AIM To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.METHODS We performed a retrospective analysis of consecutive de-...AIM To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.METHODS We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyomavirus associated nephropathy(PyV AN). Recipient plasma was screened for BKV DNA via quantitative polymerase chain reaction(PCR) at months 1,3,6,9 and 12 post-transplant and on worsening graft function.Immunosuppression was reduced at ≥ 3-log copies/mL. Those with viremia of ≥ 4-log copies/mL(presumptive PyV AN) underwent renal transplant biopsy. Presumptive Py VAN(PP) and definitive Py VAN(DP; biopsy-proven) were treated by immunosuppression reduction(IR) only. RESULTS Among 319 kidney transplant recipients,the median age was 53 years(range 19-83),65.8% were male,and 58.9% were white. Biopsy-proven acute rejection was found in 18.5% within 0-168 wk. Death-censored graft loss occurred in 5.3%(n = 17) and graft loss attributable to PyV AN was 0.6%(n = 2). Forty-seven patients were diagnosed with PP(14.7%) and 18(5.6%) with DP. Graft loss among participants with PyV AN(8.5%) and those without(4.8%) was not significantly different. Deceased donor kidney transplantation(OR = 2.3,95%CI = 1.1-4.6) and AR(OR = 2.3,95%CI = 1.2-4.7) were associated with Py VAN in the multivariate analysis. BK viremia between 3 and 4-log copies/mL occurred in 27 patients,all of whom underwent IR. Of these,16(59%) never developed PyV AN while 11(41%) developed PyV AN(4 DP,7 PP) within a range of 11-39 wk. CONCLUSION Instituting an early reduction of immunosuppression,in the absence of adjunctive antivirals,is effective at preventing PyV AN and may be associated with a lower incidence of graft-loss without a reciprocal increase in the incidence of acute rejection.展开更多
Since its inception in 1966 at the University of Minnesota,pancreas transplantation has witnessed major milestones in evolution of surgical techniques,immunosuppression regimen and more recently,machine perfusion for ...Since its inception in 1966 at the University of Minnesota,pancreas transplantation has witnessed major milestones in evolution of surgical techniques,immunosuppression regimen and more recently,machine perfusion for optimising graft utilisation(1).展开更多
BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients(KTRs)is higher than that in the general population.It is associated with long-lasting exposure to immunosuppressive agents and impair...BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients(KTRs)is higher than that in the general population.It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease.Colorectal cancer(CRC),frequently diagnosed in an advanced stage,is one of the most common malignancies in this cohort and is associated with poor prognosis.Still,because of the scarcity of data concerning adjuvant chemotherapy in this group,there are no clear guidelines for the specific management of the CRCs in KTRs.We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.CASE SUMMARY A 36-year-old woman with a medical history of kidney transplantation(2005)because of end-stage kidney disease,secondary to chronic glomerular nephritis,and long-term immunosuppression was diagnosed with locally advanced pT_(4A)N_(1B) M_(0)(clinical stage Ⅲ)colon adenocarcinoma G2.After right hemicolectomy,the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin,leucovorin and 5-fluorouracil(FOLFOX-4).The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation ofhemodialysis therapy after a few months. Shortly after that, the patient started palliativechemotherapy because of cancer recurrence with intraperitoneal spread.CONCLUSIONInitiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft lossdriven also by under-immunosuppression。展开更多
Graft-modified polybutadiene(PB) latex was synthesized and used as an admixture to improve the performance of oilwell cement. Results showed that the addition of latex to pure cement slurry can significantly reduce th...Graft-modified polybutadiene(PB) latex was synthesized and used as an admixture to improve the performance of oilwell cement. Results showed that the addition of latex to pure cement slurry can significantly reduce the fluid loss of the cement slurry. When the dosage was 8%, the fluid loss was only 38 mL, and the fluidity of the cement slurry was improved. With an increasing amount of latex, the fluidity of the cement slurry increased continuously. The toughness of cement was significantly enhanced, whose average elastic modulus was 4.2 GPa. Scanning electron microscopy revealed that the filter cake of the cement slurry with latex was thin and dense, and the surface was coated with a layer of latex film. The microstructure of the cement stone showed a high density, and an interweaving mesh network formed in the cement. The results of cement hydration heat analysis and X-ray diffraction showed that latex inhibited the hydration of cement; the effect was stronger under a larger amount of latex. It is indicated that the graft-modified PB latex has great potential to replace the conventional styrene-butadiene rubber(SBR) latex for cementing in the future.展开更多
Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus ...Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus is non-supportive. The available level of evidence is primarily derived from case series, which shows a mean survivorship of 90.5%, with revision or re-operation as the end-point, with an average follow-up of 11 years. The rate of femoral fracture requiring re-operation or revision of the component varies between several large case series, ranging from 2.5% to 9%, with an average of 5.4%.展开更多
Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introducti...Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy,CR still represents an important cause of graft injury,which might be irreversible,leading to graft loss requiring re-transplantation.To date,we still do not fully appreciate the mechanisms underlying this process.In addition to T cell-mediated CR,which was initially the only recognized type of CR,recently a new form of liver allograft CR,antibody-mediated CR,has been identified.This has indeed opened an era of thriving research and renewed interest in the field.Liver biopsy is needed for a definitive diagnosis of CR,but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation.Moreover,the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury,which should not be disregarded.Therapies for CR may only be effective in the“early”phases,and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage.Herein,we provide an overview of the current knowledge and research on CR,focusing on early detection,identification of non-invasive biomarkers,immunosuppressive management,re-transplantation and future perspectives of CR.展开更多
