Prophylaxis against hepatitis B recurrence posttransplantation using lamivudine and individualized low-dose hepatitis B immunoglobulin

Although the combination of lamivudine (LAM) and high-dose intravenous (IV) hepatitis B immunoglobulin (HBIG) is very effective in preventing hepatitis B virus (HBV) recurrence after liver transplantation (LT), the major limitation of this regimen is its high cost. A more cost-effective, convenient and widely accepted regimen is urgently needed. We evaluated the safety and efficacy of another strategy using LAM and individualized low-dose intramuscular (IM) HBIG. Between May 2002 and December 2009, a total of 254 adult patients undergoing LT for HBV-related benign end-stage liver diseases received this regimen in our center. The mean follow-up of these patients was 41.2 +/- 22.7 months. Their 1-, 3- and 5-year survival rates were 85.3%, 77.4% and 76.4%, respectively, and 1-, 3- and 5-year HBV recurrence rates were 2.3%, 6.2% and 8.2%. Fourteen patients experienced posttransplant HBV recurrence. Pretransplant high viral load and posttransplant prednisone withdrawal time were observed to be associated with recurrence. In conclusion, combination therapy with LAM and individualized low-dose IM HBIG provides a safe and effective prophylaxis against HBV recurrence after LT at about 5% of the cost of conventional high-dose IV HBIG regimens.

Ammonium removal from aqueous solutions by zeolite adsorption together with chemical precipitation

The aim of this study was to remove ammonium from aqueous solution and recycle ammonium. Ammonium removal from aqueous solution by natural and pretreated zeolites, breakthrough curve, chemical regeneration of pretreated zeolite, ammonium removal from regeneration solution by chemical precipitation and NH(4) (+) adsorption isotherms were investigated by conducting a series of batch and continuous experiments in this study. Morphologies and structures of zeolites were analyzed by Surface Area and Pore Size analysis, Scanning Electron Microscopy (SEM) and Fourier Transform Infrared (FTIR) spectroscopy. The NH(4) (+)-N removal efficiencies by natural and NaCl-treated zeolite were 30.73% and 85.55% respectively at an initial concentration of 100 mg/L. Breakthrough and exhaustion capacities for adsorption of ammonium ions were 3.36 and 4.26 mg /g (NH(4) (+)-N/zeolite), respectively. After chemical regeneration, NH(4) (+)-N removal efficiency by NaCl-treated zeolite only reduced 9.95% than previously. NH(4) (+)-N concentration of the regeneration solution was reduced from 460 to 74.55 mg/L by chemical precipitation. The Freundlich isotherm provided a slightly more consistent fit to the experimental data of ammonium adsorption on NaCl-treated zeolite than Langmuir. Based on the results, it was concluded that the objective of this study had been well achieved.

Diabetes mellitus after living donor liver transplantation: data from mainland China

Most reported data on posttransplantation diabetes mellitus (PTDM) are from Western countries with patients who underwent deceased donor liver transplantation. A retrospective study was performed to assess the prevalence and predictive factors of PTDM in the context of living donor liver transplantation (LDLT) in the Chinese population using the definition of PTDM proposed in 2003 by the World Health Organization and the American Diabetes Association. The prevalence of DM after LDLT in our study was 25% (21/84), and the incidence of PTDM was 14.9% (11/74) with 64% of cases diagnosed within 3 months after LDLT; 9.5% were observed to show impaired fasting glucose postoperatively. Multivariate analysis identified body mass index >or= 25 kg/m(2) before LDLT as the only independent risk factor for developing PTDM. Only one patient was operated for hepatitis C virus (HCV) infection. Hepatitis B virus (HBV)-related diseases were common in our study population, accounting for 78.6% of all patients. Both HCV and HBV infection status were not independent risk factors for developing PTDM. In addition, a greater tacrolimus trough blood level in the PTDM group versus no-DM group was observed at 3 months post-LDLT (11.03 ng/mL vs 4.87 ng/mL). The mean tacrolimus dose was not significantly different between the two groups. In conclusion, PTDM was prevalent among Chinese LDLT recipients.

[Safety analysis of dust mite allergen for diagnosis and immunotherapy of asthma and rhinitis]

AIM

To make a retrieval investigation of safety in using Dermatophagoides farinae extract in diagnosis and immunotherapy with patients of asthma and rhinitis.

METHODS

A questionnaire evaluation of the safety use of D. farinae extract (SMU-Df) during diagnosis and immunotherapy of patients from 1974 to 1995 was carried out.

