The efficacy and safety of intensified enteric-coated mycophenolate sodium with low exposure of calcineurin inhibitors in Chinese de novo kidney transplant recipients: a prospective study

AIMS

The aim of this study was to investigate the efficacy and safety of a transient intensified enteric-coated mycophenolate sodium (EC-MPS) dosing regimen with low exposure of calcineurin inhibitors (CNIs) in Chinese de novo kidney transplantation.

METHODS

In a 6-month prospective study, a total of 97 recipients were enrolled and assigned to either an intensified EC-MPS dosing (IS) regimen or a standard EC-MPS dosing (SD) regimen. The area under the curve (AUC) of MPA was assessed at week 1 post transplant. The incidences of acute rejection, patient and graft survival, renal allograft function and adverse events were analysed.

RESULTS

The IS regimen displayed a trend of acute rejection risk reduction (IS 2.7% vs. SD 13.3%, p = 0.061) and allograft function improvement (IS 62.8 ± 14.0 ml/min per 1.73 m(2) vs. SD 56.6 ± 18.3 ml/min per 1.73 m(2) , p = 0.084) after 6-month follow-up. MPA-AUC0-12 h was substantially higher in the intensified EC-MPS group than the standard EC-MPS group, though without a significant difference (71.4 ± 41.7 vs. 53.0 ± 27.0 mg·h/l, p = 0.107). The IS regimen did not increase the incidence of adverse effects (IS 54.1% vs. 45.0%, p = 0.39), including diarrhoea or leucopenia.

CONCLUSIONS

The intensified EC-MPS dosing regimen maintaining low-dose CNIs in this study may be beneficial for Chinese adult de novo kidney transplant recipients in terms of acute rejection and allograft function and is safe within 6 months post transplant.

Extensible chip of optofluidic variable optical attenuator

A core chip of optofluidic variable optical attenuator (VOA) is reported. The chip, with a simple structure, utilizes microfluid and compressed air to regulate the optical attenuation, and it can be expanded to form a number of VOAs by using different microfluidic driving technologies. Three VOAs based on this chip and different driving technologies are introduced. The theoretical and experimental results show that the proposed chip possesses the advantages of large optical attenuation range (> 50dB) and low insertion loss (0.55 dB). Moreover it is a broadband optical device which can be operated in visible and near infrared wavelengths. The proposed chip provides a new method for seeking miniaturized VOAs with good performances, and it is promising to develop a number of different VOAs.

[Relationships between electrophysiological characteristic of speech evoked auditory brainstem response and Mandarin monosyllable discriminative ability at different hearing impairment]

OBJECTIVE

To investigate the relationships between electrophysiological characteristic of speech evoked auditory brainstem response(s-ABR) and Mandarin phonetically balanced maximum(PBmax) at different hearing impairment, so as to provide more clues for the mechanism of speech cognitive behavior.

METHOD

Forty-one ears in 41 normal hearing adults(NH), thirty ears in 30 conductive hearing loss patients(CHL) and twenty-seven ears in 27 sensorineural hearing loss patients(SNHL) were included in present study. The speech discrimination scores were obtained by Mandarin phonemic-balanced monosyllable lists via speech audiometric software. Their s-ABRs were recorded with speech syllables /da/ with the intensity of phonetically balanced maximum(PBmax). The electrophysiological characteristic of s-ABR, as well as the relationships between PBmax and s-ABR parameters including latency in time domain, fundamental frequency(F0) and first formant(F1) in frequency domain were analyzed statistically.

RESULTS

All subjects completed good speech perception tests and PBmax of CHL and SNHL had no significant difference (P>0.05), but both significantly less than that of NH (P<0.05). While divided the subjects into three groups by 90%<PBmax≤100%, 80%<PBmax≤90% and PBmax≤80%, the results showed that all subjects decreased amplitudes of F0 and F1, and increased latency of feature peaks as PBmax reduced. In the same PBmax group, latency of feature peaks increased and amplitudes of F0 and F1 decreased from SNHL, CHL to NH. All subjects showed strongest significant positive correlation between amplitudes of F0 and F1with PBmax respectively, as well as significant negative correlation between latencies of all the feature peaks with PBmax. A stepwise regression analysis equation displayed that the sum of latencies of peak A and F, and amplitudes of F0 and F1 attributed to PBmax reached 76%, and their beta coefficient decreased from amplitudes of F0 and amplitudes of F1, latencies of peak F to latencies of peak A.

