Effectiveness of serum beta-2 microglobulin as a tool for evaluating donor kidney status for transplantation

Kidney transplantations using expanded criteria donors (ECD) are being increasingly adopted, but no consensus tools are available to evaluate donor kidney status. Beta-2 microglobulin (B2MG) is a marker of kidney function, and herein, we evaluate the usefulness of assessing B2MG to evaluate donor kidney status. Fifty-seven kidney transplantations were performed from March 2017 to April 2019. Medical records were retrospectively reviewed, and relationships between clinical and laboratory variables and transplant outcomes were investigated. Thirty-eight patients received a standard criteria donor kidney and 19 patients an ECD kidney. Ten patients experienced delayed graft function (DGF), but no patient experienced primary nonfunction. Of the parameters studied, only donor renal replacement therapy (RRT) [odds ratio (OR) 24.162; p = 0.018] and donor serum B2MG (OR 22.685; p = 0.022) significantly predicted DGF. The presence of either of these two risk factors can better reflect the condition of the donor than previous classification. However, on their last follow-up creatinine and estimated glomerular filtration rate values in those with or without these risk factors were not significantly different. For an ECD with a B2MG level of <7.18 and no history of RRT, kidney transplantation can be undertaken without considering the possibility of kidney discard.

Dentoalveolar Defects in the Hyp Mouse Model of X-linked Hypophosphatemia

Mutations in PHEX cause X-linked hypophosphatemia (XLH), a form of hypophosphatemic rickets. Hyp (Phex mutant) mice recapitulate the XLH phenotype. Dental disorders are prevalent in individuals with XLH; however, underlying dentoalveolar defects remain incompletely understood. We analyzed Hyp mouse dentoalveolar defects at 42 and 90 d postnatal to comparatively define effects of XLH on dental formation and function. Phex mRNA was expressed by odontoblasts (dentin), osteocytes (bone), and cementocytes (cellular cementum) in wild-type (WT) mice. Enamel density was unaffected, though enamel volume was significantly reduced in Hyp mice. Dentin defects in Hyp molars were indicated histologically by wide predentin, thin dentin, and extensive interglobular dentin, confirming micro-computed tomography (micro-CT) findings of reduced dentin volume and density. Acellular cementum was thin and showed periodontal ligament detachment. Mechanical testing indicated dramatically altered periodontal mechanical properties in Hyp versus WT mice. Hyp mandibles demonstrated expanded alveolar bone with accumulation of osteoid, and micro-CT confirmed decreased bone volume fraction and alveolar bone density. Cellular cementum area was significantly increased in Hyp versus WT molars owing to accumulation of hypomineralized cementoid. Histology, scanning electron microscopy, and nanoindentation revealed hypomineralized "halos" surrounding Hyp cementocyte and osteocyte lacunae. Three-dimensional micro-CT analyses confirmed larger cementocyte/osteocyte lacunae and significantly reduced perilacunar mineral density. While long bone and alveolar bone osteocytes in Hyp mice overexpressed fibroblast growth factor 23 (Fgf23), its expression in molars was much lower, with cementocyte Fgf23 expression particularly low. Expression and distribution of other selected markers were disturbed in Hyp versus WT long bone, alveolar bone, and cementum, including osteocyte/cementocyte marker dentin matrix protein 1 (Dmp1). This study reports for the first time a quantitative analysis of the Hyp mouse dentoalveolar phenotype, including all mineralized tissues. Novel insights into cellular cementum provide evidence for a role for cementocytes in perilacunar mineralization and cementum biology.

Transplant outcomes in positive complement-dependent cytotoxicity- versus flow cytometry-crossmatch kidney transplant recipients after successful desensitization: a retrospective study

BACKGROUND

Despite the obvious survival benefit compared to that among waitlist patients, outcomes of positive crossmatch kidney transplantation (KT) are generally inferior to those of human leukocyte antigen (HLA)-compatible KT. This study aimed to compare the outcomes of positive complement-dependent cytotoxicity (CDC) crossmatch (CDC + FC+) and positive flow cytometric crossmatch (CDC-FC+) with those of HLA-compatible KT (CDC-FC-) after successful desensitization.