RESULTS

A total of 8,46,342 injections were statistically analysed, among whom 142 systemic adverse reactions occurred involving urticaria 0.82@10000, severe attack of asthma 0.77@10000, anaphylactic shock 0.07@10000 (CL = 1.4-12.0/million), and angioedma 0.02@10000. The time of onset of systemic reactions of immediate type was < 30 min in 32 cases-times, and 1 h and 2 h in 6 cases-times; the time to onset of late response type was 3 h-48 h in 23 cases-times with highest incidence of severe asthmatic attacks. The systemic reactions occurred in 18 subjects during skin test, in 96 cases-times during increasing dose phase, and in 14 cases-times during. Among them 6 cases were of anaphylactic shock, and none of it after emergency treatment. The major cause of manifestation of systemic reactions for 41 cases after immunotherapy with SMU-Df extract was due to over dosage errors.

CONCLUSION

The application of SMU-Df extract in skin test and immunotherapy of asthma and rhinitis sensitive to mite for the past 22 years in this country indicated that the efficacy and safety have been high.

Following-up of a four-dose daclizumab induction therapy without calcineurin inhibitors in a liver transplantation recipient with severe renal dysfunction: a case report

BACKGROUND

There is debate on the dose schedule and pharmacokinetics of daclizumab in liver transplant recipients.

METHODS

A four-dose course of daclizumab was administered to a patient with severe renal dysfunction. Calcineurin inhibitor therapy initiation was delayed to 86 days posttransplantation.

RESULTS

The patient is well as 480 days after transplantation. No rejection was observed.

CONCLUSIONS

The result suggested the efficacy of our dose schedule, but it will be necessary to confirm it with further pharmacokinetic studies and more cases.

Protective effects of pirfenidone on D-galactosamine and lipopolysaccharide-induced acute hepatotoxicity in rats

OBJECTIVE AND DESIGN

To investigate the protective effects of pirfenidone on acute liver damage caused by D-galactosamine (GalN)/lipopolysaccharide (LPS) in rats.

MATERIAL AND TREATMENT

Sprague-Dawley rats were divided into five groups (five rats per group): normal control group, GalN/LPS-treated group, and three pirfenidone-treated group (100, 300 and 500 mg/kg i.p., respectively). All biochemical and histological indexes were determined at 12 h after GalN/LPS challenge.

METHODS

Severity of liver injury was assessed by determination of serum ALT, AST levels and histological analysis. SOD activity and MDA concentrations as well as TNF-alpha and IFN-gamma levels in the liver of rats were measured. The expression of iNOS and its product, NO concentration were also determined.

RESULTS

Pretreatment with pirfenidone significantly attenuated GalN/LPS-induced severe hepatotoxicity, as evidenced by decreased ALT, AST levels and MDA content and improved histopathological changes. Pirfenidone inhibited the elevated levels of TNF-alpha and IFN-gamma and reduced the induction of iNOS/NO in a dose-dependent manner, which might be important mechanisms related to its protective effect.

CONCLUSIONS

Pirfenidone can provide a definite protective effect against acute hepatic injury caused by GalN/LPS in rats, which may be mainly mediated through its anti-inflammatory effect.

Modeling of Nociceptor Transduction in Skin Thermal Pain Sensation

All biological bodies live in a thermal environment with the human body as no exception, where skin is the interface with protecting function. When the temperature moves out of normal physiological range, skin fails to protect and pain sensation is evocated. Skin thermal pain is one of the most common problems for humans in everyday life as well as in thermal therapeutic treatments. Nocicetors (special receptor for pain) in skin play an important role in this process, converting the energy from external noxious thermal stimulus into electrical energy via nerve impulses. However, the underlying mechanisms of nociceptors are poorly understood and there have been limited efforts to model the transduction process. In this paper, a model of nociceptor transduction in skin thermal pain is developed in order to build direct relationship between stimuli and neural response, which incorporates a skin thermomechanical model for the calculation of temperature, damage and thermal stress at the location of nociceptor and a revised Hodgkin–Huxley form model for frequency modulation. The model qualitatively reproduces measured relationship between spike rate and temperature. With the addition of chemical and mechanical components, the model can reproduce the continuing perception of pain after temperature has returned to normal. The model can also predict differences in nociceptor activity as a function of nociceptor depth in skin tissue.