CONCLUSIONS

These electrophysiological characteristics of s-ABR showed closely and stably associated with Mandarin monosyllable discriminative abilities at different hearing impairment. Some electrophysiological characteristics such as amplitudes of F0 and F1, latencies of peak F and A may play more important roles in speech recognition assess, which may be applied combined or separately to further investigation of speech perception and temporal processing abilities.

Autologous peripheral blood stem cell transplantation to treat thromboangiitis obliterans: preliminary results

OBJECTIVE

To investigate the efficiency of autologous peripheral blood stem cell transplantation (APBSCT) to treat severe the lower limbs ischemia caused by thromboangiitis obliterans (TAO).

PATIENTS AND METHODS

From April 2007 to December 2014, a total of 64 patients with TAO (80 affected limbs) received APBSCT at our hospital. The treatment effect was evaluated by subjective indicators including pains and cold sensation of the affected limbs, combined with objective indicators including claudication distance, ankle brachial index (ABI), transcutaneous oxygen pressure (TcPO2) and skin temperature.

RESULTS

Five patients (with 5 affected limbs) suffered from necrosis below the middle of the leg 4 weeks after transplantation and received amputation. For the remaining 59 patients (75 affected limbs), pain and cold sensation of the affected limbs were improved with varying extent 3 months after transplantation; there were statistically significant differences in pain score and cold sensation score of the affected limbs before and after APBSCT (p<0.05). Claudication distance, ABI, TcPO2 and skin temperature were also improved. Claudication distance increased from 85.69 m ± 43.48 m to 36.5 ± 9.88 mmHg, and the skin temperature of the lower limbs increased from 27.70 °C ± 0.53 °C to 33.49 °C ± 0.60 °C. All four indicators were considerably improved after APBSCT (p<0.05). Arteriography was performed for 75 affected limbs in 59 patients 6 months after transplantation and found that new collateral vessels were formed in the affected limbs. No patients were complicated by retinal hyperplasia, malignant tumors, myocardial infarction and cerebral infarction during the follow-up examinations; no patients underwent symptom aggravation during 9-48 month follow-up (average, 28.5 months).

CONCLUSIONS

APBSCT is an easy, safe and reliable treatment for ischemia of lower limbs, especially for those with poor distal arterial outflow tract in the lower limbs that do not permit bridging.

Detection of fetal copy number variants by non-invasive prenatal testing for common aneuploidies

OBJECTIVE

To evaluate the clinical performance of non-invasive prenatal testing (NIPT) in detecting fetal copy number variants (CNVs).

METHODS

NIPT of cell-free fetal DNA was performed retrospectively, using stored maternal plasma, at an average gestational age of 21.1 weeks in 117 pregnant women who had previously undergone invasive prenatal testing for chromosome microarray analysis (CMA). Among the fetal samples tested by CMA, 18 had positive results (CNVs > 1 megabase (Mb)) and 99 had negative results (CNVs < 1 Mb or without CNVs detected). The results of NIPT and CMA were then compared.

RESULTS

In the 11 CMA-positive samples with CNVs > 5 Mb, the detection rate of CNVs was 90.9%; the one case missed by NIPT had a fetal fraction of 4.7%. For the other seven CMA-positive samples with CNVs < 5 Mb, the detection rate was 14.3%; only one case with a 2.82-Mb duplication was detected, with a fetal fraction of 26.7%. For 35.7% (5/14) of CNVs detected by both NIPT and CMA, the differences in fragment length were within ± 1 Mb. In this study, the overall sensitivity and specificity of NIPT for detecting CNVs > 1 Mb were 61.1% and 95.0%, respectively, with a false-positive rate of 5.0%.

CONCLUSIONS

Our results demonstrate that NIPT for common aneuploidies can detect fetal CNVs > 5 Mb with high sensitivity, provided that fetal fraction is high enough, without increasing sequencing depth. The detection power of NIPT is determined mostly by fetal fraction and CNV size. A positive NIPT screening result for CNVs must be interpreted with caution and validated by additional diagnostic study.

