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This review summarizes the clinical data of one pediatric liver transplant recipient and two adult kidney transplant recipients with posterior reversible encephalopathy syndrome(PRES)at Tongji Hospital of Huazhong University of Science & Technology.The relevant clinical characteristics of recipients are discussed for providing reference for clinical diagnoses and treatments.
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Objective:To summarize the incidence of acute rejection (AR) after pediatric kidney transplantation (KT) at a single center and examine its impact on graft/patient survival and risk factors for AR.Methods:This is a retrospective cohort study including pediatric recipients who underwent kidney transplantation in past 8 years.After excluding recipients of graft thrombosis within a week post-transplant and lost to follow-ups, a total of 143 cases were ultimately recruited and assigned into two groups of AR (n=29) and non-AR (n=114).Basic profiles of both donors and recipients and graft/patient survival rate were compared between two groups.Relative risk factors for AR episodes were also examined by Logistic regression.Results:Renal grafts for 130/143 cases (90.9%) were harvested from deceased donors and 120(83.9%) cases from children.Twenty-seven transplants (18.9%) were performed in infants and young recipients aged < 3 years.During a median follow-up of 33 months, 34 AR episodes occurred in 29(20.3%) patients.Rate of re-transplantation (27.6% vs. 7.9%), pediatric donor (96.5% vs. 80.7%) and rabbit anti-human thymocyte globulin (rATG) induction (79.3% vs. 36%) were significantly higher in AR group than non-AR group ( P=0.007, P=0.046, P<0.001).Multivariate regression analysis indicated that basiliximab induction caused a significant reduction in the risk of AR incidence as compared with rATG induction (odds ratio 0.13, 95% confidence interval 0.04-0.43, P<0.001).The median time of AR incidence was 1.3 months post-transplantation and 23 episodes (67.6%) were confirmed by biopsy.After anti-rejection treatment, 52.9%(n=18) of the cases achieved a full recovery and 38.3% (n=13) had improved graft function.However, 3 cases (8.8%) developed irreversible graft failure.The 1/3-year graft survival rates were significantly lower in AR group than those in non-AR group (75.3% vs. 95.2%, 68.4% vs. 90.4%, P=0.01), and there was no significant difference in 1-and 3-year patient survival rates between two groups. Conclusions:The incidence of AR is relatively high in pediatric renal transplantation, which has an impact on graft survival.Basiliximab induction can effectively reduce the risk of AR.
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Objective:To explore the clinical features of transplanted renal artery stenosis after pediatric donor kidneys in children.Methods:We retrospectively summarized the clinical data in five cases of transplanted renal artery stenosis undergoing deceased pediatric donor kidney transplantation from May 1, 2014 to June 30, 2021.Donor/receptor characteristics, diagnosis, treatment and prognosis were recorded.The median follow-up period was 29 months.The median age of five donors and recipients was 9 and 132 months respectively.En bloc renal allograft( n=2)and single kidney transplantation( n=3)were performed.End-to-side anastomosis was performed for renal arteries.The median diagnostic time of renal artery stenosis was 10(3-60)months post-transplantation.Except for one 3-year-old recipient with an earlier onset of stenosis, four stenotic cases during a rapid growth period had a maximal height increase of 30 cm post-transplantation.Three of them had a history of surgery at graft site, including previous kidney transplantation( n=1)and transplant urinary tract reconstruction( n=2). All five cases had hypertension and two showed an elevated serum level of creatinine.Ultrasound indicated a significantly elevated flow rate of >300 cm/s( n=4)and CTA/MRA indicated that the degrees of stenosis varied from 50% to 95%( n=5). Results:After balloon dilatation, stenosis either improved( n=2)or relapsed( n=2). Further stenting succeed( n=1)or failed( n=1). One case of stenosis was relieved partially after 6-month observation without any invasive treatment. Conclusions:As a serious complication, transplant renal artery stenosis is common after pediatric donor kidney transplantation.Too small size in donor kidney and rapid recipient growth may be specific risk factors.After diagnosis, balloon dilation is a preferred treatment.Stent placement should be cautiously employed.
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Continuous intracranial hypertension in patients with severe traumatic brain injury(sTBI) is the key factor of secondary brain injury.The management of elevated intracranial pressure (ICP) can improve the outcome.ICP monitoring methods are divided into invasive and non-invasive.Non-invasive monitoring has not yet reached a level of sufficient accuracy for treatment decisions in clinical practice as invasive monitoring.The gold standard to measure ICP is through an external ventricular drain coupled to an external fluid-filled transducer measurement.The treatment strategy of sTBI is stratified.It can be divided into baseline care, first tier therapies and second tier therapies according to the difficulty of management and treatment risk.The therapeutic targets are mitigating intracranial hypertension, optimizing cerebral perfusion and oxygenation, and preventing or reversing cerebral herniation.From the baseline care, sTBI patients gradually upgrade the therapies until the targets are achieved, so to improve the outcomes of sTBI children.