METHODS

We retrospectively analyzed 330 eligible patients who underwent KTs between June 2011 and August 2017: CDC-FC- (n = 274), CDC-FC+ (n = 39), and CDC + FC+ (n = 17). Desensitization protocol targeting donor-specific antibody (DSA) involved plasmapheresis, intravenous immunoglobulin (IVIG), and rituximab with/without bortezomib for positive-crossmatch KT.

RESULTS

Death-censored graft survival and patient survival were not different among the three groups. The median estimated glomerular filtration rate was significantly lower in the CDC + FC+ group than in the compatible group at 6 months (P < 0.001) and 2 years (P = 0.020). Biopsy-proven rejection within 1 year of CDC-FC-, CDC-FC+, and CDC + FC+ were 15.3, 28.2, and 47.0%, respectively. Urinary tract infections (P < 0.001), Pneumocystis jirovecii pneumonia (P < 0.001), and cytomegalovirus viremia (P < 0.001) were more frequent in CDC-FC+ and CDC + FC+ than in CDC-FC-.

CONCLUSIONS

This study showed that similar graft and patient survival was achieved in CDC-FC+ and CDC + FC+ KT compared with CDC-FC- through DSA-targeted desensitization despite the higher incidence of rejection and infection than that in compatible KT.

Rituximab protects against development of atherosclerotic cardiovascular disease after kidney transplantation: a propensity-matched study

Recent studies have implicated B cells in atherosclerosis and have verified the atheroprotective effect of rituximab. Rituximab is widely used for desensitization in ABO-incompatible or crossmatch-positive kidney transplantation (KT). Using a single-center KT database, we performed propensity-matched analysis to investigate the association between rituximab and posttransplant atherosclerotic cardiovascular disease (ASCVD). Among 1299 eligible patients, 239 given rituximab induction were matched with 401 controls in a 1:2 propensity score matching process. The cumulative rate of ASCVD during 8 years of follow-up was significantly lower in rituximab-treated patients, compared with matched controls (3.7% vs. 11.2%; P = 0.012). However, all-cause mortality did not differ by group (2.9% vs. 4%; P = 0.943). In multivariable Cox analysis, rituximab proved independently protective of ASCVD (hazard ratio = 0.34, 95% confidence interval: 0.14–0.83). The lower risk of ASCVD seen with rituximab induction reached significance only in patient subsets of diabetes mellitus, pretransplant dialysis, or older age (>50 years). Rituximab induction confers a lower risk of ASCVD during the posttransplant period. This atheroprotective effect appears particularly beneficial in patients whose risk of ASCVD is heightened.

Effectiveness of Perioperative Immunologic Markers Monitoring for Predicting Early Acute Cellular Rejection After Living Donor Liver Transplantation

BACKGROUND

The objective of this study was to determine whether perioperative immunologic markers monitoring could predict early acute cellular rejection (ACR) after living donor liver transplantation (LDLT).

MATERIALS AND METHODS

From September 2010 to June 2013, a total of 172 patients underwent LDLT at our transplant center. Of them, 26 patients were excluded because of infection. We retrospectively reviewed the remaining 146 patients. CD4 lymphocyte activity, T cell subsets test, and serum cytokine panel were checked on the day before transplantation and at 20 days after transplantation. These patients were divided into 3 groups: 1. normal liver function test (LFT) group; 2. increased LFT without rejection group; and 3. early ACR group. We excluded the increased LFT without rejection group in order to rule out multiple factors influencing immunologic factors.

RESULTS

CD4 lymphocyte activity (P = .004) was significantly increased while CD4+/CD25+/FOXP3+ cells (P < .001) and interleukin (IL)-17 (P = .002) levels were significantly decreased during the perioperative period. Pretransplant IL-6 (P = .014) and IL-17 (P = .029) levels in the early ACR group were significantly lower than those in the normal LFT group. The proportion of patients with increased IL-6 during perioperative period in the early ACR group was higher than that in the normal LFT group, although the difference was not statistically significant (P = .065).

