体转染结肠癌细胞HCT8,分为3组:EMS1-siRNA转染组、空载体组,以及未转染组.Wester...     

小肝癌射频消融治疗后患者生存及肝内肿瘤复发的有关因素分析

目的探讨射频消融(radiofrequency ablation,RFA)对≤5cm肝细胞癌(hepatocellular carcinoma,HCC)的疗效。方法2001年6月~2008年4月,对94例≤5cm的HCC进行了135次冷循环射频消融治疗,治疗途径包括超声引导下经皮穿刺(n=102),开腹(n=22),人工胸水辅助超声引导(n=11)。术后随访资料采用Kaplan-Meier模型分析患者的生存情况、肿瘤复发情况及其影响因素。结果射频消融术后1、2、3年的累计生存率分别为88.8%、72.2%、68.4%。45例术后1.5~36个月出现肝内复发,患者1、2、3年的无瘤生存率分别为58.8%、41.3%、28.1%。单因素分析显示:生存时间与肝功能Child-Pugh分级和血清甲胎蛋白水平有关(χ2=6.37,P=0.012;χ2=5.76,P=0.016);肝硬化、肝内多发病灶和高血清甲胎蛋白水平可能是术后肝内复发的危险因素(χ2=3.87,P=0.049;χ2=4.50,P=0.034;χ2=4.28,P=0.039)。结论对≤5cm的HCC,RFA是一种有效治疗方法。     

肝炎病毒感染与肝门部胆管癌发病关系的探讨

目的　探讨乙型肝炎 (乙肝 )和丙型肝炎 (丙肝 )病毒感染在肝门部胆管癌发病中的作用。　方法　采用免疫组织化学方法对 6 8例石蜡包埋肝门部胆管癌患者手术标本中乙肝病毒X蛋白和丙肝病毒C蛋白水平进行检测 ,并结合临床资料进行分析。　结果　 6 8例肝门部胆管癌中乙肝病毒X蛋白阳性率为 8 8% (6 / 6 8) ,丙肝病毒C蛋白阳性率为 35 3% (2 4 / 6 8) ,两者均阳性 1例(1 5 % ) ;乙肝、丙肝病毒感染的肝门部胆管癌在分化程度 (χ2 =8 7,P <0 0 1)、浸润程度 (χ2 =6 7 8,P<0 0 1)、淋巴结转移 (χ2 =4 3,P <0 0 5 )、根治程度 (χ2 =5 1,P <0 0 5 )与非病毒感染的肝门部胆管癌比较差异有显著意义。　结论　乙肝病毒X蛋白、丙肝病毒C蛋白可能在乙肝、丙肝病毒感染肝门部胆管癌的发病原因中起重要作用。乙肝、丙肝病毒感染的肝门部胆管癌恶性程度高 ,可能预后较差     

热打击及中暑小鼠血清对小鼠肺微血管内皮细胞黏附单核细胞能力的影响

目的：研究热打击及10%中暑小鼠血清刺激肺微血管内皮细胞(PMVECs)对 PMVECs 表达血管内皮黏附分子(VCAM-1)和细胞间黏附分子(ICAM-1)水平及其黏附单核细胞能力的影响。方法：根据二次磁珠分选法分离乳鼠PMVECs,光镜下观察细胞形态并对其血管内皮细胞钙黏蛋白(VE-Cadherin)及Ⅷ因子进行染色鉴定。将PMVECs随机分为3组,分别进行37℃正常培养(对照组)、给予42℃2 h热打击或10%中暑小鼠血清刺激,24 h后分别提取总 RNA,荧光定量PCR及 Weston blot检测 VCAM-1及 ICAM-1mRNA和蛋白的表达水平,荧光显微镜观察其对人单核细胞(THP-1细胞)的黏附能力。结果：所分离 PMVECs 纯度较高,光镜下细胞呈特征性鹅卵石形状排列,VE-Cadherin及Ⅷ因子均可染色。与对照组相比,给予42℃2 h的热打击24 h后,VCAM-1及 ICAM-1的 mRNA 及蛋白水平表达降低(P<0.05),而给予10%中暑小鼠血清刺激24 h 后VCAM-1及ICAM-1的mRNA及蛋白水平表达增加(P<0.01)。与对照组相比,热打击组黏附THP-1细胞的细胞数无明显变化,中暑小鼠血清刺激组THP-1细胞数明显增多,显示PMVECs对单核细胞的黏附能力增强。结论：单独热打击并未使小鼠PMVECs黏附分子表达增加,而给予中暑小鼠血清刺激后其黏附分子表达显著上调,从而使单核细胞易于附壁,导致或加重了中暑相关的急性肺损伤。