Kidney transplantation from donors after cardiac death: an initial report of 71 cases from China

Shortage of deceased donors is a severe problem in recent years in China especially in a culture in which brain death criteria is not widely accepted. Donation after cardiac death (DCD) has been reported to expand the donor pool despite higher rates of primary nonfunction (PNF) and delayed graft function (DGF) after transplantation. We collected 71 DCD kidney transplants performed at our hospital between February, 2007 and June, 2012 with aims to demonstrate the feasibility of DCD donation in China. All patients were followed up, and postoperative complications and graft loss were recorded. The PNF rate was 2.8%, and DGF rate was 28.2%. The 1- and 3-year graft survival was 95.7% and 92.4%. In conclusion, graft survival of DCD kidney transplantation in China is excellent despite of higher rates of PNF and DGF after transplantation.

Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report

Aortic arch pseudoaneurysm is a rare condition but carries a high risk of rupture. We report a case of a 45-year-old man with aortic arch pseudoaneurysm between left common carotid artery (LCCA) and left subclavian artery (LSA), in which a endovascular stent graft combined with double chimneys covered stents were successfully placed. There were no any complaints and complications after 12 months follow-up. The CTA demonstrated thrombus formation in the pseudoaneurysm lumen, no endoleak and the aortic arch, LCCA and LSA were all patent. We feel that the combined endovascular and double chimneys may be a valuable therapeutic alternative when treating aortic arch lesion. However, long-term clinical efficacy and safety have yet to be confirmed.

Outcomes and risk factors for hepatitis B virus (HBV) reactivation after kidney transplantation in occult HBV carriers

PURPOSE

The purpose of this study was to explore the outcomes and risk factors for hepatitis B virus (HBV) reactivation after kidney transplantation in occult HBV carriers, who are hepatitis B surface antigen (HBsAg) seronegative and hepatitis B core antibody (HBcAb) seropositive before kidney transplantation.

METHODS

We retrospectively analyzed 322 occult HBV carriers who received kidney transplantation in our hospital from January 1998 to June 2008. HBsAg and HBV DNA were routinely checked for diagnosis of HBV reactivation.

RESULTS

Our results showed that 15 cases (4.7%) of occult HBV carriers had HBV reactivation after kidney transplantation. Kaplan-Meier analysis showed that 1-, 3-, 5-, and 10-year patient survival was 86.7%, 79.4%, 72.2%, and 65.0%, respectively, in the HBV reactivation group, and was 96.1%, 93.8%, 91.5%, and 84.5%, respectively, in the non-HBV reactivation group (log-rank 4.12, P = 0.042). Graft survival showed no difference between these 2 groups (P > 0.05). The incidences of impairment of liver function, liver function failure, hepatocellular carcinoma, and acute rejection were significantly higher in the HBV reactivation group compared with the non-HBV reactivation group (P < 0.05). Logistic multivariate analysis showed that older age (>60 years) and using anti-T-cell antibodies were independent risk factors for HBV reactivation after kidney transplantation, while being hepatitis B surface antibody (HBsAb) seropositive and using lamivudine prophylaxis could protect occult HBV carriers from HBV reactivation after kidney transplantation (P < 0.05).

CONCLUSION

In conclusion, our data showed that HBV reactivation may diminish the patient survival but not graft survival. Older age and anti-T-cell antibodies may increase the risk of HBV reactivation, whereas lamivudine prophylaxis may prevent HBV reactivation after kidney transplantation.