CONCLUSION

Our results suggest that IL-6 and IL-17 levels are associated with early ACR in LDLT patients. However, whether monitoring perioperative immunologic markers could predict early ACR remains unclear. Further prospective studies are needed to reach a definite conclusion.

Increase in 24-Hour Protein Excretion Immediately After Donation Is Associated With Decreased Functional Recovery in Living Kidney Donors

OBJECTIVES

In this study, we evaluated the occurrence of proteinuria in living kidney donors during the immediate postdonation period, aiming to determine its clinical significance in renal function recovery.

PATIENTS AND METHODS

We enrolled living kidney donors with predonation protein excretion rate (PER) < 150 mg/24 h. Participants were divided into 2 groups according to immediate postdonation PER (4 days after nephrectomy): non-microproteinuria (non-mPr; PER < 150 mg/24 h), n = 244; and immediate postdonation microproteinuria (ImPr; PER ≥ 150 mg/24 h), n = 605.

RESULTS

Estimated glomerular filtration rate (eGFR) did not differ significantly between groups immediately after nephrectomy but was consistently lower in the ImPr group 1 week to 1 year postdonation (1-year postdonation eGFR: ImPr group, 63.6 ± 12.1 mL/min/1.73 m²; non-mPr group, 68.6 ± 12.3 mL/min/1.73 m²; P = .001). Immediate postdonation microproteinuria was an independent predictor of eGFR at 1 year postdonation (β [standard error] = -2.68 [1.15], 95% confidence interval -4.94 to -0.42, P = .02), along with predonation eGFR, age, and sex. Immediate postdonation microproteinuria was more common in donors who were older or male and occurred in 71.3% of kidney donors, suggesting renal injury in this period.

CONCLUSIONS

Although proteinuria generally resolves, its impact persists and can impair renal function recovery. Donors who are older and male are more likely to undergo immediate hyperfiltration after donation.

Utilization of HbA1c in Screening Living Kidney Donors With Prediabetes

OBJECTIVES

To study the outcome of living kidney donors with prediabetes and to evaluate the utilization of baseline HbA1c to identify donors at high risk for developing diabetes during the postdonation follow-up period.

PATIENTS AND METHODS

Living kidney donors with prospectively collected preoperative fasting glucose and HbA1c results were included in the study. Donors were categorized to the high-risk group when both results were in the prediabetic range, the low-risk group when only 1 result was in the prediabetic range, and the control group when both results were normal.

RESULTS

Ninety-three donors were followed for 75.9 ± 23.3 months. A higher proportion of donors in the high-risk group progressed to diabetes compared with donors in the low-risk and control groups (31.3% vs 6.5% vs 0.0%, respectively; P < .001). Donors with prediabetes were not at a higher risk for new-onset hypertension (4.4% vs 10.0% vs 7.7%, in control, low-risk, and high-risk groups, respectively; P = .519) or microproteinuria (7.3% vs 10.3% vs 0.0%, in control, low-risk, and high-risk groups, respectively; P = .478) and exhibited equivalent postdonation renal function compared with donors with normal glucose metabolism.

CONCLUSIONS

HbA1c can identify donors with prediabetes who are at risk for progression to diabetes. Our results indicate that carefully accepted donors with prediabetes are not at increased risk of renal function deterioration in the immediate postdonation period.

[Non-gonococcal urethritis in men]

This literature review is dedicated to urethritis which is one of the most common disorders of urogenital tract in men. The current views in its etiology as well as problems in diagnosis with the main being the frequent inability to isolate etiological factor of inflammation it the urethra are described. The analysis of literature suggests a possible role of bacteria, which are associated with bacterial vaginosis in women, in the development of the urethritis in men. However, the frequency of such urethritis and causative role of specific pathogens has not been studied yet. Meanwhile, the exact determination of the causes of inflammation has direct influence on the choice of appropriate etiologic treatment and can increase its efficiency.

