Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective:To evaluate the efficacy of individualized removal therapeutic regimen for donor-specific antibodies (DSA) and examine its related influencing factors.Method:From January 2016 to January 2021, 34 recipients of kidney transplant (KT) underwent regular DSA testing and the results were positive. DSA removal therapy based upon rituximab (RTX) plus intravenous immune globulin (IVIG) was offered. Correlation between DSA negative conversion rate and DSA types, time from start of treatment to transplantation, HLA loci targeted by DSA and DSA mean fluorescent intensity (MFI) were analyzed retrospectively. Changes of immunedominant DSA (iDSA) and serum creatinine in individuals with de novo DSA (dnDSA) before and after treatment were also examined.Results:At Month 3 post-treatment, antibodies turned negative in 17/34(50.0%) patients and DSA became negative in 19/34(55.9%) at the last follow-up. Then we identified 78 DSA from all patients. No significant difference existed in negative conversion rate of pfDSA and dnDSA at Month 3 post-treatment [62.9%(39/62) vs 37.5%(6/16)] and at the last follow-up [4.2%(46/62) vs 56.3%(9/16)]( P=0.067, 0.219). For pfDSA, negative conversion rate of pfDSA with different MFIs after 3-month treatment varied significantly [negative conversion rate of weak positive DSA was 78.6%(33/42) and positive and above DSA 30%(6/20), P<0.001]. It was an independent related factor of whether or not pfDSA could turn negative (48.6%, 95% CI: 22.3%-66.8%, P=0.001). At the last follow-up, negative conversion rate of pfDSA differed markedly at different timepoints from start of treatment to transplantation [treated within 30 days post-operation was 79.2%(42/53) and over 30 days post-operation was 44.4%(4/9), P=0.042] and among different DSA MFI [88.1%(37/42) of weakly positive DSA and 45%(9/20) of positive and above DSA, P<0.001] and they were independent related factors for negative conversion of pfDSA (34.8%, 95% CI: 3.2%-61.8%, P=0.008; 43.1%, 95% CI: 18.5%-63.4%, P=0.001). Mean decline rate in iDSA was 66.67% at Month 3 post-treatment and 77.90% at the last follow-up. The difference was statistically significant ( P=0.035). Serum level of creatinine of 9 patients with dnDSA was (110.2±26.9) μmol/L pre-treatment, (178.8±90.5) μmol/L during treatment, (153.9±72.8) μmol/L at Month 3 post-treatment and (213.6±185.8) μmol/L at the last follow-up. Serum creatinine rose during treatment ( t=-2.794, P=0.023), declined at Month 3 post-treatment ( t=3.430, P=0.009) and spiked again at the last follow-up ( P=0.028). Conclusion:After DSA removal therapy based upon RTX plus IVIG, negative conversion rate of pfDSA is correlated with its MFI and time from start of treatment to transplantation. There is no significant rebound in DSA MFI and graft function of dnDSA patients improves immediately after treatment.