Optimizing gene transfer to conventional outflow cells in living mouse eyes

The mouse eye has physiological and genetic advantages to study conventional outflow function. However, its small size and shallow anterior chamber presents technical challenges to efficient intracameral delivery of genetic material to conventional outflow cells. The goal of this study was to optimize methods to overcome this technical hurdle, without damaging ocular structures or compromising outflow function. Gene targeting was monitored by immunofluorescence microscopy after transduction of adenovirus encoding green fluorescent protein driven by a CMV promoter. Guided by a micromanipulator and stereomicroscope, virus was delivered intracamerally to anesthetized mice by bolus injection using a 33 gauge needle attached to Hamilton syringe or infusion with glass micropipette connected to syringe pump. The total number of particles introduced remained constant, while volume of injected virus solution (3-10 μl) was varied for each method and time of infusion (3-40 min) tested. Outflow facility and intraocular pressure were monitored invasively using established techniques. Unlike bolus injections or slow infusions, introduction of virus intracamerally during rapid infusions (3 min) at any volume tested preferentially targeted trabecular meshwork and Schlemm's canal cells, with minimal transduction of neighboring cells. While infusions resulted in transient intraocular pressure spikes (commensurate with volume infused, Δ40-70 mmHg), eyes typically recovered within 60 min. Transduced eyes displayed normal outflow facility and tissue morphology 3-6 days after infusions. Taken together, fast infusion of virus solution in small volumes intracamerally is a novel and effective method to selectively deliver agents to conventional outflow cells in living mice.

In vitro ovicidal and larvicidal activity of the essential oil of Artemisia lancea against Haemonchus contortus (Strongylida)

Prolonged use of chemical anthelmintics has been found to result in anthelmintic resistance and environmental issues, thereby limiting the application of these drugs in domestic animals and prompting interest in the study of plant extracts as alternative sources thereof. The aim of this study was to evaluate the in vitro effect of the essential oil (EO) of Artemisia lancea against the parasitic nematode Haemonchus contortus using egg hatch assay, larval development assay, and larval migration inhibition assay. The EO yield of extraction was 0.63% (w/w), and the major constituents were 1,8-cineole (34.56%) and camphor (16.65%). In the egg hatch assay, an inhibition greater than 99% was observed with the EO at 10 mg mL(-1) and the LC50 was 1.82 mg mL(-1). 1,8-Cineole demonstrated moderate ovicidal activity with a LC50 of 4.64 mg mL(-1), whereas camphor did not show enough activity to have its LC50 determined. In the larval development assay, the EO, 1,8-cineole, and camphor inhibited 93.6%, 65.2%, and 57% of larval development at 10 mg mL(-1) and exhibited dose-dependent responses with LC50 values of 1.66, 5.07, and 7.80 mg mL(-1), respectively. In the migration inhibition assay, the EO and 1,8-cineole at best inhibited 77% and 60.3% of larval migration at 10 mg mL(-1), respectively. Camphor showed low inhibition capacity, and its efficacy was not dose dependent. The results indicate that the in vitro anthelmintic activity of the EO of A. lancea may be associated with the additive action of the two major constituents, as well as other more minor terpenoid components.

Selective up-regulation of JunD transcript and protein expression in vasopressinergic supraoptic nucleus neurones in water-deprived rats

The magnocellular neurones (MCN) of the supraoptic nucleus (SON) undergo reversible changes during dehydration. We hypothesise that alterations in steady-state transcript levels might be partially responsible for this plasticity. In turn, regulation of transcript abundance might be mediated by transcription factors. We have previously used microarrays to identify changes in the expression of mRNAs encoding transcription factors in response to water deprivation. We observed down-regulation of 11 and up-regulation of 31 transcription factor transcripts, including members of the activator protein-1 gene family, namely c-fos, c-jun, fosl1 and junD. Because JunD expression and regulation within the SON has not been previously described, we have used in situ hybridisation and the quantitative reverse transcriptase-polymerase chain reaction to confirm the array results, demonstrating a significant increase in JunD mRNA levels following 24 and 72 h of water deprivation. Western blot and immunohistochemistry revealed a significant increase in JunD protein expression following dehydration. Double-staining fluorescence immunohistochemistry with a neurone-specific marker (NeuN) demonstrated that JunD staining is predominantly neuronal. Additionally, JunD immunoreactivity is observed primarily in vasopressin-containing neurones with markedly less staining seen in oxytocin-containing MCNs. Furthermore, JunD is highly co-expressed with c-Fos in MCNs of the SON following dehydration. These results suggest that JunD plays a role in the regulation of gene expression within MCNs of the SON in association with other Fos and Jun family members.