Expression of dopamine transporter in the different cerebral regions of methamphetamine-dependent rats

Objectives:

To observe the expression of the dopamine transporter (DAT) in six cerebral regions of a methamphetamine (MA)-dependent rat, which were frontal cortex, nucleus accumbens septi, striatum, hippocampus, substantia nigra and ventral tegmental area.

Methods:

The rats were administrated intraperitoneally with 10 mg/kg/day of MA for 10 days consecutively; the behaviour changes were measured via the conditioned place preference (CPP), and the scores of stereotyped behaviour (SB) were used to confirm animal addiction. Then, the animals were further injected with MA respectively for 1, 2, 4 and 8 weeks to establish different periods of MA-dependent models. The expressions of DAT and DAT messenger RNA in six cerebral regions were detected.

Results:

The results of CPP and SB scores were significant different when comparing all four experimental groups with the control group ( p < 0.05). Comparing between different experimental groups, the expression of DAT mainly decreased and had dynamic changes in the same regions ( p < 0.05). Comparing the different regions with each other in the same experimental group, the expression of DAT also had significant difference in several regions p < 0.05).

Conclusions:

The expression of DAT mainly decreased and had different in the six cerebral regions at the same MA-dependent time period as well as at different time periods in the same cerebral region. It was speculated that DAT might play a crucial role in the mechanism of MA dependence.

Establishment of plasma microRNA detection method by using taqman probe based quantitative reverse transcription PCR

MicroRNAs (miRNAs) are a kind of short non&mdash;coding RNAs that regulate gene expression at the post&mdash;transcriptional level. Recently, many studies have found that circulating miRNAs have the potential to sever as diagnostic biomarkers for many diseases. However, the methods for the quantification of circulating miRNAs still need more adjustment. In this study, we tried to establish a reliable method to quantify the plasma miRNAs. We used quantitative real&mdash;time PCR with taqman probes to detect the plasma miR&mdash;153 level. Three controls were used in this study, including two external miRNAs control from C. elegans miRNAs (cel&mdash;miR&mdash;54 and cel&mdash;miR&mdash;238) and one internal control (hsa&mdash;miR&mdash;486). All of these controls were stable in plasma and the cel&mdash;miR&mdash;238/cel&mdash;miR&mdash;54/hsa&mdash;miR&mdash;486 combination could improve the normalization process. The expression level of the target miRNA, human plasma miR&mdash;153, could be quantified accurately with taqman probes .The assay has high accuracy, high sensitivity and a large dynamic range from 100 copies to 10(13) copies in the PCR reaction. Our study provided a standardized quantification method for plasma miRNAs which might be used as biomarker in many diseases research.

Docosahexaenoic acid attenuates hyperglycemia-enhanced hemorrhagic transformation after transient focal cerebral ischemia in rats

Hemorrhagic transformation (HT) is a feared complication of cerebral ischemic infarction, especially following the use of thrombolytic therapy. In this study, we examined whether docosahexaenoic acid (DHA; 22:6n-3), an omega-3 essential fatty acid family member, can protect the brain from injury and whether DHA can decrease the risk of HT enhanced by hyperglycemia after focal ischemic injury. Male Sprague-Dawley rats were injected with 50% dextrose (6ml/kg intraperitoneally) to induce hyperglycemia 10min before 1.5h of filament middle cerebral artery occlusion (MCAO) was performed. Treatment with DHA (10mg/kg) 5min before reperfusion reduced HT and further improved the 7-day neurological outcome. It also reduced infarct volume, which is consistent with the restricted DWI and T2WI hyperintensive area. Reduced Evans Blue extravasation and increased expression of collagen IV indicated the improved integrity of the blood-brain barrier (BBB) in DHA-treated rats. Moreover, DHA reduced the expression of the intercellular adhesion molecule-1 (ICAM-1) in the ischemic injured brain. Therefore, we conclude that DHA attenuated hyperglycemia-enhanced HT and improved neurological function by preserving the integrity of BBB and reducing inflammation.

The natural history of the multicystic dysplastic kidney--is limited follow-up warranted?

