Outcomes of standard dose EC-MPS with low exposure to CsA in DCD renal transplantation recipients with DGF

AIMS

The lower limit of exposure to cyclosporine A (CsA) has not yet been established in donation after cardiac death (DCD) renal transplantation recipients with delayed graft function (DGF) receiving enteric-coated mycophenolate sodium (EC-MPS) therapy. Stable and adequate mycophenolic acid (MPA) dosing may facilitate lower CsA exposure after DCD renal transplantation in recipients with DGF without compromising safety.

METHODS

A 12-month, single-centre open-label prospective trial was performed in our centre. According to their DGF risk index using the previous DGF prediction models, we divided up the patients on oral CsA into either a DGF group (n = 26) and no DGF group (n = 48). All of the patients initially received the standard EC-MPS dosing (1440 mg/day). The initial dose of CsA in the low risk of DGF group was 4.5 mg/kg/day and in the high risk of DGF group was 2.5 mg/kg/day. Efficacy parameters, safety and tolerability were assessed over a 12-month study period.

RESULTS

The incidence of DGF was 18.5% in the 162 DCD recipients. Between the DGF group and the no DGF group, the 1-year patient survival and graft survival were not significantly different. The incidence of BPAR was higher in the DGF group (26.9% vs. 8.3%, p = 0.032). Most patients in the DGF group had recovery of renal function after 1 month. The adverse events between the two groups were not significantly different. The daily EC-MPS doses of the DGF group were significantly higher than the no DGF group before the 6-month follow-up period. There were no significant differences between the two groups regarding the mean AUC levels during the follow-up period.

CONCLUSIONS

These results show that low expose CsA with standard dosing of EC-MPS and thymoglobulin was efficacious, safe and well-tolerated in DCD renal transplant recipients with DGF in China. Furthermore, stable and adequate MPA exposure helped to reduce the dose of and exposure to CsA. Thus, this may lead to less-induced nephrotoxicity and better renal function recovery.

[A multi-center study on the long-term mortality and related risk factors in patients with chronic heart failure receiving resynchronization therapy]

Objective: To analyze long-term mortality and patients characteristics of cardiac resynchronization therapy (CRT) for patients with chronic heart failure. Methods: In-patients with chronic heart failure who received CRT in the three medical centers(Bethune International Peace Hospital, General Hospital of Shenyang Military Command of Chinese People's Liberation Army, and 251 Hospital of People's Liberation Army)from March 2001 to June 2013 were included.Mortality and related causes, echocardiographic parameters were analyzed. Results: A total of 200 patients were treated with CRT therapy (154 males, mean age (60.57±11.75) years), 59 cases suffered from ischemic cardiomyopathy (ICM), patients were followed up from 0.5 to 12 years.The all-cause mortality rate was 25.50% (51/200), 20 out of 59 (33.90%) ICM patients died, as compared with 31 deaths out of 141 (21.98%) in non-ischemic cardiomyopath (NICM) patients.Thirty-six patients died due to cardiac death (70.59%), in which sudden death occurred in 21 patients (41.18%). Non-cardiac death occurred in 13 patients (25.49%), two patients died due to unknown reasons (3.92%). Incidence of cardiac death was significantly higher than non-cardiac death (P<0.01). The main cause for cardiac death was NICM (28/36, 77.78%), while the main cause of non-cardiac death was ICM (11/13, 84.62%, P<0.01). Patients died due to cardiac death were younger (P<0.01) and had larger left atrial end-diastolic diameter (LAEDD) and left ventricular end-diastolic diameter (LVEDD) (P<0.01), lower left ventricular ejection fraction (LVEF)(P<0.05), higher pulmonary artery pressure(P<0.05) compared to patients with non-cardiac death.One hundred and fifty-two cases received CRT-P and 48 cases received CRT-D, there were no significant differences in gender, the course of heart failure, serum creatinine levels, pre-operative and post-operative QRS duration and so on between the CRT-P and CRT-D groups(all P>0.05). Eleven out of the 48 cases with CRT-D died during the following-up (21.57%) , while 40 out of 152 cases with CRT-P died (78.43%) during the following-up(χ²=3.13, P<0.01). The proportional mortality rate in cause of death in patients with CRT-D was non-cardiac while in those with CRT-P was cardiac (χ²=2.66, P<0.01), sudden death rate was also significantly higher in CRT-P group than in CRT-D group (χ²=2.16, P<0.01). By using single- and multiple-factor Cox regression analysis, age, disease course, pre-operation QRS duration and NYHA classification were predictors of cardiac death(all P<0.05). Conclusions: The all-cause mortality of CRT is 25.50% in this patient cohort, mortality rate was higher in ICM patients than in NICM patients.Sudden cardiac death rate was the highest mortality reason.The mortality rate of patients with CRT-P was significantly higher than in patients with CRT-D.In comparison with patients of non-cardiac death, patients of cardiac death had larger left atrium and left ventricle and worse heart function before CRT implantation.

A novel method for assessing signal intensity within infrapatellar fat pad on MR images in patients with knee osteoarthritis

PURPOSE

To assess reliability and validity of a semi-automated quantitative method to measure infrapatellar fat pad (IPFP) signal intensity in patients with knee osteoarthritis (OA).