Topoisomerase IIα, rather than IIβ, is a promising target in development of anti-cancer drugs

DNA topoisomerase II (TOP2) is a well-known anticancer target. Its inhibitors are among the most effective anticancer drugs currently in clinical use. TOP2-targeting agents fall into two major classes of "Topo poisons" and "Topo inhibitors" based on their mechanisms of action. Mammalian cells possess two genetically distinct TOP2 isoforms, TOP2α and TOP2β, that are differentially regulated and play different roles in living cells. Compared to TOP2β, TOP2α may be an efficacious and safe chemotherapeutic target for cancer treatment. This review discusses the advantage of targeting TOP2α over TOP2β and action of various agents on TOP2α.

Shifting bright spatial solitons in LiNbO3

We observe spatial bright solitons in a transversely shifting LiNbO3 crystal. In this scheme, the photovoltaic nonlinearity in LiNbO3 can be switched from self-defocusing to self-focusing by continuous shifting of the beam. Moreover, the shifting velocity has a strong influence on the wave shape of the bright spatial solitons.

C60:LiF nanocomposite for high power efficiency fluorescent organic light-emitting diodes

To reduce the driving voltage, and hence enhance the power efficiency of OLEDs, the mobility of the various carrier transport layers needs to be increased. Buckminsterfullerene (C(60)) has been proposed to be one possible alternative conductive electron transport layer (ETL) to enhance the power efficiency in OLEDs, due to its high conductivity and the formation of an ohmic contact with the LiF/Al cathode. The optical properties of a nanocomposite of C(60) with LiF (C(60):LiF) and its potential as an efficient ETL in OLEDs was studied. With proper optimization of the device structure, a more than 50% improvement in the power efficiency, without sacrificing the high EQE, in optimized fluorescent OLEDs with the use of C(60):LiF nanocomposite ETL was achieved.

Treatment for Helicobacter pylori infection and risk of Parkinson's disease in Denmark

BACKGROUND AND PURPOSE

It has been speculated that gastrointestinal infection with Helicobacter pylori (HP) contributes to the development of Parkinson's disease (PD). We used nationwide Danish registers to investigate this hypothesis.

METHODS

 We identified 4484 patients with a first time PD diagnosis between 2001 and 2008 from the Danish National Patient Register (DNPR) and 22, 416 population controls from the Danish Civil Registration System (CRS). Information on drug use was obtained from the National Prescription Registry (NPR). We used logistic regression to compute odds ratios (OR) for the association between treatment for HP and risk of PD.

RESULTS

Prescriptions for HP-eradication drugs and proton pump inhibitors (PPI) 5 or more years prior to the diagnosis of PD were associated with a 45% and 23% increase in PD risk, respectively. Hospitalizations and outpatient visits for gastritis and peptic/duodenal ulcers, however, were not associated with PD.

CONCLUSIONS

  Our population-based study suggests that chronic HP infections and/or gastritis contribute to PD or that these are PD-related pathologies that precede motor symptoms.

Kidney transplantation from donation after cardiac death donors in China--a single-center experience

OBJECTIVE

To report clinical outcomes of kidney transplantation from cardiac death donors (DCD) in China, and to investigate its feasibility to expand the organ donor pool.

PATIENTS AND METHODS

We retrospectively studied clinical data of 46 DCD kidneys from 31 donors from February 2007 to August 2011. Recipients were followed for patient and graft survival.

RESULTS

We discarded the organs from 3 of 29 (10.3%) DCD donors and 7 of 42 (16.7%) kidneys that displayed renal thrombosis. Of the 39 recipients engrafted with DCD kidneys successfully, the mean follow-up was 16 months, (range = 50 days to 43 months). Delayed graft function (DGF) occurred in 15 (38.5%) recipients, who except one recovered within 3 months. Three biopsy-proven acute rejection episodes were observed in two recipients (5.1%). All patients survived through the follow-up. The graft survival rate was 97.4% at 12 months and 94.9% at 24 months. A 45-year-old male recipient who received a pair of grafts from a 6-year-old child survived with good renal function.

