Sirolimus as primary immunosuppressant for calcineurin inhibitor-related renal insufficiency after liver transplantation

BACKGROUND: Calcineur ininhibitor-related renal toxicity affects patient and graft survival in transplant recipients. This study aimed to determine whether sirolimus is effective and safe in treating renal insufficiency related to tacrolimus after liver transplantation. METHODS: Tacrolimus for primary immunosuppression was used in 16 patients after liver transplantation. Patients with a creatinine level higher than 132.6 mu mol/L were eligible for conversion to sirolimus. Simultaneously, the dose of tacrolimus was decreased to half. Blood urea nitrogen, creatinine, tacrolimus level, liver function and rejection episodes were monitored dynamically. RESULTS: All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from 146.8 +/- 92.4 to 105.3 +/- 71.3 mu mol/L (P<0.05). One patient had an acute rejection episode that was successfully treated with pulsed corticosteroids and low-dose tacrolimus. The side-effects of sirolimus included hyperlipidemia (4 patients) and leukocytopenia (2). CONCLUSION: Sirolimus can be safely used in liver transplant recipients suffering from tacrolimus-related renal insufficiency.

Abdominal pain among children re-evaluation of a diagnostic algorithm

AIM: To re-evaluate the algorithm that has been used forover 40 years for diagnosis of acute abdominal pain amongchildren.METHODS: Among the 937 cases admitted to the surgicalemergency ward in 2000, 656 cases of acute appendicitiswere studied to evaluate the usefulness of the presentalgorithm for its colculated accuracy, false positive and falsenegative rates, the sensitivity and specificity in the instantdiagnosis of various types of acute appendicitis in differentage groups.The algorithm used was established in 1958and revisedror this study in 1999. It includes a 3-step analysisof clinical presentations, i.e.: firstly, a diagnosis of surgicalpain by definite organic abdominal signs; then a diagnosisof the subgroup of surgical condition by special signs; andfinally the diagnosis of the present disease by specific signs.A footnote describes a 'comparative technique″ of abdominalexamination in non-cooperative children.RESULTS: The general accuracy of diagnosis was 92.8 %,overall mortality 0.1% among 973 cases of abdominal painin 2000. 373 attending surgeons and 241 residents includingtrainees joined the diagnosis and treatment with noremarkable difference in the results. The incidence of acuteappendicitis, 656 in 973 cases, was 67.4 % representingthe majority of abdominal pain. In the series of 656 cases,the accuracy of diagnosis of acute appendidtis was 93.6 %,false positive 6.4 %, false negative 0.9 %, sensitivity at firstvisit 82.7 %, specificity for appendicitis 98.0 %, no death ordocumentary complication.CONCLUSION: The present algorithm used for diagnosisof acute abdominal pain is effective and preferable inreducing misdiagnosis and maltreatment at emergency. Theuse of some modern technology should be further explored.

Synthesis and Crystal Structure of 〔EDA〕〔Ni（dmit）2〕3

The crystal structure of the compound EDA Ni(dmit) 2 3 (EDA=2 diethylamino 1,3 dithioanylium; dmit=1,3 dithiole 2 thione 4,5 dithiolate)C 25 H 14 NNi 3S 32 , has been determined by single crystal X ray diffraction at 300K. The crystal is triclinic with space group P1, a=11.252, b=12.192(2), c=20.055(6) , α=108.127(2), β=106.287(8), γ=90.005(9)°; V=2498.3(3) 3, Z=2, M r=1530.38, D c =2.03(2) g/cm 3. Final R and R w values were 0.0603 and 0.0704, respectively. The structure consists of thick layers of stacked Ni(dmit) 2 entities separated by EDA cations. This salt shows semiconducting behaviour with room temperature conductivity of 0.2 Scm -1 and activation energy of 0.11 eV.

Can we be aware of both visceral and somatic sensations via a single neuronal pathway?

Sensory information arising from somatic and visceral area is thought to be respectively transmitted to the brain by two distinct sensory neuronal systems, the somatic and visceral sensory pathway. A novel and unique spinal sensory system, the spinosolitary tract-dorsal column postsynaptic neuronal system (SST-DCPS), was physiologically and anatomically identified. The spinal neurons project to both visceral (the solitary tract nucleus) and somatic sensory (the dorsal column nuclei) nuclei via their branched axons and receive both visceral and somatic sensory information ascending from periphery through dichotomized primary afferents and descending from their targets via their branched axons. The brain might thus be aware of both visceral and somatic sensation via a single SST-DCPS neuronal channel. The finding of SST-DCPS system, as an example, might be considered as an intersection or fuzzy set of the SST and DCPS system and the concept of dichotomy in classification of neurons and neuronal pathways

Dual innervation of spinal ganglion neurons on perineum and bladder

Experiments were performed on 13 Wister rats. Fastblus (FB) was injected into subcutaneous tissue in perineum area and nuclear yellow (NY) was injected into subserous lamina of the bladder wall, respectively. FB, NY and FB+NY were mostly found in the spinal ganglions of L6, S1 ans S2 segments. The numbers of FB,NY and FB+NY labeled cells were 146, 186 and 81, in a total of 463 labeled cells and their proportion was 40%, 51% and 9%, respectively. The result indicates that the spinal ganglion neurons dually innervate both the somatic and visceral tissues, and the convergence of somato_visceral sensory pathways might occur in the spinal ganglion cells.