文摘AIM To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.METHODS We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyomavirus associated nephropathy(PyV AN). Recipient plasma was screened for BKV DNA via quantitative polymerase chain reaction(PCR) at months 1,3,6,9 and 12 post-transplant and on worsening graft function.Immunosuppression was reduced at ≥ 3-log copies/mL. Those with viremia of ≥ 4-log copies/mL(presumptive PyV AN) underwent renal transplant biopsy. Presumptive Py VAN(PP) and definitive Py VAN(DP; biopsy-proven) were treated by immunosuppression reduction(IR) only. RESULTS Among 319 kidney transplant recipients,the median age was 53 years(range 19-83),65.8% were male,and 58.9% were white. Biopsy-proven acute rejection was found in 18.5% within 0-168 wk. Death-censored graft loss occurred in 5.3%(n = 17) and graft loss attributable to PyV AN was 0.6%(n = 2). Forty-seven patients were diagnosed with PP(14.7%) and 18(5.6%) with DP. Graft loss among participants with PyV AN(8.5%) and those without(4.8%) was not significantly different. Deceased donor kidney transplantation(OR = 2.3,95%CI = 1.1-4.6) and AR(OR = 2.3,95%CI = 1.2-4.7) were associated with Py VAN in the multivariate analysis. BK viremia between 3 and 4-log copies/mL occurred in 27 patients,all of whom underwent IR. Of these,16(59%) never developed PyV AN while 11(41%) developed PyV AN(4 DP,7 PP) within a range of 11-39 wk. CONCLUSION Instituting an early reduction of immunosuppression,in the absence of adjunctive antivirals,is effective at preventing PyV AN and may be associated with a lower incidence of graft-loss without a reciprocal increase in the incidence of acute rejection.
文摘Since its inception in 1966 at the University of Minnesota,pancreas transplantation has witnessed major milestones in evolution of surgical techniques,immunosuppression regimen and more recently,machine perfusion for optimising graft utilisation(1).
文摘BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients(KTRs)is higher than that in the general population.It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease.Colorectal cancer(CRC),frequently diagnosed in an advanced stage,is one of the most common malignancies in this cohort and is associated with poor prognosis.Still,because of the scarcity of data concerning adjuvant chemotherapy in this group,there are no clear guidelines for the specific management of the CRCs in KTRs.We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.CASE SUMMARY A 36-year-old woman with a medical history of kidney transplantation(2005)because of end-stage kidney disease,secondary to chronic glomerular nephritis,and long-term immunosuppression was diagnosed with locally advanced pT_(4A)N_(1B) M_(0)(clinical stage Ⅲ)colon adenocarcinoma G2.After right hemicolectomy,the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin,leucovorin and 5-fluorouracil(FOLFOX-4).The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation ofhemodialysis therapy after a few months. Shortly after that, the patient started palliativechemotherapy because of cancer recurrence with intraperitoneal spread.CONCLUSIONInitiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft lossdriven also by under-immunosuppression。
基金supported by the National Science and Technology Major Project of China (No. 2016ZX05020-004)
文摘Graft-modified polybutadiene(PB) latex was synthesized and used as an admixture to improve the performance of oilwell cement. Results showed that the addition of latex to pure cement slurry can significantly reduce the fluid loss of the cement slurry. When the dosage was 8%, the fluid loss was only 38 mL, and the fluidity of the cement slurry was improved. With an increasing amount of latex, the fluidity of the cement slurry increased continuously. The toughness of cement was significantly enhanced, whose average elastic modulus was 4.2 GPa. Scanning electron microscopy revealed that the filter cake of the cement slurry with latex was thin and dense, and the surface was coated with a layer of latex film. The microstructure of the cement stone showed a high density, and an interweaving mesh network formed in the cement. The results of cement hydration heat analysis and X-ray diffraction showed that latex inhibited the hydration of cement; the effect was stronger under a larger amount of latex. It is indicated that the graft-modified PB latex has great potential to replace the conventional styrene-butadiene rubber(SBR) latex for cementing in the future.
文摘Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus is non-supportive. The available level of evidence is primarily derived from case series, which shows a mean survivorship of 90.5%, with revision or re-operation as the end-point, with an average follow-up of 11 years. The rate of femoral fracture requiring re-operation or revision of the component varies between several large case series, ranging from 2.5% to 9%, with an average of 5.4%.
文摘Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy,CR still represents an important cause of graft injury,which might be irreversible,leading to graft loss requiring re-transplantation.To date,we still do not fully appreciate the mechanisms underlying this process.In addition to T cell-mediated CR,which was initially the only recognized type of CR,recently a new form of liver allograft CR,antibody-mediated CR,has been identified.This has indeed opened an era of thriving research and renewed interest in the field.Liver biopsy is needed for a definitive diagnosis of CR,but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation.Moreover,the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury,which should not be disregarded.Therapies for CR may only be effective in the“early”phases,and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage.Herein,we provide an overview of the current knowledge and research on CR,focusing on early detection,identification of non-invasive biomarkers,immunosuppressive management,re-transplantation and future perspectives of CR.
