Objective:To explore the clinical characteristics and outcomes of SARS-CoV-2 infection in kidney transplant recipients(KTRs)and examine the risk factors for severe/critical infection.Methods:A retrospective analysis was conducted for 208 adult KTRs diagnosed with SARS-CoV-2 infection between December 15, 2022, and March 15, 2023.They were assigned into two groups of mild/ordinary(n=168)and severe/critical(n=40)according to the severity of SARS-CoV-2 infection.Two groups were compared with regards to general profiles, status of baseline vaccination against COVID-19, transplant history, immunosuppressive regimens, comorbidities and treatment outcomes.For continuous variables, t or Mann-Whitney U test was utilized for comparing the inter-group differences.For categorical variables, chi-square or Fisher's exact test was employed.Bonferroni correction was applied for multiple comparisons when p value was ≤0.05.Logistic regression analysis of univariates and multivariates was conducted for identifying the risk factors for severe/critical infections.Results:The rates of hospitalization, severe illness, ICU admission, mechanical ventilation and mortality among 208 KTRs with COVID-19 were 27.4%(57/208), 19.2%(40/208), 3.4%(7/208), 5.3%(11/208)and 1.9%(4/208)respectively.Among 57 COVID-19 infected individuals, 43.9%(25/57)experienced bone marrow suppression with an incidence of anemia 36.8%(21/57)and thrombocytopenia 22.8%(13/57). The lowest counts of whole blood lymphocyte, CD4 + T lymphocyte and CD8 + T lymphocyte were 390.0(245.0, 615.0), 138.0(78.0, 293.5)and 180.0(94.7, 575.2)cells/μL respectively.The incidence of bacterial, cytomegaloviral, Pneumocystis jirovecii and other fungal infections after COVID-19 infection was 17.8%(37/208), 3.8%(8/208), 2.9%(6/208)and 2.9%(6/208)respectively.The severe/critical group had a higher incidence of other pathogen infections as compared to mild/ordinary group, including bacterial infections[62.5%(25/40)vs 7.1%(12/168), 95% CI: 47.5%~63.3%, P<0.001], cytomegaloviral infections[15.0%(6/40)vs 1.2%(2/168), 95% CI: 8.1%~19.5%, P=0.001], P.jirovecii infections[15%(6/40)vs 0(0/168), 95% CI: 9.4%~20.6%, P<0.001]and other fungal infections of Candida, Cryptococcus, Malassezia and Aspergillus fumigatus[15.0%(6/40)vs 0(0/168), 95% CI: 9.4%~20.6%, P<0.001]. The incidence of acute kidney injury(AKI)after COVID-19 infection was 13.5%(28/208)and severe/critical group had a higher incidence of AKI than mild/ordinary group[52.5%(21/40)vs 4.2%(7/168), 95% CI: 40.3% to 56.3%, P<0.001]. Univariate analysis showed that age( P=0.003), male gender( P=0.002), smoking history( P=0.012), coronary heart disease( P=0.011), diabetes mellitus( P=0.002), chronic renal insufficiency( P=0.001)and pulmonary disease history( P=0.001)were significantly different between severe/critical and mild/ordinary groups.Multivariate regression analysis revealed that comorbid chronic kidney disease( OR=3.34, 95% CI: 1.46-7.64, P=0.004)and a history of lung disease( OR=3.42, 95% CI: 1.49-7.87, P=0.004)were independent risk factors for severe/critical illness.Baseline vaccination rate against COVID-19 was 17.8%(37/208). Completion of baseline vaccination was associated with a lower risk of severe/critical COVID-19 infection( OR=0.28, 95% CI: 0.08-0.98, P=0.047). Conclusions:KTRs with severe/critical COVID-19 infections are more prone to multiple pathogen co-infections and the incidence of kidney function impairment after infection has remained relatively high.Histories of pulmonary and chronic kidney diseases are independent risk factors for severe/critical infections.Completion of baseline vaccination provides protection against severe/critical infections.

OBJECTIVETo assess the association of extracellular superoxide dismutase (EC-SOD) gene methylation with cerebral infarction.

METHODSEighty-three patients with cerebral infarction and 94 healthy controls were enrolled. Based on cerebral MR findings, the size of infarction, extent of intracranial atherosclerosis, the National Institutes of Health Stroke Scale (NIHSS) score, and Barthel index were calculated. Methylation-specific PCR was used to analyze the methylation status of the EC-SOD gene in peripheral blood samples and its correlation with cerebral infarction.

RESULTSThe rate of EC-SOD gene promoter region methylation of the cerebral infarction group was lower than that of the control group (30.1% vs. 53.2%, P < 0.05). Patients with larger area of cerebral infarction (>4 cm in diameter) showed a lower methylation rate than those with a smaller cerebral infarction (0 vs. 39.1%, P < 0.05). Based on their cerebral MRA, 57 patients were divided into none, mild, moderate, and severe cerebral arteriosclerosis groups. The rate of EC-SOD gene methylation of the four groups showed a downward trend (at 45.5%, 42.9%, 23.8%, and 14.3%, respectively), though no statistical significance was found (P > 0.05). For the cerebral infarction group, those with higher rate of methylation had lower NIHSS scores (P < 0.05) but insignificantly higher Barthel index (P > 0.05).

