Long‐term graft function with tacrolimus and cyclosporine in renal transplantation: Paired kidney analysis

Aim: The first prospective, randomized trial with paired kidney analysis was conducted to compare the efficacy and safety of tacrolimus with cyclosporine‐based immunosuppressive therapy in renal transplant recipients. This paper reports the long‐term follow‐up results of the authors' previously published study, with the main focus on graft survival and renal function. Methods: Chinese patients transplanted in our centre between June 1998 and June 2005 with their first deceased renal transplant were included. Patients were included if both kidneys were received by the authors' centre, thus allowing a paired analysis. Patients were randomized to receive triple immunosuppressive therapy with either tacrolimus or Neoral cyclosporine, concomitantly with prednisolone and azathioprine therapy. Results: Seventy‐six patients received cadaveric kidneys from 38 donors. Each pair of kidneys was randomly assigned to a separate group (38 subjects/group). The mean follow‐up duration was 6.1 ± 1.8 years. The mean calculated creatinine clearance was significantly higher in patients receiving tacrolimus‐based therapy. The rate of biopsy‐proven acute rejection was lower in the tacrolimus group (18.4% vs 42.1%, P = 0.03). The patient and graft survival were comparable in both treatment arms. Significantly fewer patients on tacrolimus‐based therapy developed hypercholesterolaemia (P = 0.05). However, there was no significant difference in the development of post‐transplant diabetes mellitus, hypertension, opportunistic infection and malignancy between both groups. Conclusion: Using the immunosuppressive regimen, tacrolimus‐based therapy provided adequate immunosuppression with better renal function and less acute rejection, as compared with cyclosporine‐based therapy.     

西藏某VCT门诊自愿咨询检测者HIV感染状况分析

目的分析艾滋病自愿咨询检测（VCT）门诊,自愿咨询检测者的艾滋病病毒（HIV）感染状况,为西藏预防HIV传播提供科学依据。方法收集整理2003-2012年西藏某VCT门诊自愿咨询者的人口学信息及HIV抗体检测结果,用描述性方法进行统计分析。结果1929名自愿咨询检测者中,检出HIV抗体阳性188例,阳性率9．75％;女性阳性率（12．94％）高于男性（8．40％）;15～44岁年龄组阳性率达9．92％,其阳性人数占所有阳性者中的94．15％（177／188）。小学及以下文化程度HIV阳性率较高,为17．92％,无业者高于其他职业;静脉注射吸毒阳性率高达62．50％。性传播占总数的89．89％。结论青壮年、小学及以下文化程度者及无业者是感染HIV的高危人群,性接触是主要的传播方式,应针对高危人群的特点,加强艾滋病的宣传教育以及行为干预工作,阻断HIV传播。     

Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients

Background

The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions.

Methods and Results

Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7–65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step‐by‐step closure of the right ventricular to the CA connections. No procedure‐related deaths occurred.

Conclusion

Congenital and post‐procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long‐term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail‐out strategies should be planned in all coronary interventions. (J Interven Cardiol 2013;26:287–294)

     

Emergency department utilization among HIV‐infected patients in a multisite multistate study*

Objective

The aim of this study was to examine Emergency Department (ED) utilization and clinical and sociodemographic correlates of ED use among HIV‐infected patients.

Methods

During 2003, 951 patients participated in face‐to‐face interviews at 14 HIV clinics in the HIV Research Network. Respondents reported the number of ED visits in the preceding 6 months. Using logistic regression, we identified factors associated with visiting the ED in the last 6 months and admission to the hospital from the ED.

Results

Thirty‐two per cent of respondents reported at least one ED visit in the last 6 months. In multivariate analysis, any ED use was associated with Medicaid insurance, high levels of pain (the third or fourth quartile), more than seven primary care visits in the last 6 months, current or former illicit drug use, social alcohol use and female gender. Of those who used ED services, 39% reported at least one admission to the hospital. Patients with pain in the highest quartile reported increased admission rates from the ED as did those who made six or seven primary care visits, or more than seven primary care visits vs. three or fewer.

Conclusions

The likelihood of visiting the ED has not diminished since the advent of highly active antiretroviral therapy (HAART). More ED visits are to treat illnesses not related to HIV or injuries than to treat direct sequelae of HIV infection. With the growing prevalence of people living with HIV infection, the numbers of HIV‐infected patients visiting the ED may increase, and ED providers need to understand potential complications produced by HIV disease.     

Steady‐state amprenavir and tenofovir pharmacokinetics after coadministration of unboosted or ritonavir‐boosted fosamprenavir with tenofovir disoproxil fumarate in healthy volunteers

Objective

An open‐label, three‐period pharmacokinetic study was conducted to investigate the drug interaction potential between fosamprenavir (FPV) and tenofovir disoproxil fumarate (TDF).

Methods

Thirty‐six healthy subjects received TDF 300 mg once daily (qd) for 7 days (period 1), and then were randomized to 14 days of either FPV 1400 mg twice daily (bid) or FPV/ritonavir (RTV) 700/100 mg bid alone or with TDF (period 2). Subjects continued their randomized dose of FPV for 14 more days, adding or removing TDF based upon its receipt in period 2 (period 3). Twenty‐four‐hour pharmacokinetic sampling was carried out on day 7 of period 1 and on day 14 of periods 2 and 3. Steady‐state plasma amprenavir (APV) and tenofovir (TFV) pharmacokinetics were assessed by noncompartmental analysis and parameter values observed with each regimen were compared using geometric mean ratios with 90% confidence intervals.

