Purpose: Due to chronic toxicity, tacrolimus-sparing is an important issue in kidney transplant recipients (KTRs). Several studies have shown that bisphosphonate use is associated with favorable graft outcomes in KTRs. We investigated whether the association between tacrolimus trough levels (TTLs) and graft outcomes differed according to bisphosphonate use in KTRs. Materials and Methods: We conducted a retrospective study encompassing 1441 KTRs who were administered tacrolimus-based immunosuppressants. The primary exposure was a time-dependent cross-product of TTLs (low TTLs vs. normal-high TTLs with a reference of 6 ng/mL) and bisphosphonate use. Two primary outcomes were evaluated: overall graft loss (death or conversion to kidney replacement) and an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 . Results: During the median follow-up of 6.1 (3.4–9.7) years, overall graft loss occurred in 157 (10.9%) patients. Cox regression revealed that normal-high TTLs without bisphosphonate use were associated with a reduced risk of overall graft loss [adjusted hazard ratio (aHR), 0.65; 95% confidence interval (CI), 0.45–0.95] compared to low TTLs without bisphosphonate use. The use of bisphosphonate in conjunction with normal-high TTLs correlated with an even lower risk of overall graft loss (aHR, 0.25; 95% CI, 0.08–0.80) compared with low TTLs without bisphosphonate use. In patients with low TTLs, bisphosphonate use was associated with a reduced risk of overall graft loss compared with non-use (aHR, 0.20; 95% CI, 0.09–0.43). Similar trends were observed in the eGFR outcome. Conclusion The use of bisphosphonate was associated with favorable graft outcomes, even with low TTLs. Incorporating bisphosphonate into a conventional immunosuppressant regimen may potentially reduce tacrolimus requirement.

OBJECTIVES: normal circadian rhythm of autonomic nervous system function stands for the daily change of sympathetic and parasympathetic modulation, which can be measured by heart rate variability (HRV). Generally, patients in the intensive care unit (ICU) are prone to sleep-wake cycle dysregulation, therefore, it may have an influence on the circadian rhythm of autonomic nervous system. This study was designed to interpret possible dysregulation of autonomic nervous system in ICU patients by using HRV. METHODS: HRV was assessed every 3 hours in 21 ICU patients during a 7-minute period. The statistical differences of HRV features between the morning (AM 6 : 00–PM 12 : 00), and the afternoon (PM 12 : 00–PM 18 : 00) periods were evaluated in time domain and frequency domain. RESULTS: Patients showed significantly increased normalized power of low frequencey (nLF), absolute power of low frequencey (LF)/absolute power of high frequencey (HF) in the afternoon period as compared to the morning period. However, normalized power of high frequency (nHF) was significantly decreased in the afternoon period. There was no statistically significant difference between the morning period and the afternoon period in the time domain analysis. CONCLUSIONS: The increased sympathetic tone in the afternoon period supports possible dysregulation in the circadian rhythm of autonomic nervous system in ICU patients. Future studies can help to interpret the association between autonomic dysregulation and negative outcomes of ICU patients.
Autonomic Nervous System* ; Circadian Rhythm* ; Critical Care* ; Heart Rate* ; Heart* ; Humans ; Intensive Care Units*

Kikuchi disease, also called histiocytic necrotizing lymphadenitis, is an uncommon, idiopathic and generally self-limited disease, characterized by cervical lymphadenopathy. It can present systemic symptoms and signs, but ocular involvement is unusual. We report a 35-year-old woman who presented sudden decreased visual acuity and a swollen lymph node on the left side of her neck. On laboratory findings, there were no evidences of infection, autoimmune disease and systemic vasculitis. She was diagnosed with Kikuchi disease and bilateral retinal vasculitis by histologic analysis of lymph node, fundoscopy and fluorescein angiography.
Adult ; Autoimmune Diseases ; Female ; Fluorescein Angiography ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Neck ; Retinal Vasculitis ; Retinaldehyde ; Systemic Vasculitis ; Visual Acuity