Evaluation and treatment of marginal grafts with surgical diseases in kidney transplantation

Background  Marginal renal grafts may alleviate the shortage of suitable organs to meet an increasing demand of kidney transplantation, especially when live donors are currently limited to relatives of patients in China. The aim of this study was to investigate how to increase the available donors pool, evaluation, and treatment of marginal donors.

Methods  We had performed 121 kidney transplantation cases with living relative donors. Five out of these cases applied marginal grafts with surgical diseases, including one renal stone, one duplex kidney, one renal leiomyoma and two cases of simple renal cysts. In each case, particular surgical interventions were exerted on the graft prior to standard engrafting procedures.

Results  All recipients recovered with functioning transplants given that their serum creatinine levels declined to a normal range within one week after operation. These recipients were subsequently followed up for 10 months on average and their kidney functions remained stable.

Conclusions  Marginal renal grafts with surgical diseases, which can be treated surgically before engrafting, may provide satisfying transplantation outcomes. Positive and cautious consideration of these grafts may increase renal donor pool.

     

槲皮素通过SIRT1/ROS/DR5途径发挥对TRAIL的协同抗前列腺癌活性

目的: 探讨中药活性成分槲皮素是否对TRAIL有协同抗前列腺癌效应并研究其机制。方法: MTT实验检测前列腺癌细胞系PC3的细胞活力;流式细胞术检测PC3细胞的凋亡和ROS的产生;western blot实验检测PC3细胞中SIRT1、DR5的表达水平及caspase-8、caspase-3的活化水平。结果: TRAIL联合槲皮素对PC3的细胞活力抑制率(64.7±5.2)和凋亡诱导率(34.7±2.6)显著高于TRAIL单治疗组的细胞活力抑制率(16.9±1.4,P<0.05)和凋亡诱导率(9.1±0.8,P<0.05)。TRAIL联合槲皮素治疗组的SIRT1表达水平显著低于TRAIL单治疗组,同时TRAIL联合槲皮素治疗组的DR5表达水平、ROS产生水平及caspase-8、caspase-3活化水平均显著高于TRAIL单治疗组。另外,TRAIL+槲皮素+SIRT1质粒组PC3的细胞活力抑制率(23.4±1.9)和凋亡诱导率(12.5±1.2)及TRAIL+槲皮素+NAC组PC3的细胞活力抑制率(21.5±1.8)和凋亡诱导率(11.3±1.1)均显著低于TRAIL联合槲皮素组PC3的细胞活力抑制率(64.7±5.2,P<0.05)和凋亡诱导率(34.7±2.6,P<0.05)。结论: 槲皮素通过SIRT1/ROS/DR5途径发挥对TRAIL的协同抗前列腺癌活性。     

器官和组织捐献家属沟通专家共识

家属沟通是器官和组织捐献工作的关键环节,也是捐献成功与否的关键。为更好地帮助潜在器官和组织捐献者家属了解法律赋予的器官捐献自主选择权利,提升家属沟通效率,充分体现人文关怀,同时帮助相关从业者长期保持专业的工作状态及健康的心理状态,分享和总结各地最佳临床经验,共同商议并解决目前家属沟通面临的困难,在多方专家的共同参与下,特制订《器官和组织捐献家属沟通专家共识》。本共识以器官和组织捐献家属沟通的关键问题为导向,查阅相关文献,经多学科专家编写,并通过德尔菲投票方法达成共识,形成18个器官和组织捐献家属沟通关键元素及推荐建议,以期为器官和组织捐献家属沟通工作提供指引。本共识已在国际实践指南注册平台进行中英文注册。

     

Organ donor screening using parallel nucleic acid testing allows assessment of transmission risk and assay results in real time

Expansion of the donor pool may lead to utilization of donors with risk factors for viral infections. Donor laboratory screening relies on serological and nucleic acid testing (NAT). The increased sensitivity of NAT in low prevalence populations may result in false‐positive results (FPR) and may cause unnecessary discard of organs.We developed a screening algorithm to deal, in real time, with potential FPR. Three NAT assays: COBAS AmpliScreen assay (CAS), AmpliPrep Total Nucleic Acid Isolation/CAS, and AmpliPrep/TaqMan assays, were validated and used in parallel for prospective screening of increased‐risk donors (IRD), and the probability of FPR was calculated. The lower limit of detection of this algorithm was 9.79, 21.02, and 4.31 IU/mL for human immunodeficiency virus‐1, hepatitis C virus, and hepatitis B virus, respectively, with an average turn‐around‐time of 7.67 h from sample receipt to result reporting. The probability that a donor is potentially infectious with two NAT concordant results was >90%. NAT screening of 35 IRD within 18 months resulted in transplantation of 102 additional organs that without screening would either not be used or used with restrictions in Australia. Using a parallel testing algorithm, real‐time confirmation of seropositive donors allows use of organs from IRD and safer expansion of the donor pool.     