Favourable outcome of pathologic downstaging by locoregional treatment for hepatocellular carcinoma in liver transplantation

No distinct guidelines are available regarding the effect of pretransplant locoregional treatment (LRT) in hepatocellular carcinoma (HCC) staging system. The aim of this study was to investigate the prognosis of pathologic downstaging (PDS) by the exclusion of total necrosis after liver transplantation. We conducted a study of 326 HCC patients who underwent liver transplantation between September 2005 and December 2016. Two hundred twenty-two patients received pretransplant LRT and 102 patients did not. Among the former group, 74 (33.0%) achieved PDS while 150 (67.0%) showed unchanged T stage after the exclusion of total necrosis. Five-year HCC recurrent free survival (RFS) of PDS group (85.1%) was similar to that of the no LRT group (88.8%) but higher than that of the non-PDS group (68.9%; P < 0.001). Based on T stage adjusted with total necrosis and PDS status, RFS was similar in the PDS T1 (82.4%) and non-PDS T1 (86.5%) groups. Non-PDS T2 cancers had worse outcome regardless of the Milan (P = 0.982) or University of California San Francisco criteria (P = 0.466). On preoperative examination, parameters like less than 1 viable tumor, less than 1 cm of tumor size, and less than 20 ng/mL of serum alpha fetoprotein were associated with PDS. This study showed that PDS by LRT was associated with favorable outcome in HCC patients after liver transplantation.

Clinical Significance of Revised Banff Criteria in the Diagnosis of Antibody-Mediated Rejection

BACKGROUND

The diagnostic criteria of antibody-mediated rejection (ABMR) has been significantly changed since Banff 2013. The most important revision was adopting microvascular inflammation (MVI) as immunopathologic evidence for ABMR even in C4d-negative cases. In this study, we retrospectively reviewed previous allograft biopsy results and evaluated the impact of this change.

METHODS

We reviewed results of 536 renal allograft biopsies at Severance Hospital during 2011 to 2013, which were diagnosed according to the Banff 2009 criteria. All biopsy results were reassessed according to the Banff 2017 criteria.

RESULTS

According to the Banff 2009 criteria, antibody-mediated changes were observed in 48 cases out of the 536 allograft biopsies (9.0%). According to the Banff 2017 criteria, 28 additional cases (5.2%) were reclassified as antibody-mediated changes. Twenty-six of these cases were C4d-negative ABMR. The most frequent diagnostic finding in these cases was MVI comprising glomerulitis and peritubular capillaritis. Donor-specific antibodies were investigated in 14 of these cases, which revealed positive results in 12 cases.

CONCLUSION

The incidence rate of ABMR has increased after the recent revision of the Banff criteria. The MVI in C4d-negative ABMR cases is the major cause for this increase.

Early hospital readmissions after ABO- or HLA- incompatible living donor kidney transplantation

Early hospital readmission (EHR) after kidney transplantation (KT) is associated with adverse outcomes and significant healthcare costs. Despite survival benefits, ABO- and HLA-incompatible (ABOi and HLAi) KTs require desensitization and potent immunosuppression that increase risk of EHR. However, little data exist regarding EHR after incompatible KT. We defined EHR as admission for any reason within 30 days of discharge from the index hospitalization. Patients who underwent living donor KT from 2010–2017 were classified into one of three groups (control, ABOi KT, or HLAi KT). Our study included 732 patients, 96 (13.1%) of who experienced EHR. HLAi KT patients had a significantly higher incidence of EHR than other groups (26.6%; P < 0.001). In addition, HLAi KT (HR, 2.26; 95% CI, 1.35–3.77; P = 0.002) and advanced age (≥60 years) (HR, 1.93; 95% CI, 1.20–3.12; P = 0.007) were independent risk factors for EHR. Patients with EHR showed 1.5 times and 3 times greater risk of late hospital readmission and death-censored graft loss, respectively, and consistently exhibited inferior renal function compared to those without EHR, regardless of immunologic incompatibilities. We recommend that KT recipients experiencing EHR or its risk factors be managed with extreme care due to their increased susceptibility to adverse outcomes.

