Efficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis

ObjectivesCordyceps sinensis (cordyceps) is a fungus used in traditional Chinese medicine as adjuvant immunosuppressive agent in patients with kidney transplant. This review evaluates current evidence on the efficacy and safety of natural and fermented cordyceps preparations in patients with kidney transplant.MethodsEnglish and Chinese electronic databases including The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and CNKI (China National Knowledge Infrastructure) were searched up to December 2015 for relevant randomized controlled trials. Journals and conference proceedings were also searched. Two review authors independently selected trials for inclusion, extracted data, and assessed methodological quality. The primary outcome measures were incidence of acute graft rejection in the first year post-transplantation, one-year graft survival rate (defined as the percentage of patients with functioning grafts) and patient survival rate (or all-cause mortality).ResultsNine studies were eligible for inclusion. These studies were considered to be at moderate risk of bias due to poor reporting of methods. Four studies that compared cordyceps-based therapy with azathioprine-based therapy gave comparable acute rejection rates, and graft and patient survival. The cordyceps-treated group however showed better kidney function and lower incidences of hyperuricemia, hyperlipidemia, hyperglycemia and liver injury. Cordyceps used with different combinations of immunosuppressant therapy showed significant reduction in proteinuria after 6–12 months. Compared to the group receiving cyclosporine A monotherapy, treatment with a combination of cordyceps and cyclosporine A showed less treatment-induced nephrotoxicity. Adverse events were either not monitored or poorly documented in most trials.ConclusionsCurrent evidence shows that cordyceps as an adjuvant to routine immunosuppressant therapy may benefit kidney transplant patient, however, better quality evidence is still required.     

Midterm patency and risk factors for vein graft occlusion after endoscopic harvest

ObjectivesTo evaluate midterm patency of saphenous vein grafts harvested endoscopically and identify risk factors for subsequent vein graft occlusion.MethodsFifty consecutive patients undergoing coronary artery bypass surgery with venous graft harvested by endoscopic method were included in the study. Patients underwent computed tomography angiography follow-up at mean 24 months. Multivariate logistic regression was used to analyze associations between preoperative variables (age, ejection fraction, body mass index, gender, hyperlipidemia, hypertension, diabetes mellitus, smoking, number of defects per graft and target vessel stenosis) and the incidence of saphenous vein graft occlusion.ResultsOcclusion of the saphenous vein graft occurred in 7 patients (14.3%) and occlusion of the left internal mammary artery graft in 1 patient (2.3%) during the 24 months after surgery. No significant stenosis (i.e. narrowing by >50%) was found in the remaining grafts. Multivariate logistic regression found no association between preoperative variables and saphenous vein graft occlusion.ConclusionsPatency rates 2 years after endoscopic vein harvesting are comparable to those from open techniques. Our data indicated no association between preoperative variables and vein graft occlusion. These results support the use of endoscopic saphenectomy in a wide spectrum of patients undergoing coronary artery bypass surgery.     

Coût d’un greffon rénal : calcul médico-économique des montants remboursés par l’Assurance maladie pour financer les étapes préalables et périphériques à la transplantation rénale

Successful organ transplantation relies on several ancillary activities such as the identification of a compatible donor, organ allocation and procurement and the coordination of the transplant process. No existing study of the overall costs, in France, of these additional transplantation activities could be identified. This study determines the total additional costs of ancillary transplantation activities by comparing the costs of kidney transplantations with living donors against those using deceased donors. The data used are drawn from the 2013 public healthcare tariff calculations, PMSI recorded activity and transplant activity in 2012 as assessed and reported by the Agence de la biomédecine. The results show that, in 2012, additional transplant costs varied from 13835.44 € to 20050.67 € for a deceased donor and were 13601.66 € for a living donor. In conclusion, this study demonstrates that all the costs covered by National Health Insurance need to be taken into account in the economic impact evaluation of renal transplantation and during the development of this national priority activity.     

Prolonged Bone Marrow Failure With Monosomy 7 After Engraftment Failure Following Bone Marrow Transplantation

A patient with acute myelogenous leukemia developed prolonged bone marrow failure along with the monosomy 7 chromosome abnormality. The patient had undergone bone marrow transplantation with CD34+ selection following induction failure. However, she then suffered engraftment failure and long-term pancytopenia. Her white blood cell count gradually increased with supportive therapy including granulocyte colony-stimulating factor (G-CSF), and chromosomal analysis of bone marrow cells revealed an abnormal karyotype. Thirty months after the bone marrow transplantation we observed monosomy 7 together with the existing chromosomal abnormality in the patient's bone marrow cells. It has been reported that some patients with idiopathic and posthepatitis aplastic anemia develop clonal disorders such as myelodysplastic syndrome/acute myelogenous leukemia with monosomy 7. The findings in our case suggest that the appearance of monosomy 7 in patients with aplastic anemia may be caused by prolonged low-level hematopoiesis, with or without G-CSF stimulation.     

前后联合手术入路治疗腰骶段脊柱结核35例临床分析

目的：探讨腰骶部脊柱结核通过前后联合手术入路行病灶清除一期椎间植骨融合加内固定的治疗疗效。方法选取采用前路病灶清除、植骨加后路内固定治疗腰骶段脊柱结核35例,病变均位于腰骶段,累及到2个椎体30例（L 4～519例,L 5～S 111例）,累及到3个椎体（L 4、L 5和S 1）5例,该手术方式适用于L 4～S 1脊柱结核,所选病例均伴有脓肿形成,13例伴有不同程度的神经压迫症状。术前腰骶椎前凸消失或后突畸形,35例均一期手术完成。结果本组35例患者均获得随访,随访时间8～30个月,平均随访2年,切口均愈合良好,术后腰骶椎后突畸形消失,植骨融合率100%,疗效优良率97%,术后无1例复发。结论前后联合入路手术行病灶清除一期椎间植骨融合、内固定主要适用于L 4～S 1椎体结核,该术式有利于清除病灶、恢复脊柱的稳定性,提高植骨融合率,矫正后突畸形。