Histopathological analysis of infiltrating T cell subsets in acute T cell-mediated rejection in the kidney transplant

AIM To compare the differential immune T cell subset com-position in patients with acute T cell-mediated rejection in the kidney transplant with subset composition in the absence of rejection, and to explore the association of their respective immune profiles with kidney transplant outcomes.METHODS A pilot cross-sectional histopathological analysis of the immune infiltrate was performed using immunohistochemistry in a cohort of 14 patients with acute T cellmediated rejection in the kidney transplant and 7 kidney transplant patients with no rejection subjected to biopsy to investigate acute kidney transplant dysfunction. All patients were recruited consecutively from 2012 to 2014 at the Singapore General Hospital. Association of the immune infiltrates with kidney transplant outcomes at up to 54 mo of follow up was also explored prospectively.RESULTS In a comparison to the absence of rejection, acute T cell-mediated rejection in the kidney transplant was characterised by numerical dominance of cytotoxic T lymphocytes over Foxp3^+ regulatory T cells, but did not reach statistical significance owing to the small sample size in our pilot study. There was no obvious difference in absolute numbers of infiltrating cytotoxic T lymphocytes, Foxp3^+ regulatory T cells and Th17 cells between the two patient groups when quantified separately. Our exploratory analysis on associations of T cell subset quantifications with kidney transplant outcomes revealed that the degree of Th17 cell infiltration was significantly associated with shorter time to doubling of creatinine and shorter time to transplant loss.CONCLUSION Although this was a small pilot study, results support our suspicion that in kidney transplant patients the immune balance in acute T cell-mediated rejection is tilted towards the pro-rejection forces and prompt larger and more sophisticated studies.

Symptom clustering in chronic gastritis based on spectral clustering

OBJECTIVE: Apply spectral clustering to analyze the patterns of symptoms in patients with chronic gastritis(CG).METHODS: Based on 919 CG subjects, we applied mutual information feature selection to choose the positively correlated symptoms with each pattern.Then, we used the Shi and Malik spectral clustering algorithm to select the top 20 correlated symptoms.RESULTS: We ascertained the results of six patterns.There were three categories for the pattern of accumulation of damp heat in the spleen-stomach(0.00332). There were six categories for the pattern of dampness obstructing the spleen-stomach(0.02466). There were two categories for the pattern of spleen-stomach Qi deficiency(0.013 89).There were three categories for the pattern of spleen-stomach deficiency cold(0.009 15). There were five categories for the pattern of liver-Qistagnation(0.01910).There were four categories for the pattern of stagnant heat in the liver-stomach(0.00585).CONCLUSION: Most of the spectral clustering results of the symptoms of CG patterns were in accordance with clinical experience and Traditional Chinese Medicine theory. Most categories suggested the nature and/or location of the disease.