FCC to BCC transformation-induced plasticity based on thermodynamic phase stability in novel V10Cr10Fe45CoxNi35-x medium-entropy alloys

We introduce a novel transformation-induced plasticity mechanism, i.e., a martensitic transformation from fcc phase to bcc phase, in medium-entropy alloys (MEAs). A VCrFeCoNi MEA system is designed by thermodynamic calculations in consideration of phase stability between bcc and fcc phases. The resultantly formed bcc martensite favorably contributes to the transformation-induced plasticity, thereby leading to a significant enhancement in both strength and ductility as well as strain hardening. We reveal the microstructural evolutions according to the Co-Ni balance and their contributions to a mechanical response. The Co-Ni balance plays a leading role in phase stability and consequently tunes the cryogenic-temperature strength-ductility balance. The main difference from recently-reported metastable high-entropy dual-phase alloys is the formation of bcc martensite as a daughter phase, which shows significant effects on strain hardening. The hcp phase in the present MEA mostly acts as a nucleation site for the bcc martensite. Our findings demonstrate that the fcc to bcc transformation can be an attractive route to a new MEA design strategy for improving cryogenic strength-ductility.

Association between post-transplant serum uric acid levels and kidney transplantation outcomes

Background

Serum uric acid (UA) level has been reported to be associated with chronic allograft nephropathy and graft failure in patients who undergo kidney transplantation (KT). However, the role of serum UA level in renal graft survival remains controversial.

Objective

This study aimed to investigate the effect of mean serum UA level during two different post-KT periods on long-term renal graft outcomes in a large population cohort in which living donor KT prevails.

Material and methods

A retrospective cohort study was performed using KT data prospectively collected at a single institution. Patients (n = 2,993) were divided into low-, normal-, and high-UA groups according to the mean serum UA level within the first year (1-YR) and 1–5 years (5-YR) after transplantation.

Results

In the 1-YR Cox proportional hazards analysis, the low- and high-UA groups had a significantly decreased and increased risk, respectively, for overall graft failure (OGF), death-censored graft failure (DCGF), and composite event (return to dialysis, retransplantation, death from graft dysfunction, and 40% decline in estimated glomerular filtration rate) compared with the normal-UA group. Similarly, in the 5-YR analysis, the low-UA group had a significantly reduced risk of DCGF compared with the normal-UA group, whereas the high-UA group had a significantly increased risk of all three graft outcomes. In a marginal structural model, hyperuricemia had a significant causal effect on worsening graft outcomes, with consideration of all confounding variables (OGF: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.33–3.78; DCGF: HR 2.38, 95% CI 1.09–4.9; composite event: HR 3.05, 95% CI 1.64–5.49).

Conclusions

A low-to-normal serum UA level within the first year and 1–5 years after KT is an independent factor for better renal allograft outcomes in the long-term follow-up period rather than high serum UA level.

Effects of rituximab dose on hepatitis B reactivation in patients with resolved infection undergoing immunologic incompatible kidney transplantation

Sensitized patients received desensitization therapy with rituximab for kidney transplantation. However, the impact of rituximab dose on hepatitis B virus (HBV) reactivation is unknown. Patients who underwent living donor kidney transplantation between 2008 and 2016 were grouped according to rituximab dose (control vs. standard-dose rituximab [375 mg/m²] vs. reduced-dose rituximab [200 mg/body]) for comparison of HBV reactivation. A total of 336 hepatitis B surface antigen (HBsAg)-negative/antibody to hepatitis B core antigen (anti-HBc)-positive patients underwent kidney transplantation, of whom 91 (27.1%) received rituximab for desensitization (57 standard-dose and 34 reduced-dose rituximab). During the study period, eight patients experienced HBV reactivation (three in the control group, five in the standard-dose group). In the standard-dose group, four patients experienced hepatitis flare, and one patient died due to hepatic failure. No HBV reactivation occurred in the reduced-dose group. Standard-dose rituximab significantly decreased hepatitis B surface antigen antibody titer (anti-HBs; −99.8 IU/L) at 12 months, compared with reduced-dose rituximab (−20.1 IU/L) and control (−39.1 IU/L, P = 0.017). Standard-dose rituximab (HR, 10.60; 95% CI, 2.52–44.60; P = 0.001) and anti-HBs < 100 IU/L at transplantation (HR, 9.06; 95% CI, 1.11–74.30; P = 0.04) were independent risk factors for HBV reactivation. Standard-dose rituximab significantly increased HBV reactivation risk for HBsAg-negative/anti-HBc-positive kidney transplant patients.