CONCLUSIONThe EC-SOD methylation frequency of case group was lower than the control group. The methylation status is associated with the size of cerebral infarction, degree of cerebral arteriosclerosis and severity of neurological impairment.

Aged ; Cerebral Infarction ; genetics ; DNA Methylation ; Extracellular Space ; enzymology ; Female ; Humans ; Male ; Middle Aged ; Superoxide Dismutase ; genetics

Ischemic stroke is mainly seen in the elderly,and more than 90％ of the patients have suffered hypertension.Thiazide diuretic is one of the five types of the first-line antihypertensive drugs,its characteristics include relaxation in action,a broad spectrum of anti-hypertension,exact effect,safety,and low price.It has been used for antihypertensive treatment for more than 50 years.As global evidence-based medicine,it is especially suitable for the elderly patients.Thiazide diuretic can effectively reduce the incidence and recurrence of stroke for the elderly hypertensive patients,no matter how it is used alone or in combination with other antihypertensive drugs,the efficiency of thiazide diuretic has withstood the test of time and practice and has been confirmed with clear evidences.Thus,in the elderly patients at high-risk for ischemic stroke,the use of this effective antihypertensive drug should be further emphasized.

Objective To explore the clinical effects of S-1 single agent chemotherapy for the patients undergoing radical resection of cholangiocarcinoma.Methods The clinical data of 51 patients receiving radical resection of cholangiocarcinoma who were admitted to the Second Affiliated Hospital of Zhejiang University from November 2011 to December 2013 were retrospectively analyzed.After radical resection of cholangiocarcinoma,25 patients receiving non-special treatment and 26 patients receiving S-1 single agent chemotherapy were divided into the operation group and chemotherapy group,respectively.S-1 was taken orally twice per day.Forty mg/once of S-1 was applied to patients with the body surface area ＜ 1.25 m2,50 mg/once of S-1 was applied to patients with the body surface area ≥ 1.25 m2 and ＜ 1.50 m2,and 60 mg/once of S-1 was applied to patients with the body surface area ≥ 1.50 m2.The 14 days usage and 7 days withdrawal of S-1 were used as one course of treatment.The standard usage of S-1 was 6-8 courses of treatment.All the patients were followed up by outpatient examination and telephone interview till December 1,2014.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results Twenty-six patients in the chemotherapy group finished the courses of chemotherapy without chemotherapy-related death,and 14 patients had chemotherapy adverse reactions with remission after discontinuation of S-1.All the 51 patients were followed up for 5-37 months with a median time of 19 months.The median overall survival time,1-,3-year overall survival rates,tumor-free median survival time and 1-,3-year tumor-free survival rates were 22 months (range,18-27 months),72.3％,42.9％,21 months (range,16-26 months),60.0％,55.0％ in the operation group and 32 months (range,29-35 months),84.6％,44.4％,26 months (range,21-31 months),76.9％,61.9％ in the chemotherapy group,respectively.There was a significant difference in the overall survival between the 2 groups (x2=6.032,P ＜ 0.05).There was no significant difference in the tumor-free survival between the 2 groups (x2=0.498,P ＞ 0.05).Conclusion S-1 single agent chemotherapy after radical resection of cholangiocarcinoma could improve the survival of patients,while no obvious advantages of inhibiting tumor recurrence is observed.

Objective To assess the feasibility of computed tomography angiography (CTA) in renal artery using the iterative reconstruction technique (iDose4) in Brilliance iCT (Philips Ltd.).Methods 90 patients (body weight 60-70 kg) supposed to undergo renal artery CTA were selected and randomly divided into three groups:A(120 kV,120 mAs),B(120 kV,60 mAs) and C(100 kV,100 mAs).CTA images from Group A were obtained using filtered back projection and those from the rest groups were generated by iDose4.Then CT number of renal artery,noise (denoted as standard deviation SD),signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of images for each group were measured and recorded.Images were post-processed using volume reformation (VR) 3D imaging and image quality were assessed in five-level grade (1-5).Results The five parameters (CT number of renal artery,SD value,SNR,CNR and VR grade) of group A and group B were statistically insignificant (P ＞ 0.05).While SD values of group C were comparable to those of group A and B,the rest four parameters of group C were apparently larger,which was statistically significant (tCT value =-12.326,tSNR =-7.136,tCNR =-7.649,ZVR =-2.690,PVR ＜ 0.05).Conclusions Image quality could still fit the diagnosis requirements using iDose4 when mAs decreased lower than 50％.The image quality increases when radiation dose is halved at 100 kVp kV.