Objective:To explore the risk factors related to acute rejection (AR) after pediatric kidney transplantation (KT).Methods:Retrospective analysis was performed for 189 pediatric KT recipients from September 2011 to August 2022.They were divided into two groups of AR (n=33) and non-AR (n=156).Univariate and multivariate Logistic regression analyses were performed for identifying potential risk factors of AR.And the effects of AR on graft function and survival were also examined.Results:During follow-ups, a total of 33(17.5%) patients developed AR with a 1-year cumulative incidence of AR of 16.9%(32/189).Univariate analysis revealed that median time on dialysis was longer in AR group than that in non-AR group (19 vs. 11 months, P=0.034).Median age of donors (12 vs. 24 months, P=0.033), median weight of donors (9.5 vs. 12 kg, P=0.025) and median donor/recipient body weight ratio (0.36 vs. 0.50, P=0.005) were lower in AR group than those in non-AR group.And the proportion of subtherapeutic tacrolimus (TAC) trough level was higher in AR group than that in non-AR group (45.5% vs. 21.2%, P=0.004).Multivariate regression analysis indicated that subtherapeutic TAC trough level was an independent risk factor for AR ( OR=2.977, 95% CI: 1.314-6.743, P=0.009).At the last follow-up, serum creatinine and eGFR were (78.4±24.3) vs. (74.6±24.7) μmol/L and (85.3±26.3) vs. (89.5±24.2) ml·min -1·1.73 m -2 in AR and non-AR groups respectively.There were no significant differences.1/5-year patient survival rate was both 97% in AR group and both 99.4% in non-AR group; 1/5-year graft survival rate both 90.9% in AR group and was 98.1% and 97.4% in non-AR group.No significant inter-group differences existed in patient and graft survival. Conclusions:Although an occurrence of early AR does not negatively impact graft outcomes, the incidence of AR remains high after pediatric KT.Therefore prompt diagnosis and treatment of AR should be strengthened.

Objective To explore the effect of miR-23b-3p regulation on osteogenic differentiation of renal intersti-tial fibroblasts(hRIFs)on the formation of Randall plaque and its possible mechanism.Methods qRT-PCR was used to detect the expression levels of miR-23b-3p and osteogenic marker:myocyte enhancer factor 2C(MEF2C),osteocalcin(OCN),osteopontin(OPN),runt-related transcription factor 2(Runx2)mRNA in Randall plaque tis-sue of CaOx stone patients(RP)and normal papillary tissue of kidney tumor patients undergoing nephrectomy(nRP).Isolation and culture of human normal hRIFs were isolated and cultured in vitro.The miR-23b-3p overex-pression plasmid pSi-miR-23b-3p and its negative no-load plasmid pSi-NC,the MEF2C lentivirus overexpression plasmid Lv-MEF2C and the no-load plasmid Lv-NC were transfected into hRIFs cells,and the cells were induced to osteogenic differentiation for 14 days.The activity of alkaline phosphatase(ALP)was determined by ELISA.Aliz-arin red staining was used to observe the formation of mineralized nodules.The expression levels of miR-23b-3p and MEF2C,OCN,OPN,Runx2 mRNA were detected by qRT-PCR.The expression level of MEF2C protein was de-tected by Western blot.Dual luciferase reporter gene assay verified the targeting relationship between miR-23b-3p and MEF2C.Results ① Compared with the nRP group,miR-23b-3p was low expressed and MEF2C,OCN,OPN,and Runx2 were highly expressed in the RP group.② 14 days after osteogenic induction of hRIFs cells,the activity of ALP in cells significantly increased,the ability of cells to form mineralized nodules was enhanced,the expression level of miR-23b-3p significantly decreased,the mRNA expression levels of MEF2C,OCN,OPN,and Runx2 significantly increased,and the expression level of MEF2C protein significantly increased.③ Overexpres-sion of miR-23b-3p decreased the activity of ALP in hRIFs cells after osteogenic induction,inhibited the formation of mineralized nodules in cells,and down-regulated the mRNA expression levels of OCN,OPN,and Runx2 in cells.④ Overexpression of MEF2C reversed the inhibitory effect of miR-23b-3p overexpression on osteoblast differ-entiation of hRIFs cells.⑤ MEF2C was the downstream target gene of miR-23b-3p.Conclusion miR-23b-3p is underexpressed in RP tissues and during osteoblastic differentiation of hRIFs cells.Up-regulation of miR-23b-3p in-hibits osteogenic differentiation of hRIFs cells,and its mechanism may be related to targeted silencing MEF2C.