Increased amyloid beta-peptide (1-40) level in brain of streptozotocin-induced diabetic rats

The aims of the study were to investigate whether the level of amyloid beta-peptide (Abeta) (1-40) was increased in brain of diabetic rats and whether the increase was associated with dysfunction of P-glycoprotein at the blood-brain barrier. A diabetes-like condition was induced by single administration of 65 mg/kg streptozotocin via i.p. injection. Abeta (1-40) levels in brain of the diabetic rats were measured using an enzyme linked immunosorbent assay (ELISA) kit. The in vivo brain-to-blood efflux and blood-to-brain influx transport of [(125)I]-labeled human amyloid-beta-peptide (hAbeta) (1-40) were measured using the brain efflux index and brain permeability coefficient-surface area product, respectively. [(14)C]inulin served as a reference compound. The results showed that Abeta (1-40) levels significantly increased in temporal cortex and hippocampus of the diabetic rats. The brain remaining percentage of [(125)I]hAbeta (1-40) in diabetic rats significantly increased at 30 min after intracerebral microinjection, accompanied by decrease of the brain efflux index. Pretreatment of P-glycoprotein inhibitors verapamil or cyclosporin A significantly increased the brain remaining percentage of [(125)I]hAbeta (1-40). The brain permeability coefficient-surface area product of [(125)I]hAbeta (1-40) was increased in diabetic rats, accompanied by increased Abeta (1-40) levels in plasma. The present study demonstrated that a diabetic state could increase Abeta (1-40) levels in brain, which might be explained, at least in part, by the decline in brain-to-blood efflux of Abeta (1-40) due to deficient cerebral P-glycoprotein function in diabetic rats.

Costs of metabolic syndrome-related diseases induced by obesity in Taiwan

The objective of this paper is to estimate the cost of obesity's contribution to the metabolic syndrome diseases in Taiwan. We used individual data from the Cardiovascular Disease Risk Factors Two-Township Study survey and medical use and expenditures data from the Bureau of National Health Insurance (NHI) of Taiwan. By adopting the prevalence-based and population attributable risk (PAR) approaches, direct costs of obesity for six kinds of obesity related metabolic syndrome diseases have been estimated. Comorbidities used in our analysis included ischemic heart diseases, congestive heart failure, cerebrovascular disease accident, diabetes, hyper-cholesterolaemia and hypertension. The results indicate that overweight and obesity are associated with a higher prevalence and costs of the metabolic syndrome related diseases. PAR increases as the obese [body mass index (BMI)] prevalence increases. About 4-9% of the costs of those diseases can be attributed to overweight (24 < or = BMI < 27) and about 7-13% and 8-19% of such costs are attributable to the first and second degree obesity (27 < or = BMI < 30 and BMI > or = 30). The cost of obesity derived from the PAR and medical costs of metabolic syndrome diseases accounts for 2.9% of the national total healthcare expenditure. We therefore conclude that overweight and obesity have increased health costs and resulted in higher prevalence of and greater costs from metabolic syndrome related diseases in Taiwan. These findings provide important support for implementing obesity prevention programs in Taiwan.

Skin biothermomechanics for medical treatments

Electromagnetic heating, such as microwave, radiofrequency, and laser etc., is widely used in medical treatments. Recent advances in these technologies resulted in remarkable developments of thermal treatments for a multitude of diseases and injuries involving skin tissue. The comprehension of heat transfer and related thermomechanics in skin tissue during these treatments is thus of great importance, and can contribute to the further developments of these medical applications. Biothermomechanics of skin is highly interdisciplinary, involving bioheat transfer, burn damage, biomechanics, and physiology. The aim of this study is to develop a computational approach to examine the heat transfer process, heat-induced mechanical response, as well as the associated pain level, so that the differences among the clinically applied heating modalities can be quantified. In this paper, numerical simulation with the finite difference method (FDM) was used to analyze the temperature, burn damage, and thermal stress distributions in the skin tissue subjected to various thermal treatments. The results showed that the thermomechanical behavior of skin tissue is very complex: blood perfusion has little effect on thermal damage, but a large influence on skin temperature distribution, which, in turn, influences significantly the resulting thermal stress field; for laser heating, the peak temperature is higher for lasers with shorter wavelengths, but the peak is closer to the skin surface; the thermal stress due to laser and microwave heating is mainly limited to the top epidermis layer due to the exponential decrease of heat generation along skin depth; the thin (and commonly overlooked) stratum corneum layer dominates the thermomechanical response of skin tissue.

Small-for-size syndrome secondary to outflow block of the segments V and VIII anastomoses--successful treatment with trans-splenic artery embolization: a case report

Despite the rapid expansion of living donor liver transplantation (LDLT) in the adult population over the last few years, small-for-size syndrome (SFSS) has emerged as an important clinical problem. We have herein reported a patient who developed clinical evidence of prolonged cholestasis and intractable ascites after a small-for-size right lobe LDLT. The SFSS was attributed to outflow block of segments V and VIII anastomoses with severe portal overperfusion injury. It was successfully treated by reduction of portal pressure and blood flow after trans-splenic arterial ligation. We recommend that trans-splenic artery embolization, a technically simple procedure, be applied to treat portal overperfusion injury in SFSS.