CONCLUSION

Although kidney transplantations from DCD donors showed a higher rate of DGF with a longer duration of graft recovery, we achieved favorable short-term clinical outcome in terms of graft survival and function. Donation after cardiac death can expand the organ donor pool in China.

Relationship between brain natriuretic peptide and recurrence of atrial fibrillation after successful electrical cardioversion: a meta-analysis

A meta-analysis was undertaken to examine the relationship between plasma brain natriuretic peptide (BNP) levels and recurrence of atrial fibrillation (AF) after successful electrical cardioversion. The literature search was conducted using key inclusion criteria for papers published between January 1980 and March 2011 listed in the PubMed(®)/MEDLINE(®)

DATABASE

Data were analysed using RevMan version 5.1 software; a manual search was also performed. Ten studies were finally included. Results showed that baseline BNP levels were higher in patients with AF recurrence than in those without recurrence, the standardized mean difference in plasma BNP level being -1.35 (95% confidence interval -2.17, -0.53, Z-score for overall effect 3.22). These results suggest that higher plasma BNP levels are associated with a greater risk of AF recurrence. BNP levels may predict AF recurrence after successful electrical cardioversion.

Depletion and recovery of lymphoid subsets following morphine administration

BACKGROUND AND PURPOSE

Opioid use and abuse has been linked to significant immunosuppression, which has been attributed, in part, to drug-induced depletion of lymphocytes. We sought to define the mechanisms by which lymphocyte populations are depleted and recover following morphine treatment in mice.

EXPERIMENTAL APPROACH

Mice were implanted with morphine pellets and B- and T-cell subsets in the bone marrow, thymus, spleen and lymph nodes were analysed at various time points. We also examined the effects of morphine on T-cell development using an ex vivo assay.

KEY RESULTS

The lymphocyte populations most susceptible to morphine-induced depletion were the precursor cells undergoing selection. As the lymphocytes recovered, more lymphocyte precursors proliferated than in control mice. In addition, peripheral T-cells displayed evidence that they had undergone homeostatic proliferation during the recovery phase of the experiments.

CONCLUSIONS AND IMPLICATIONS

The recovery of lymphocytes following morphine-induced depletion occurred in the presence of morphine and via increased proliferation of lymphoid precursors and homeostatic proliferation of T-cells.

Improving superficial target delineation in radiation therapy with endoscopic tracking and registration

PURPOSE

Target delineation within volumetric imaging is a critical step in the planning process of intensity modulated radiation therapy. In endoluminal cancers, endoscopy often reveals superficial areas of visible disease beyond what is seen on volumetric imaging. Quantitatively relating these findings to the volumetric imaging is prone to human error during the recall and contouring of the target. We have developed a method to improve target delineation in the radiation therapy planning process by quantitatively registering endoscopic findings contours traced on endoscopic images to volumetric imaging.

METHODS

Using electromagnetic sensors embedded in an endoscope, 2D endoscopic images were registered to computed tomography (CT) volumetric images by tracking the position and orientation of the endoscope relative to a CT image set. Regions-of-interest (ROI) in the 2D endoscopic view were delineated. A mesh created within the boundary of the ROI was projected onto the 3D image data, registering the ROI with the volumetric image. This 3D ROI was exported to clinical radiation treatment planning software. The precision and accuracy of the procedure was tested on two solid phantoms with superficial markings visible on both endoscopy and CT images. The first phantom was T-shaped tube with X-marks etched on the interior. The second phantom was an anatomically correct skull phantom with a phantom superficial lesion placed on the pharyngeal surface. Markings were contoured on the endoscope images and compared with contours delineated in the treatment planning system based on the CT images. Clinical feasibility was tested on three patients with early stage glottic cancer. Image-based rendering using manually identified landmarks was used to improve the registration.