This review described the management of 11 recipients hospitalized with severe COVID-19 after kidney transplantation during the omicron variant epidemic in Shanghai from December 2022 to January 2023.After withdrawing oral immunosuppressants and starting immunoreplacement therapy, taking small molecule antiviral drugs and treating mixed infections, 10 recipients recovered and were discharged.One critically recipient died from a mixed bacterial and fungal infection after 80-day treatment.No overproduction of inflammatory cytokines was observed during treatment.And no rejection occurred during a cessation of oral immunosuppression.Delayed administration(>1 week of SARS-CoV-2 infection)of small molecule antiviral agents could effectively control viral replication.And there was simultaneous restoration of immune function.

Objective:To retrospectively summarize the clinical experiences of managing renal artery stenosis after donor kidney transplantation in children.Methods:From January 2018 to October 2021, 114 pediatric kidney transplants(donor/recipient aged <18 years)were performed.According to the findings of color Doppler ultrasonography, they were divided into two groups of normal( n=80)and rapid flow( n=34). Rapid flow group were assigned into symptomatic( n=13)and asymptomatic( n=21)sub-groups based upon clinical features of hypertension and renal instability. Results:Among them, there were 65 males and 49 females.A significant inter-gender difference existed in the proportion of higher arterial flow rate of transplanted kidney(38.5% and 18.4%, P=0.02). No significant difference existed in age or body weight of transplant recipients among all groups( P>0.05). The mean age(10.4 months)and body weight(9 kg)of donors were significantly lower in symptomatic group than those in normal group(65.3 months, 21 kg)and asymptomatic group(64.4 months, 21.2 kg). The mean velocity of symptomatic group was significantly higher than that of asymptomatic group(363.5 vs 228.8 cm/s)( P<0.001). In symptomatic group, 6 cases received medications and their clinical manifestations were completely relieved.Among 7 patients invasively treated, one percutaneous transluminal angioplasty(PTA)was offer once( n=2), twice( n=2)and triple( n=1)with clinical relief and stable renal function.One case of bleeding at puncture site during PTA had treatment failure with a gradual loss of graft function.One ineffective case of PTA was subsequently placed with an endovascular stent.However, repeated stent dilation failed due to restenosis.After surgical exploration, vascular stent removal and transplantation of renal artery clipping, clinical symptoms were relieved. Conclusions:Male recipient, low body weight or young donor may be risk factors for transplant renal artery stenosis(TRAS)during pediatric donor renal transplantation.A higher flow rate of transplanted renal artery on ultrasonography could not confirm the diagnosis of TRAS.Greater arterial flow and associated clinical manifestations often hint at a strong possibility of TRAS, requiring drug or invasive treatment interventions.If PTA efficacy is not satisfactory, multiple treatments should be performed.Nevertheless, stenting should be avoided as far as possible to prevent in-stent restenosis.

Objective:To explore the feasibility and efficacy of kidney transplantation with pediatric donors to pediatric recipients (PTP) according to the quality control parameters of kidney transplantation in China.Methods:From September 2011 to September 2019, the clinical data were reviewed for 147 children undergoing kidney transplantation. The general status of donors and recipients, survival rate and complications of transplantation were analyzed.The median age was 130(21-270) month and the median weight 26.0(8.5-71.5) kg. The median age of 120 donors was 12 month (4 day-180 month) and the median weight 9.3(2.5-50.0) kg.Results:After a follow-up period of 10 days to 9 years, the cumulative survival rates of patients and grafts were 97.3% and 88.8%. The cumulative survival rates of patients and grafts were 95.7% and 60.9% in en bloc kidney transplant recipients versus 96.8% and 94.2% in single kidney transplant recipients. The major complications of en bloc kidney transplantation were graft thrombosis (47.8%) and ureteral complications (17.4%). Single kidney transplantation was characterized by delayed graft function recovery (DGF, 18.6%) and acute rejection reaction (10.5%). Two cases died from donor-derived infection after transplantation, one from cytomegalovirus infection and one from epileptic seizure.Conclusions:PTP kidney transplantation is effective. Organ matching and optimal operative mode selection are essential. Preventing postoperative thrombosis for avoiding an early graft loss has remained a high priority during PTP kidney transplantation.