Clinical significance of lactate clearance for the development of early allograft dysfunction and short-term prognosis in deceased donor liver transplantation

This retrospective study evaluated lactate clearance (LC), measured at 6, 12, 18, and 24 hours after reperfusion, as a predictor of early allograft dysfunction (EAD) and short-term outcomes in patients receiving deceased donor liver transplantation. Of 181 transplant recipients, 44 (24.3%) developed EAD and had lower LCs than those who did not develop EAD. A receiver operating characteristic analysis showed that LC determined at 6 hours showed the highest area under curve value of 0.828 (95% confidence interval [CI]: 0.755-0.990) for predicting the development of EAD at a cutoff value of 25.8% with 76.7% sensitivity and 77.9% specificity. LC values that fell below the cutoff values were significantly associated with EAD in a multivariate analysis, with values at 6 hours having the highest adjusted odds ratio (11.891, 95% CI: 4.469-31.639). In-hospital and 6 month mortalities were higher in patients with LC values below the cutoffs compared with those above the cutoff values at each time point. Thus, LC calculated shortly after reperfusion of an allograft is significantly discriminative for the development of EAD and is associated with short-term prognosis after deceased donor liver transplantation.

CO2 low-level laser therapy has an early but not delayed pain effect during experimental tooth movement

OBJECTIVES

To test the hypothesis that the use of low-level laser therapy (LLLT) reduces elevated pain by controlling the release of neurochemicals during orthodontic tooth movement.

SETTING AND SAMPLE POPULATION

Department of Orthodontics and Dentofacial Orthopedics, Okayama University. Sixty-five Sprague Dawley rats were subjected to tooth movement and LLLT.

MATERIALS AND METHODS

Adult Sprague Dawley rats were used in this study. Groups included day 0 controls, irradiation only controls and with or without irradiation sacrificed at 1, 3, 5, 7 and 14 days after tooth movement (n=5 each, total n=65). Tooth movement was achieved by insertion of an elastic module between molar teeth. Immunohistochemistry for CD-11b, GFAP and c-fos in the brain stem was performed. Stains were quantified by constructing a three-dimensional image using IMARIS, and counted using NEURON TRACER and WinROOF software. Two-way ANOVA followed by a Tukey's post hoc test (P<.05) was used for statistical comparison between groups.

RESULTS

C-fos expression was significantly increased at one and three days after tooth movement. LLLT significantly diminished this increase in c-fos expression only at one day after tooth movement CD-b11 and GFAP expression also significantly increased after tooth movement. No significant change was observed for CD-11b and GFAP expression in the central nervous system upon LLLT.

CONCLUSION

Low-level laser therapy may reduce early neurochemical markers but have no effect on delayed pain neurochemical markers after tooth movement.

Ten-Year Experience With Bowel Transplantation at Seoul St. Mary's Hospital

A retrospective review of intestinal transplantation (ITx) at Seoul St. Mary's Hospital was made by collecting clinical data over the past 10 years. Fifteen consecutive cases from 2004 were analyzed. Five children and 10 adults (6 months to 69 years of age) were included. Primary diseases in adults included 4 mesenteric vessel thromboses, 2 strangulations, and 1 each of visceral myopathy, malignant gastrointestinal stromal tumor (GIST), mesenteric lymphangiectasis, and injury. Pediatric cases involved 2 Hirschsprung disease, 2 visceral myopathy, and 1 necrotizing enterocolitis. Three of 7 stomas were closed using a serial transverse enteroplasty procedure before transplantation. The ITx were performed using 3 living-donor Itx, 12 deceased-donor ITx, 14 isolated Itx, and 1 modified multivisceral transplantation. Daclizumab, basiliximab, alemtusumab, or basiliximab with rabbit antithymocyte globulin (rATG) was used for the induction; tacrolimus monotherapy was used as the basic maintenance immunosuppressant; and m-TOR inhibitor was used for renal dysfunction patients. Seven cases of acute cellular rejection were treated with rATG. Three cases of antibody-mediated rejection were treated with rituximab alone or with rituximab and bortezomib combination. There were 4 cases of early mortality within 6 months after Itx. Causes of death were declamping shock, cardiac tamponade with acute cellular rejection, dysmotility, and sepsis. Surgical complications consisted of 1 feeding jejunostomy displacement, and a minor leakage at a colo-colostomy site. One-year survival of the patient and graft was 73.33% (Kaplan-Meier survival curve). Although the total number of ITx is small, its social impact has been remarkable in changing the related laws and reimbursement policy in Korea.