OBJECTIVE

Imaging of patients with multicystic dysplastic kidney (MCDK) has increased over the past three decades. This increased use of imaging has provided additional insights into the natural history of MCDK. The present study looked at this data for predictors of involution and associated anomalies.

METHODS AND MATERIALS

Institutional review board approval was obtained for this retrospective study. The University of Michigan Departments of Urology and Radiology records were searched to identify unilateral MCDK patients during 1980-2012. Available clinical, radiological and surgical records were reviewed, and pertinent data were recorded. The log-rank test and a Cox proportional regression analysis were performed to identify predictors of MCDK involution. Probability of involution over time was assessed using Kaplan-Meier methodology.

RESULTS

301 unilateral MCDKs were identified; 195 (64.8%) were detected antenatally. Of the MCDKs found, 136 (45.2%) were in girls; 160 (53.2%) were right-sided. Mean size at baseline was 5.0 ± 0.2 cm (Mean ± SE). Associated abnormalities included: contralateral ureteropelvic junction obstruction (n = 10; 3.3%); contralateral ureterovesical junction obstruction/primary megaureter (n = 6; 2.0%); ipsilateral VUR (n = 21; 7.0%); contralateral VUR (n = 63; 20.1%); and renal fusion anomaly (n = 4; 1.3%). The cumulative probability of involution was: 9.8% at one year, 38.5% at five years, and 53.5% at ten years of age. Baseline MCDK size was the only significant predictor of involution at bivariate (p < 0.0001) and multivariate (p < 0.0001; HR 0.58 [95% CI: 0.49, 0.69]) analyses. No MCDK developed malignancy during the follow-up period.

CONCLUSION

As many MCDKs eventually involute and the risk of associated malignancy appears to be very low, there is no absolute indication for nephrectomy. Based on the data and other recent studies, it is believed that pediatric MCDK patients with no other urologic abnormalities can safely tolerate more limited urological and radiological follow-up.

Susceptibility-diffusion mismatch predicts thrombolytic outcomes: a retrospective cohort study

BACKGROUND AND PURPOSE

Asymmetric hypointensity of cerebral veins on susceptibility-weighted imaging has been shown to indirectly reflect tissue hypoxia after cerebral ischemia. We therefore investigated whether patients with prominent asymmetry of the cerebral veins on SWI and a relatively small diffusion-weighted imaging lesion (SWI-DWI mismatch), representing the presence of salvageable tissue, were more likely to benefit from thrombolytic therapy.

MATERIALS AND METHODS

We conducted a retrospective study of the anterior circulation of patients with ischemic stroke with SWI/DWI acquired before thrombolysis. The asymmetry index was defined as the ratio of cerebral vein voxel count between the ischemic and normal hemisphere on the SWI phase map. We defined SWI-DWI mismatch as an asymmetry index score of ≥1.75 with a DWI lesion volume of ≤25 mL. Favorable outcome was defined as modified Rankin Scale 0-2 at 3 months. Univariate and multivariate logistic regression analyses were used to examine the association between the mismatch profile and favorable outcome.

RESULTS

Fifty-four patients undergoing thrombolytic treatment were enrolled in this study. The rate of favorable outcome was significantly higher among patients with baseline SWI-DWI mismatch compared with those without (78% versus 44%; adjusted odds ratio, 6.317; 95% CI, 1.12-35.80; P = .037). Patients with SWI-DWI mismatch were also more likely to have a favorable outcome from reperfusion (91% versus 43%, P = .033) or recanalization (100% versus 40%, P = .013). The accuracy of SWI-DWI mismatch for predicting favorable outcome was higher than that of perfusion-diffusion mismatch (63% versus 48.1%).

CONCLUSIONS

The presence of SWI-DWI mismatch may identify patients with ischemia who would benefit from early reperfusion therapy.