METHODS

Hundred patients with knee OA were selected. Sagittal planes of fat-saturated T2-weighted images obtained on 1.5-T magnetic resonance imaging (MRI) were utilized to assess IPFP signal intensity using MATLAB. Knee structural abnormalities including cartilage defects, bone marrow lesions (BML) and radiographic OA (ROA) were evaluated. Clinical construct validity and concurrent validity were examined through describing associations of IPFP measurements with knee structural abnormalities and a semi-quantitative scoring method, respectively. The reliability was examined by calculating the intra- and inter-observer correlation coefficients.

RESULTS

Significantly positive associations were found between standard deviation of IPFP signal intensity [sDev (IPFP)], clustering factor (H) and all knee structural abnormalities. The volume of high signal intensity regions [Volume (H)] and the ratio of Volume (H) to volume of whole IPFP [Percentage (H)] were positively associated with cartilage defects and ROA, but not with BMLs. The median value [Median (H)] and upper quartile value [UQ (H)] of high signal intensity were only significantly associated with quartiles of cartilage defect score. Significant correlations were found between all quantitative measurements and semi-quantitative scores (All P < 0.001). Intraclass and interclass correlation coefficients for these quantitative measures were high (>0.90).

CONCLUSIONS

A novel and efficient method to segment IPFP and calculate its signal intensity on T2-weighted MRI images is documented. This method is reproducible, and has concurrent and clinical construct validity, but its predictive validity needs to be examined by future longitudinal studies.

μSR investigation of a new diluted magnetic semiconductor Li(Zn,Mn,Cu)As with Mn and Cu codoping at the same Zn sites

We report the successful synthesis and characterization of a new type I-II-V bulk form diluted magnetic semiconductor (DMS) Li(Zn,Mn,Cu)As, in which charge and spin doping are decoupled via (Cu,Zn) and (Mn,Zn) substitution at the same Zn sites. Ferromagnetic transition temperature up to  ∼33 K has been observed with a coercive field  ∼40 Oe for the 12.5% doping level. μSR measurements confirmed that the magnetic volume fraction reaches nearly 100% at 2 K, and the mechanism responsible for the ferromagnetic interaction in this system is the same as other bulk form DMSs.

Associations between vitamin D receptor gene polymorphisms and ankylosing spondylitis in Chinese Han population: a case-control study

We assessed whether the vitamin D receptor gene polymorphisms (FokI, BsmI, ApaI, and TaqI) were associated with ankylosing spondylitis (AS) in a Chinese Han population. The TaqI polymorphism G allele was a risk factor in AS susceptibility.

INTRODUCTION

Previous studies have found that serum vitamin D levels are declined in patients with AS. The present study aims to evaluate the role of vitamin D receptor (VDR) gene polymorphisms in AS susceptibility in a Chinese Han population.

METHODS

Four single nucleotide polymorphisms (SNPs) in the VDR gene (FokI (rs2228570), BsmI (rs1544410), ApaI (rs7975232), and TaqI (rs731236)) were genotyped by the improved multiplex ligase detection reaction (iMLDR) method in 620 AS patients and 620 geographically and ethnically matched healthy controls. Haplotypes were constructed after linkage disequilibrium (LD) analysis.

RESULTS

Statistically significant difference was only found in the TaqI polymorphism between AS patients and controls. The TaqI polymorphism G allele was higher in AS group than that in controls (OR [95 % CI] = 1.624 [1.122-2.352], χ (2) = 6.705, P = 0.006). Linkage disequilibrium has been detected in TaqI and BsmI polymorphisms (D' = 0.87, r (2) = 0.70). Two novel haplotypes (H1: AC and H2: GT) were significantly associated with the risk of AS, and they play protective and risk roles in AS morbidity, respectively.

CONCLUSIONS

The VDR gene TaqI polymorphism G allele may be a risk factor in AS susceptibility.

Kinetic analysis of RNA editing of Newcastle disease virus P gene in the early period of infection

As a paramyxovirus, Newcastle disease virus (NDV) has the ability to edit its P (phosphoprotein) gene to synthesize three kinds of viral protein (P, V and W). It is technically very difficult to differentiate P, V and W mRNAs, and little was known about NDV regulation of RNA-editing frequency. To investigate the rules of NDV RNA editing, the ratio of the P gene-derived transcripts (P, V and W) was determined by sequencing at different time points post-infection. The results showed unstable ratio of V and W mRNA at different time points, and the frequency of NDV editing was significantly increased at the early period of infection (P 

KEYWORDS

Newcastle disease virus; phosphoprotein; RNA editing; G insertion.

Effects of electrical stimulation on meat quality of bison striploin steaks and ground patties

As bison is characteristically dark in colour, this study was conducted to determine if high-voltage electrical stimulation (HVES) could improve the colour and other quality characteristics in bison, similar to positive effects of HVES previously observed in beef. Forty bison bull carcasses were split and HVES (400 V peak, 5 ms pulses at 15 pulses s−1 for 30 s) was applied to the right sides and subsequently evaluated for grade characteristics, metabolic activity, and quality characteristics. The bison carcasses used in this study had a wide range of lean and fat, with minimal marbling. In the present study, HVES had no effect on bison quality traits, sensory attributes, retail display characteristics, nor the glycolytic metabolites (P > 0.05) except lactate. Inherent differences in muscle fibre type or physical carcass differences may have influenced the response to the electrical parameters used in the present study and merits further investigation.