Objective To investigate the imaging features of splenic littoral cell angioma (LCA)and correlate with pathological findings.Methods Ten patients of LCA with pathologically confirmed diagnosis were included in this study.A retrospective review of clinical data and imaging findings on CT and MRI was performed,along with review of the literature.Results Splenic littory cell angiomas presented with multiple nodules of varying sizes with a predoninance of small ones.Nine of 10 patients had clinical symptoms of splenomegalia and hypersplenia.MR T2WI and DWI showed masses with high-signalintensity.The CT and MRI enhancing pattern of LCA was similar to splenic hemangioma.There were many mammiliform structures pointing inside in the wall of the vascular channels,a hallmark feature allowing its differentiation from splenic hemangioma pathologically.Conclusion The CT and MRI findings of LCA can show some of its characteristic signs,especially on DWI,which can assist to identify LCA in clinical practice.

Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.

Objective To analyze and identify the differentially expressed proteins in human renal tubular epithelial cells (HK-2) after injury caused by oxalic acid and calcium oxalate monohydrate (COM) crystal, and to explore the potential role of renal tubular cell injury in kidney stone formation.Methods Normal HK-2 cells were cultured in vitro and the culture medium was changed with serum-free medium after cell growth to confluence. Oxalic acid and COM crystals (final concentration at 2 mmol/L and 200 mg/L, respectively) were added in the experimental group. Cells in both groups were then incubated at 37 ℃ for 12 h. The extracted proteins from both groups were separated by two dimensional electrophoresis followed by analysis, and the differentially expressed proteins were identified by liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS). Two identified proteins were then verified by western blot. Results Reproducible two dimensional gel images of the proteins from both groups were successfully obtained. By using LC-ESI-MS/MS, 12 proteins: FK506-binding protein 4, isoform alpha-enolase of alpha-enolase, isoform M1 of pyruvate kinase isozymes M1/M2, ATP synthase subunit alpha, isoform 1 of 3′(2′), 5′-bisphosphate nucleotidase 1, isoform 2 of nucleophosmin, L-lactate dehydrogenase B chain, Budding uninhibited by benzimidazoles 3, Cofilin-1, Fascin, pyIsoform 1 of cytosol aminopeptidase, were identified. The deferentially expressed proteins were related to cellular processes including energy metabolism, cell multiplication, apoptosis, Ca2+ channel activity regulation, cell movement and signal transduction. Western blot verified that higher ENO1 but lower Cofilin-1 expressed in HK-2 cells after the injury. Conclusions High level oxalic acid and COM crystals can cause protein expression profile changes in normal human HK-2 cells. The changes of protein expression may not only protect HK-2 cells from being injured, but also be related to kidney stone formation.

BACKGROUND: The number of living renal donation has increased in China and abroad, thus, it is important to guarantee the safety of donors. How to accurately diagnose potential renal disease and provide guidance plays an import role in protecting safety of living renal donors.OBJECTIVE: To establish an evaluation method for analyzing the correlation between histological abnormalities and clinical predonation parameters.METHODS: The related data on renal transplantation of Fuzhou general Hospital of Nanjing Military Area Command of Chinese PLA were retrospectively reviewed. Paracentesis were performed when the vessels of kidney were mutilated and perfusions were finished. Time-zero renal biopsy was evaluated for following pathological changes: interstitial fibrosis, tubularatrophy, arteriolar hyalinosis, mesangial proliferation, and glomerulosclerosis. Predonation data were demography, body weight, body mass index' systolic/diastolic blood pressure, serum creatinine, glomerular filtration rate, and proteinuria.RESULTS AND CONCLUSION: There were no signs of kidney disease in preoperative examination of all the 62 patients, time-zero renal biopsy found there were 28 donors with histological changes, interstitial fibrosis with age and serum creatinine, tubularatrophy with diastolic blood pressure and protein excretion rate, arteriolar hyalinosis with serum creatinine and glomerular filtration rate, mesangial proliferation only with body mass index, and finally the presence of glomerulosclerosis did not correlate with any variable.

BACKGROUND: Presently, the kidney source is limited. Urinary fistula-induced nephrectomy of transplanted kidney is regrettable. Reasonable diagnosis of urinary fistula should be paid great attention by workers of organ transplantation. OBJECTIVE: To study the diagnosis and treatment of the urinary fistula in kidney transplantation patients. METHODS: The clinical data of 16 patients with the urinary fistula following kidney transplantation, who was recruited from the Organ Transplantation Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, were retrospectively analyzed. RESULTS AND CONCLUSION: The morbidity of the urinary fistula following kidney transplantation was 1.26%, the conservative treatment were used to 13 cases of simple urinary fistulas, 11 of 13 cases were successful (84.6%). 2 case failed (15.4%), pedicled omentum grafts were successful used to treat 3 cases of complex urinary fistulas after renal transplantation by one operation. Intensive care and active measures should be given to the urinary fistula patients after kidney transplantation. The key to the successful treatment involved with the diagnosis in early stage and the correct measures. With biological characteristics of omentum, applying pedicled omentum grafts to repair complex urinary fistulas and simple urinary fistulas which were failure of the conservative treatment after renal transplantation has advantages as followings, convenient to draw material, recovering tissue quickly and low recurrence rate. It is fit for clinic.