Follistatin-like 3 is a mediator of exercise-driven bone formation and strengthening

Exercise is vital for maintaining bone strength and architecture. Follistatin-like 3 (FSTL3), a member of follistatin family, is a mechanosensitive protein upregulated in response to exercise and is involved in regulating musculoskeletal health. Here, we investigated the potential role of FSTL3 in exercise-driven bone remodeling. Exercise-dependent regulation of bone structure and functions was compared in mice with global Fstl3 gene deletion (Fstl3-/-) and their age-matched Fstl3+/+ littermates. Mice were exercised by low-intensity treadmill walking. The mechanical properties and mineralization were determined by μCT, three-point bending test and sequential incorporation of calcein and alizarin complexone. ELISA, Western-blot analysis and qRT-PCR were used to analyze the regulation of FSTL3 and associated molecules in the serum specimens and tissues. Daily exercise significantly increased circulating FSTL3 levels in mice, rats and humans. Compared to age-matched littermates, Fstl3-/- mice exhibited significantly lower fracture tolerance, having greater stiffness, but lower strain at fracture and yield energy. Furthermore, increased levels of circulating FSTL3 in young mice paralleled greater strain at fracture compared to the lower levels of FSTL3 in older mice. More significantly, Fstl3-/- mice exhibited loss of mechanosensitivity and irresponsiveness to exercise-dependent bone formation as compared to their Fstl3+/+ littermates. In addition, FSTL3 gene deletion resulted in loss of exercise-dependent sclerostin regulation in osteocytes and osteoblasts, as compared to Fstl3+/+ osteocytes and osteoblasts, in vivo and in vitro. The data identify FSTL3 as a critical mediator of exercise-dependent bone formation and strengthening and point to its potential role in bone health and in musculoskeletal diseases.

Removal of road deposited sediments by sweeping and its contribution to highway runoff quality in Korea

Highway runoff is known to be an important non-point source (NPS), increasing the load of pollutants in receiving water. For reducing NPS pollutants in runoff, removal of road deposited sediment (RDS) by sweeping is considered effective. However, the contribution of sweeping to the improvement of runoff quality has not been clearly and quantitatively demonstrated so far. In this study, a field test was carried out on a section of operating highway in Korea to investigate the effectiveness of sweeping on improving the quality of highway runoff. Results showed that the average reduction in the load of RDS by sweeping was 61.10% with a standard deviation of 1.74%. RDS removal efficiency decreased when the sweeping speed increased from 4-8 to 20 km h(-1), the load decreased from 12.5 to 1.25 g m(-2) and particle size decreased from sand to silt/clay size ranges. Runoff was induced by applying a 15 mm h(-1) artificial rainfall to both swept and non-swept sections. Analysis of runoff quality showed that the event mean concentrations of total suspended solid, biological oxygen demand, chemical oxygen demand, nutrients and most of the heavy metals were reduced by 31-87% after sweeping. In addition, field tests for RDS build-up indicated a sweeping frequency of once every four or five days to prevent re-suspension of RDS. The results of this study suggest that sweeping can be the best management practice for effectively reducing RDS on highways and improving the quality of highway runoff.

Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon's experience and a rapid systematic review with meta-analysis

BACKGROUND

Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes.

METHODS

The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted.

RESULTS

The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3% in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups.

CONCLUSIONS

We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon's preference.

Single-port laparoscopy-assisted donor right hepatectomy in living donor liver transplantation: sensible approach or unnecessary hindrance?

BACKGROUND

Single-port laparoscopic (SPL) surgery has rapidly gained attention worldwide. Since May 2008, we have propagated the use of SPL surgery, mainly for cholecystectomy and appendectomy. Recently, we have used this modality of minimally invasive surgery for various liver surgeries. We hereby discuss our outcomes of SPL-assisted donor right hepatectomies.