Results

After TDF coadministration, APV geometric mean minimum concentration (C_min), maximum concentration (C_max), and area under the plasma concentration–time curve (AUC) increased by 31, 3 and 7% above values observed with unboosted FPV alone; they also increased by 31, 4 and 16% above values observed with FPV/RTV alone. TFV C_min, C_max and AUC decreased by 12, 25 and 15% after FPV coadministration and by 9, 18 and 7% after FPV/RTV coadministration. No significant changes in RTV pharmacokinetics were observed. No differences were noted in adverse events among dosing periods.

Conclusions

In this evaluation of the interaction between FPV and TDF, increases in APV exposures and modest decreases in TFV exposures were observed. These were unlikely to be clinically significant.

     

关节镜手术治疗踝关节骨折后创伤性关节炎17例

目的 观察关节镜手术治疗踝关节骨折后创伤性关节炎的近期效果.方法 2007年12月～2009年4月我院对17例踝关节骨折术后创伤性关节炎进行踝关节镜手术治疗,并运用关节镜观察踝关节病变情况.结果 术中踝关节镜下见慢性滑膜炎性增生17例,胫骨下端前缘骨赘6例,距骨颈部骨赘4例,距骨关节软骨损伤11例,胫骨关节软骨损伤4例,游离体2例.术后48 h 5例有关节疼痛、轻度肿胀,1周后好转,余无明显关节疼痛.16例随访12～25个月,平均18.2个月.根据Baird等踝关节评分系统评定疗效,优4例,良10例,可2例,优良率87.5%.结论 踝关节镜手术治疗踝关节骨折后创伤性关节炎近期效果满意.     

Production of chitosan from endolichenic fungi isolated from mangrove environment and its antagonistic activity

Objective

To screen the chitosan producing ability of endolichenic fungi and its antibacterial activity.

Methods

Lichen collected from mangroves was screened for endophytes and the chitosan producing ability of endolichenic fungi by submerged fermentation was also determined. Antibacterial activity was carried out against different pathogens.

Results

Totally 4 different groups of fungi were isolated from the lichen Roccella montagnei. Among the four genera, Aspergillus niger (A. niger) is potential to produce chitosan (1.3 g/L) on the twelfth day of incubation. Glucose plays an important role in the productivity of chitosan and the yield was maximum at 10% (1.93 g/L). Antibacterial activity revealed that Vibrio cholerae was sensitive to chitosan followed by Escherichia coli.

Conclusions

In conclusion, our findings suggest that A. niger is a potential candidate to produce more chitosan than the other strains and glucose plays an important role in the production of chitosan which proves to have a good antibacterial activity.     

河南省燃煤污染型地方性氟中毒流行现况调查

目的 掌握河南省燃煤污染型地方性氟中毒(简称地氟病)流行现状,为地氟病的防治工作提供依据.方法 2006、2007年对河南省13个县(市、区)的1832个历史燃煤污染型地氟病病区村燃煤情况、生活习惯、主食、住房结构、水氟等因素进行普查,对仍使用高氟煤的216个村进行重点抽样调查,每村对8～12岁全部儿童进行氟斑牙检查,并采集30份即时尿样检测尿氟.结果 所有历史病区村饮水含氟量<1.0 mg/L;有独立厨房的居民户占93.7%(241 281/257 393),炉灶有排烟设施的占41.9%(107 917/257 393),使用当地高氟煤做饭的户数占28.6%(73 686/257 393);使用当地高氟煤取暖的户数占24.1%(61 924/257 393);主食来源为自产,占病区村的95.7%(1753/1832),均采用自然晾晒的方式干燥粮食;16.2%(35/216)的病区村8～12岁儿童氟斑牙检出率>30.0%,全部集中在洛阳市;77.8%(168/216)的病区村儿童尿氟≤1.50 mg/L.结论 河南省燃煤污染型地氟病病区范围已大大缩小,危害程度明显减轻.其中8个县(市、区)历史病区村8～12岁儿童氟斑牙病情已经达到了病区控制标准,有5个县(市、区)未达到控制标准,集中分布在洛阳市.     

Quantifying the risks and benefits of efavirenz use in HIV‐infected women of childbearing age in the USA

Objectives

The aim of the study was to quantify the benefits (life expectancy gains) and risks (efavirenz‐related teratogenicity) associated with using efavirenz in HIV‐infected women of childbearing age in the USA.

Methods

We used data from the Women's Interagency HIV Study in an HIV disease simulation model to estimate life expectancy in women who receive an efavirenz‐based initial antiretroviral regimen compared with those who delay efavirenz use and receive a boosted protease inhibitor‐based initial regimen. To estimate excess risk of teratogenic events with and without efavirenz exposure per 100 000 women, we incorporated literature‐based rates of pregnancy, live births, and teratogenic events into a decision analytic model. We assumed a teratogenicity risk of 2.90 events/100 live births in women exposed to efavirenz during pregnancy and 2.68/100 live births in unexposed women.

Results

Survival for HIV‐infected women who received an efavirenz‐based initial antiretroviral therapy (ART) regimen was 0.89 years greater than for women receiving non‐efavirenz‐based initial therapy (28.91 vs. 28.02 years). The rate of teratogenic events was 77.26/100 000 exposed women, compared with 72.46/100 000 unexposed women. Survival estimates were sensitive to variations in treatment efficacy and AIDS‐related mortality. Estimates of excess teratogenic events were most sensitive to pregnancy rates and number of teratogenic events/100 live births in efavirenz‐exposed women.

Conclusions

Use of non‐efavirenz‐based initial ART in HIV‐infected women of childbearing age may reduce life expectancy gains from antiretroviral treatment, but may also prevent teratogenic events. Decision‐making regarding efavirenz use presents a trade‐off between these two risks; this study can inform discussions between patients and health care providers.