Introduction of Microsurgical Technique to Biliary Reconstruction in Living Donor Liver Transplantation

OBJECTIVE

High rates of biliary complications continue to be a major concern associated with living donor liver transplantation (LDLT). In this article, we report our experience of applying a microsurgical technique to biliary reconstruction in LDLT.

PATIENTS AND METHODS

From January 2001 to December 2005, 32 patients underwent LDLTs (8 children and 24 adults). Biliary reconstruction for 43 hepatic duct orifices in the 32 donor grafts 21 duct-to-duct anastomoses, and 22 cholangiojejunostomies. Nine cholangiojejunostomies in 4 donors used a microsurgical technique under an operative microscope.

RESULTS

Biliary complications weren't observed among the cases of cholangiojejunostomy using a microsurgical technique. An anastomotic biliary leakage was found in a recipient with cholangiojejunostomy performed using a surgical loupe and a biliary stricture in another recipient who underwent duct-to-duct anastomoses using a surgical loupe.

CONCLUSION

Introduction of a microsurgical technique for biliary reconstruction in LDLT, especially using an operating microscope in the setting of hepatico-jejunostomy for small hepatic duct (< or =2 mm in diameter), showed good results. We believe that using the operative microscope for biliary reconstruction could reduce the incidence of biliary complications associated with LDLT.

Factors related to post-liver transplantation acute renal failure

Acute renal failure (ARF) after liver transplantation (OLT) is a common complication with severe impact on early and late prognosis of recipients. Factors predicting its incidence have not been fully identified due to the lack of a universal standard as well as the variance of data between transplant centers. To identify factors related to post-OLT ARF, we retrospectively collected materials on 89 patients, who underwent OLT from 1999 to 2001 in our center. Factors associated with post-OLT ARF were identified using univariate logistic regression. Significant factors were then entered into a multivariate logistic regression to identify factors independently associated with post-OLT ARF. Upon univariate analysis, intraoperative volume of blood transfusion (P = .041) and duration of operation (P = .005) were significant. ARF was associated with a poor prognosis (P < .001). Only duration of operation (P = .026) was an independent factor predicting the development of ARF. In conclusion, intraoperative volume of blood transfusion and duration of operation were factors contributing to post-OLT ARF in which the duration of the operation was an independent risk factor. The incidence of post-OLT ARF greatly increased recipient mortality in the early postoperative period.

Systematic parameter screening for capillary electrophoresis monitoring of surfactants on silicon wafer surfaces by designed experiments

The surface purity of silicon wafers is an important parameter to monitor for yield improvement of semiconductor devices in a production line. Surfactants are used to reduce the surface potential in order to facilitate the removal or cleaning of particles and metals. Traces of surfactant residues from the cleaning bath may still be present on the wafer surface after the final cleaning step. In this report, two capillary electrophoresis (CE) methods for the analysis of dodecylbenzene sulfonate (DBS) are developed for monitoring the surfactant residues in the wafer manufacturing process. One method is developed for the sensitive determination of all DBS homologues and isomers in one single peak. Another method is developed for the fingerprint analysis of the homologues and isomers of DBS. The Taguchi methodology was used as a systematic optimization tool for the DBS analysis by CE. The experiments were evaluated by calculating the signal-to-noise ratio values with four responses. The lowest detection limit for DBS was 15 microg/L at 95% confidence level. The percent recovery of surfactant was between 90% and 110%.

Cloning of the KcURA3 gene and development of a transformation system for Kluyveromyces cicerisporus

KcURA3 was cloned from Kluyveromyces cicerisporus CBS4857 by complementation of the ura3 mutation in Saccharomyces cerevisiae. KcURA3 encodes a 267-amino-acid protein with 80% sequence identity to that of S. cerevisiae. An ura3 mutant strain from K. cicerisporus CBS4857, named Y179U, was obtained by selection on 5-fluoroorotic acid plates. Sequence analysis of this mutated gene revealed that it contained a point mutation at nucleotide position +277. Two vectors, pUK1 and pUKD, bearing KcURA3 were constructed. Either the lithium acetate method or electroporation could be used to transform pUK1 and pUKD intoY179U. The transformation efficiency using electroporation was higher than that using the lithium acetate method.

Type of inversion problem in physics: an inverse emissivity problem

Inversion problems have recently drawn vast amounts of attention from the physics community due to their potential widespread applications. In this Rapid Communication, a different type of inversion problem in physics is proposed: an inverse emissivity problem, which aims to determine the emissivity g(nu) by measuring only the total radiated power J(T). Like other inverse problems, this one has potential for important practical applications. An exact solution is obtained for the proposed inverse problem. A unique existence theorem and techniques for eliminating divergences are also presented. A universal function set (UFS) suggested for numerical calculations is shown to be very useful in a numerical example. The UFS makes this inversion method practical and convenient for realistic calculations.