RESULTS

Using the T-shaped phantom with X-markings, the 2D to 3D registration accuracy was 1.5-3.5 mm, depending on the endoscope position relative to the markings. Intraobserver standard variation was 0.5 mm. Rotational accuracy was within 2°. Using the skull phantom, registration accuracy was assessed by calculating the average surface minimum distance between the endoscopy and treatment planning contours. The average surface distance was 0.92 mm with 93% of all points in the 2D-endoscopy ROI within 1.5 mm of any point within the ROI contoured in the treatment planning software. This accuracy is limited by the CT imaging resolution and the electromagnetic (EM) sensor accuracy. The clinical testing demonstrated that endoscopic contouring is feasible. With registration based on em tracking only, accuracy was 5.6-8.4 mm. Image-based registration reduced this error to less than 3.5 mm and enabled endoscopic contouring in all cases.

CONCLUSIONS

Registration of contours generated on 2D endoscopic images to 3D planning space is feasible, with accuracy smaller than typical set-up margins. Used in addition to standard 3D contouring methods in radiation planning, the technology may improve gross tumour volume (GTV) delineation for superficial tumors in luminal sites that are only visible in endoscopy.

Prolonged exclusive breastfeeding, autumn birth and increased gestational age are associated with lower risk of fever in children with hand, foot, and mouth disease

Epidemics of hand, foot, and mouth disease (HFMD) have been emerging and reemerging in recent years. This study aims to investigate whether breastfeeding and other factors may affect the profile of fever and disease course in children with HFMD. Three hundred seventy-two preschool children with HFMD were included. The demographics, environmental factors, and delivery- and feeding-associated factors in the children were obtained and their effects on the profile of fever and disease course were analyzed. Of the 372 children, 139 (37.37%) had fever during the disease course. Gender, breastfeeding pattern, birth season and gestational age were significantly different between the children with and without fever (p = 0.034, p < 0.0001, p = 0.035 and p = 0.013, respectively). After multivariate-adjusted analysis, prolonged exclusive breastfeeding (p = 0.001, OR 0.401, 95% CI 0.229-0.704), autumn birth (p = 0.007, OR 0.409, 95% CI 0.214-0.784) and higher gestational age (p = 0.029, OR 0.089, 95% CI 0.010-0.781) were protective factors for the incidence of fever.

Correlated expression of Fas, NF-kappaB, and VEGF-C in infiltrating ductal carcinoma of the breast

OBJECTIVE

To investigate the expressions of Fas, NF-kappaB, and vascular endothelial growth factor-C (VEGF-C) in infiltrating ductal carcinoma of the breast and provide scientific basis for early diagnosis and prognosis of breast cancer.

MATERIALS AND METHODS

The immunohistochemical technique (SP method) was used to detect expression of Fas, NF-kappaB, and VEGF-C in 137 cases of breast-infiltrating ductal carcinoma, 17 cases of intraductal carcinoma of the breast, and 20 cases of normal breast tissues, and analyze its relationship with clinicopathologic factors of breast cancer and patients' survival rate, as well as the correlation among their expression, clinicopathologic factors, and survival rate.

RESULTS

Fas expression was less commonly detected in infiltrating ductal carcinoma than in intraductal carcinoma and normal tissue. In contrast, both NF-kappaB and VEGF-C were more commonly detected in infiltrating ductal carcinoma than in intraductal carcinoma and normal tissue. Fas expression was correlated with tumor size, histological grade, and clinicopathological stage; NF-kappaB expression was correlated with tumor size, histological grade, lymph node metastasis; VEGF-C expression was correlated with lymph node metastasis and clinical and pathological stages of breast cancer (p < or = 0.05). Spearman rank correlation analysis revealed a negative correlation between Fas expression and both NF-kappaB and VEGF-C expression in infiltrating breast cancer (p < 0.05) Additionally, Kaplan-Meier survival analysis demonstrated that five-year survival was higher for patients with Fas-positive samples but lower for those with VEGF-C-positive samples.

CONCLUSIONS

The present results demonstrate that Fas and NF-B play a role in the initiation and development of breast cancer, while VEGF-C appears to promote lymph node metastasis. Thus, these proteins may serve as useful diagnostic and prognostic markers of invasive breast cancer.