Aspirin may modify tumor microenvironment via antiplatelet effect

High-quality evidence suggests that aspirin is a promising agent for cancer prevention and treatment. Direct inhibition of cyclooxygenase-2 (COX-2) pathway is generally thought to be the main mechanism by which aspirin inhibits cancer development. However, either pharmacological properties of aspirin or recent results of epidemiologic studies do not support that mechanism. To address this inconsistency, we hypothesize that antiplatelet effect of aspirin via inhibition of COX-1 may be one of potential mechanisms to inhibit carcinogenesis. Aberrant platelet activation will lead to promote hostility of tumor microenvironment by releasing an abundant array of angiogenesis regulators. Given the outstanding ability of antiplatelet, aspirin may restore balance of pro- and anti-angiogenic factors released from platelet to "normalize" tumor vasculature and shape tumor microenvironment to some extent, which will not only diminish tumor aggressiveness and progression, but also enhance the sensitivity to therapeutic treatment. Thus, targeting the platelet activation leading to alter tumor microenvironment may provide a novel way to tumor therapy.

Methamphetamine induces autophagy as a pro-survival response against apoptotic endothelial cell death through the Kappa opioid receptor

Methamphetamine (METH) is a psychostimulant with high abuse potential and severe neurotoxicity. Recent studies in animal models have indicated that METH can impair the blood-brain barrier (BBB), suggesting that some of the neurotoxic effects resulting from METH abuse could be due to barrier disruption. We report here that while chronic exposure to METH disrupts barrier function of primary human brain microvascular endothelial cells (HBMECs) and human umbilical vein endothelial cells (HUVECs), an early pro-survival response is observed following acute exposure by induction of autophagic mechanisms. Acute METH exposure induces an early increase in Beclin1 and LC3 recruitment. This is mediated through inactivation of the protein kinase B (Akt)/mammalian target of rapamycin (mTOR)/p70S6K pathway, and upregulation of the ERK1/2. Blockade of Kappa opioid receptor (KOR), and treatment with autophagic inhibitors accelerated METH-induced apoptosis, suggesting that the early autophagic response is a survival mechanism for endothelial cells and is mediated through the kappa opioid receptor. Our studies indicate that kappa opioid receptor can be therapeutically exploited for attenuating METH-induced BBB dysfunction.

Screening of key genes of unruptured intracranial aneurysms by using DNA microarray data analysis techniques

This study aimed to identify differentially expressed genes (DEGs) of unruptured intracranial aneurysms (IAs) and provide beneficial information for early diagnosis and treatment of IAs. The gene expression profile GSE26969 from the Gene Expression Omnibus database was downloaded, which included six human IA samples: three intracranial arterial aneurysm samples and three normal superficial temporal artery samples (control). Based on these data, we identified the DEGs between normal and disease samples with packages in the R language. The selected DEGs were further analyzed using bioinformatic methods. First, the STRING software was used to search co-expression relationships among DEGs, and the most important hub gene was found. We then used the plugins of the Cytoscape software, Mcode and Bingo, to conduct a module analysis. Next, pathways of the module genes were annotated using the FuncAssociate program. Compared with the control group, we obtained 169 DEGs in total, and by mining a module with the hub gene MYH11, we retrieved the ACTA2, MYH11, MYLK, and MYL9 genes, which were all in the module and were most significantly related to vascular smooth muscle contraction. We hypothesize that the genes identified here can be beneficial for early diagnosis and treatment of IAs.

Primary choriocarcinoma of the fallopian tube: a case report and literature review

Choriocarcinoma is a highly malignant tumor of trophoblastic origin. Primary fallopian tube choriocarcinoma is an extremely rare occurrence, especially in women over 50 years of age. This article concerns a case of tubal choriocarcinoma developing in a 54-year-old woman, which the authors present together with a brief review of the literature. The woman presented with irregular vaginal bleeding for two months, following three months of amenorrhea. Transvaginal dopolar and pelvic computed tomography (CT) scan showed an adnexal cystomic-solid mass. Her serum human chorionic gonadotropin (hCG) levels were 29,1116 mIU/ml. The patient underwent hysterectomy and bisalpingo-oophorectomy. Histology was suggestive of tubal choriocarcinoma. Immunohistochemistry tests were positive for the hCG, Ki 67, CK, PLAP, and negative for CD30, supporting the diagnosis of choriocarcinoma. A combination of 5-Fu and KSM was administrated postoperatively. After four cycles of chemotherapy, her serum hCG level fell to the normal range. The patient remains disease-free 14 months after disease diagnosis.