Objective:To explore the application of high-throughput second-generation gene sequencing technology based upon metagenomics in the diagnosis of pulmonary infection after organ transplantation.Methods:From June 2016 to January 2020, clinical records were retrospectively reviewed for 34 renal and liver transplant recipients hospitalized for pulmonary infection. From June 2016 to December 2018, they were assigned as group A (n=20) of traditional pathogen detections. From January 2019 to January 2020, 14 cases in group B were sequenced by high-throughput second-generation technology. The detection rate, sensitivity and specificity, the return time of detection results, the average length of stay and the mortality of 28 days between two groups were analyzed.Results:No significant inter-group difference existed in clinical data (age, gender, antibody induction method, immunosuppressant use, etc.). As compared with group A, the positive detection rate of etiology and the the sensitivity were higher in group B and the differences in specificity were statistically insignificant. The return time of test results in group B was significantly shorter than that in group A. And the difference was statistically significant. The average hospitalization stay and 28-day mortality of group B were lower than those of group A. And the differences were statistically significant.Conclusions:High-throughput second-generation gene sequencing technology can improve the detection rate of pulmonary infection after organ transplantation. Providing a " precise and accurate" direction for disease treatment, it is a useful supplement to traditional diagnostic methods.

Objective To summarize the pathogenic characteristics and treatments of parvovirus B19 infection in patients after renal transplantation .Methods Twenty-two cases of parvovirus B19 infection after renal transplantation were diagnosed by quantitative polymerase chain reaction (qPCR) from March 2016 to January 2019 .And the pathogenic characteristics and treatments of parvovirus B19 infection after renal transplantation were analyzed .Results The overall incidence rate of parvovirus B19 after renal transplantation was 2 .97％ .The median diagnostic time was 39 (15～572) days .Administration of intravenous immunoglobulin (IVIG) ,conversion of immunosuppressants and other comprehensive regimens were adopted .Except for 1 patient dying from cardiovascular accident at 4 days post-diagnosis , the remainders were cured . The accumulative dosage of IVIG was (7 .7 ± 3 .8) g/kg in 5 patients with delayed conversion and un-conversion of immunosuppressants ,and (2 .7 ± 1 .9) g/kg in 16 patients with early conversion of immunosuppressants .During a follow-up period of (13 .0 ± 9 .1) months ,the level of hemoglobin remained stable .Conclusions Parvovirus B19 infection after renal is predominant immediately after transplantation .And the dosage of IVIG may be lowered by an early conversion of immunosuppressants after a definite diagnosis .

Objective To compare HLA loci versus eplet match in predicting de novo DSA after renal transplantation and establish a risk stratification scheme based upon eplet mismatch for predicting the risk of de novo DSA .Methods A retrospective analysis of HLA serological versus and eplet mismatch was performed for 141 pairs of donors and recipients .And the predictive power of de novo DSA was evaluated by the follow-up results .Based upon eplet mismatch ,a preliminary scheme of risk stratification was established and experimentally verified .Results No significant difference existed in HLA serological mismatch between de novo DSA and DSA negative groups (10 .40 vs 8 .94 ,P=0 .1224) while there was a significant difference in eplet mismatch (100 .60 vs 70 .37 , P< 0 .0001 ) . The risk stratification scheme based upon HLA serological mismatch could not differentiate de novo DSA-free rates between low/medium/high-risk groups (100％ vs 94 .74％ vs 90 .41％ , P=0 .4485 , P=0 .4506 , P=0 .2060 ) .Instead the novel scheme based upon eplet mismatch revealed significant difference in the prevalence of de novo DSA between low /medium/high-risk groups (100％ vs 91 .04％ vs 66 .67％ ,P=0 .0001 ,P=0 .0001 ,P<0 .0001) .Conclusions As a better tool of predicting de novo DSA ,Eplet match is vital for the risk stratification scheme of de novo DSA .