METHODS

The preoperative workup is the same as for a standard donor hepatectomy. We retrospectively reviewed the data of 150 patients who underwent donor right hepatectomy from October 2008 to May 2011. We divided them into 3 groups depending on the type of surgical procedure.

RESULTS

Among 150 patients, 20 underwent laparoscopy-assisted donor right hepatectomy (LADRH); 40 underwent single-port laparoscopy-assisted donor right hepatectomy (SPLADRH); and 90 underwent open donor right hepatectomy (ODRH). The donor demographics were comparable among the groups. Postoperative complication and reoperation rates revealed no significant differences. The SPLADRH group showed the lowest level of postoperative pain, thereby leading to a better quality of life postoperatively.

CONCLUSIONS

SPLADRH seems to be a simple, feasible approach.

Reduction of N-tropic mutant porcine endogenous retrovirus infectivity by human tripartite motif-containing 5-isoform alpha

In cases of retroviral infection, the host cell deploys antiviral proteins as a type of innate immunity. Tripartite motif-containing 5-isoform alpha (TRIM5α) is a potent antiviral protein. TRIM5α has been reported to restrict human immunodeficiency virus (HIV) 1 infection in rhesus monkey cells by targeting the incoming viral capsid at the postentry or preintegration stage of the viral life cycle. As a consequence, virus replication and reverse transcription are interrupted. TRIM5α of human origin has also been shown to inhibit N-tropic murine leukemia virus infection. To investigate the inhibitory effect of TRIM5α on porcine endogenous retrovirus (PERV) infection in humans, we constructed a 293T cell line stably expressing human TRIM5α (293T-huTRIM5α) and tested the infectivity of vesicular stomatitis virus glycoprotein envelope pseudotyped viruses (wild-type PERV [wt-PERV], N-tropic mutant PERV, N-tropic murine leukemia virus, and MoMLV). Infectivity of N-tropic mutant PERV was reduced by 43.3% in 293T-huTRIM5α cells, a decrease in efficiency that was more than 3-fold greater than that of wt-PERV in 293T-huTRIM5α cells. Human TRIM5α exhibited inhibitory activity against N-tropic MLV and N-tropic mutant PERV, but showed no antiviral activity against Moloney murine leukemia virus or wt-PERV.

High mortality associated with Acinetobacter species infection in liver transplant patients

BACKGROUND

Acinetobacter species have become increasingly important nosocomial pathogens worldwide and can result in a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis, among others. The aim of this study was to investigate clinical characteristics, mortality, and outcomes among liver transplant recipients with Acinetobacter species infections.

METHODS

We retrospectively analyzed 451 subjects who had undergone living donor liver transplantations between January 2001 and May 2010. Pandrug-resistant (PDR) Acinetobacter species were defined as resistant to all commercially available antibiotics except colistin.

RESULTS

Infectious complications due to Acinetobacter species appeared in 26 patients (5.8%) with a total of 37 episodes. Of the species identified, 34 were Acinetobacter baumannii and 3 Acinetobacter Iwoffiii. The presumed sources of infection were the biliary tract (n = 21, 56.8%), lung (n = 7, 18.9%), intra-abdomen (n = 6, 16.2%), catheter (n = 2, 5.4%), and urinary tract (n = 1, 3.6%). Among the 37 Acinetobacter species, 75.7% (28/37) were PDR species. Age, duration of intensive care unit stay, Child-Pugh score, and Model for End-stage Liver Disease score were not significant risk factors for Acinetobacter species infection. However, the overall mortality among patients with Acinetobacter species infections was 50% (13/26), which was significantly higher than that among those free of infection (50% vs 11.5%, P < .05). Multivariate analysis using a Cox regression model showed that inappropriate antimicrobial treatment was a significant independent risk factor for mortality among patients with Acinetobacter species infections (hazard Ratio = 4.19, 95% confidence interval 1.1-18.7; P = .06).

CONCLUSION

Patients with Acinetobacter species infections after liver transplantation show a significantly worse prognosis. PDR Acinetobacter species have been a major problem in our center.