Cord blood transplantation in Western Australia

Background/Aims: Thirty‐one umbilical cord blood transplants performed in Western Australia were retrospectively examined in order to document local experience and relevant prognostic factors. Three cord units were from human leucocyte antigen‐matched siblings and the remainder were unrelated single (n= 22) or double (n= 6) cord blood transplants. Methods: Twenty patients were transplanted for malignant conditions and 11 for non‐malignant conditions. Cord units contained a median of 5.6 × 10⁷ total nucleated cells/kg and 1.4 × 10⁵ CD34+ cells/kg. Cumulative incidence of neutrophil engraftment was 76% at day 60. Results: Of those who did not engraft, two patients remain alive following subsequent allogeneic bone marrow transplant. There were no deaths caused by graft‐versus‐host disease. Overall survival at median follow up of 28 months was 62%. Two year overall survival was influenced by type of disease (non‐malignant = 91 ± 9% vs malignant = 41 ± 13%, P= 0.005), total nucleated cell dose (>3.5 × 10⁷/kg = 87 ± 9% vs <3.5 × 10⁷/kg = 34 ± 15%, P= 0.01) and CD34 dose (>1.7 × 10⁵/kg = 92% vs <1.7 × 10⁵/kg = 46%, P= 0.04). Age and human leucocyte antigen match did not influence survival. Four relapses occurred, all of which were fatal. Conclusion: Cord blood transplantation for malignant and non‐malignant disease is practised in Western Australia and outcomes are satisfactory. Trends and techniques in cord blood transplantation in this state are comparable with those observed nationally and overseas. Although numbers are small, cell dose appears to be predictive of overall survival.     

From a Social Issue to Policy

Summary

This paper outlines a 22 year campaign to introduce openness into the arena of donor conception in the UK. It identifies key aspects of the development of an advocacy based approach to such work and argues that social work values and principles can prove key to identifying structural inequalities which are not necessarily based in socio-economic disadvantage. Donor conceived people may find themselves in families which enjoy material privilege but whose exposure to a legislative framework and dominant professional cultures within the treatment centres encourages secrecy around genetic origins. Social workers' experience of adoption and family work leads them to recognise the danger of such secrets within families. Turning such social issues into policy changes requires vision, strategic long term advocacy and partnership with those directly affected.     

先天性多发性肺囊肿与囊状支气管扩张DR胸片鉴别诊断分析

目的分析先天性多发性肺囊肿与囊状支气管扩张在DR胸片表现上的差异,提高对两种疾病的x线鉴别。方法整理我院2007年1月～2013年1月期间确诊的先天性多发性肺囊肿与囊状支气管扩张病例各12例,分别分析其x线征像,寻找差异进行鉴别。结果先天性多发性肺囊肿与囊状支气管扩张病灶均位于双下肺及左肺舌叶,先天性多发性肺囊肿多数囊腔较大,壁薄,病灶范围分布较广泛,确诊的12例肺囊肿中,DR胸片诊断10例,准确率为83．3％,2例误诊为囊状支气管扩张,误诊率16．7％;囊状支气管扩张病例多数囊腔较小,壁稍增厚,2例囊腔内充满积液呈结节改变,病变范围相对较小,确诊的12例囊状支气管扩张中,DR胸片诊断12例,准确率为100％,无误诊病例。结论充分认识先天性多发性肺囊肿与囊状支气管扩张的X线征像,动态观察,结合临床病史．可提高两者的鉴别诊断。     

USDA Environmental Statement ARS-PPD

Abstract

The ingestion of hydrogen peroxide is usually benign. However, the ingestion of greater than 10% hydrogen peroxide can result in significant pathology. Two fatalities are reported in the literature involving children who ingested 27% and 40%. We report a case involving the ingestion of one mouthful of 35% hydrogen peroxide by a 26-month-old female. The child vomited spontaneously. In the Emergency Department the child was lethargic and had an episode of bright red emesis. Several hours later the child experienced a fainting episode followed by a brief respiratory arrest after which she began drooling bright red blood. The initial oral evaluation was negative. Endoscopic evaluation performed 16 hours postingestion revealed erosion of the cardia of the stomach, erythema of the lower esophageal sphincter, and an additional gastric burn. The child was observed for six days and discharged. Follow-up endoscopy performed 12 days postingestion showed only minimal hyperemia in the cardia of the stomach. Exposures to concentrated hydrogen peroxide should be managed aggressively.     

Confirmation of correct tracheal tube placement in newborn infants

Tracheal intubation remains a common procedure during neonatal intensive care. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes. The current gold standard test to confirm tube position is a chest radiograph, however this is often delayed until after ventilation has commenced. Hence, point of care methods to confirm correct tube placement have been developed. The aim of this article is to review the available literature on tube placement in newborn infants. We reviewed books, resuscitation manuals and articles from 1830 to the present with the search terms “Infant, Newborn”, “Endotracheal intubation”, “Resuscitation”, “Clinical signs”, “Radiography”, “Respiratory Function Tests”, “Laryngoscopy”, “Ultrasonography”, and “Bronchoscopy”. Various techniques have been studied to help clinicians assess tube placement. However, despite 85 years of clinical practice, the search for higher success rates and quicker intubation continues. Currently, chest radiography remains the gold standard test to confirm tube position. However, rigorous evaluation of new techniques is required to ensure the safety of newborn infants.