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Objective:To identify clinical characteristics of slit ventricle syndrome (SVS) in children, thus improving pediatricians′ understanding of pediatric SVS.Methods:Clinical data of children diagnosed as SVS in the Emergency Department of Beijing Children′s Hospital, Capital Medical University from June 2015 to May 2019 were collected and retrospectively analyzed.Results:A total of 10 children with SVS were included, including 3 cases of arachnoid cyst, 3 cases of congenital hydrocephalus, 2 cases of Dandy-Walker syndrome, 1 case of idiopathic intracranial hypertension syndrome, and 1 case of hydrocephalus secondary to intracranial hemorrhage as the primary disease.The age of first shunting, and that at diagnosis of SVS were 1.3 (0.3-12.8) years, and 9.9 (3.8-13.3) years, respectively.SVS-associated symptoms appeared in 4.4 (0.5-12.0) years after shunting, including intermittent headache (10/10 cases), vomiting (10/10 cases), irritability (4/10 cases), seizures (5/10 cases), diminution of vision (2/10 cases), and intracranial hypertension (10/10 cases) at varying severities.When SVS occurred, the cerebral ventricle presented slit-like morphology.Three cases were relieved with mannitol treatment and 7 cases were treated with emergency lumbar-peritoneal shunt after mannitol failure.During 1-5 years of follow-up, 9 patients did not have SVS-associated symptoms and 1 case with medical therapy had recurrences.Conclusions:SVS is a rare complication after shunt surgery, with the clinical manifestations of intermittent headache and slow valve refilling conforming; imaging showed that the cerebral ventricle was slit-like morphology.When there are signs of intracranial hypertension after shunting and there is no cerebral ventricle dilatation in imaging, SVS should be highly vigilant.Once SVS is confirmed, surgical intervention should be introduced as early as possible after treatment failure of medication, so as to improve the prognosis.
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Objective:To explore the efficacy and safety of a novel Tripterygium preparation (Kunxian Capsules)in kidney transplant recipients developing refractory proteinuria after transplantation.Methods:A total of 59 kidney transplant recipients received regular follow-ups from August 2018 to July 2021.Severity of proteinuria, kidney graft function and adverse effects were retrospectively recorded before and at Month 1/2/3/6 months after Kunxian treatment.They were divided into two groups of effective and void to explore the potential effect-related factors.Results:Six-month treatment was completed in 57 patients except for 2 cases of discontinued treatment due to severe adverse effects.A significant reduction in amount of proteinuria was observed at Month 1 [1.09(0.42, 2.59 g/24 h)vs 1.82(1, 2.7 g/24 h, P<0.01)]and the trend continued during subsequent follow-ups.Twenty-nine patients(50.9%)responded remarkably.Eighteen patients(31.6%)showed no response.The overall effective rate was 68.4%.Inter-group comparison revealed strong correlations between treatment efficacy and baseline serum creatinine levels, early initiation of treatment and symptom duration from onset to treatment.Kidney graft IgA nephropathy demonstrated the highest effective rate(11/13, 84.6%). Furthermore, elevated blood concentration of tacrolimus hinted at a potential drug interaction. Conclusions:Kunxian Capsules is efficacious and safe for renal transplant recipients developing moderate-severe proteinuria and not responding to traditional medications.Early initiation of treatment before graft function decline is recommended.Reducing tacrolimus dose cautiously in advance and monitoring adverse events are also essential.
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Objective:To investigate the prognosis of pediatric arterial ischemic stroke(PAIS).Methods:We retrospectively analyzed the clinical data of patients aging from 1 month to 18 years old who were diagnosed with PAIS at the Emergency Department of Beijing Children′s Hospital from July 2015 to April 2020.We used the modified Rankin scale(MRS)to evaluate patients.We analyzed their recovery of neurological function, mortality rates, and the recurrence of PAIS, while statistically calculating the risk factors leading to disability and death caused by PAIS.Results:A total of 101 children with PAIS were involved.During the follow-up period, 32.7%(33/101)had no obvious neurological sequelae(MRS 0), and 24.8%(25/101)had mild symptoms that did not affect the patients′daily life(MRS 1). The proportion of mild disability(MRS 2)and moderate to severe disability(MRS 3-5)were 13.9%(14/101)and 9.9%(10/101), respectively.Notably, 18.8%(19/101)of the patients died during the follow-up period, and PAIS-related fatality rate was 7.9%.Of the 49 patients with MRS score of 1-5, 89.8%(44/49)had dyskinesia, 16.3%(8/49)had language disorder, 10.2%(5/49)had epilepsy, 10.2%(5/49)had intellectual impairment, and 4.1%(2/49)had memory impairment.Four children relapsed during the follow-up period.Infantile onset, cardiogenic stroke, consciousness disorder and multiple angiopathy may be the risk factors of severe disability and death of PAIS.Conclusion:PAIS has a certain probability of mortality and disability.Infantile onset, complicated with consciousness disorder, cardiogenic stroke and multiple angiopathy are risk factors for poor prognosis.
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Both hyperkalemia and hypokalemia crisis are potentially life-threatening electrolyte disorder.The abnormality of potassium concentration in plasma is mainly caused by potassium cell shift and the abnormal renal potassium excretion.It is regulated by many factors such as insulin, catecholamine, acid-base balance and aldosterone.To prevent or treat life-threatening complications, correct hyperkalemia or hypokalemia, diagnose and treat potential causes are treatment strategies for severe abnormalities of blood potassium.
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Three hundred and nine patients with thyroid nodules detected by physical examination in Harrison International Peace Hospital from October 2013 to October 2017 were divided into intervention group (155 cases) and control group (154 cases). Patients in intervention group received oral levothyroxine sodium 25 g / d for 12 months and those in control group had no treatment, patients were followed up every 3 months to 12 months. After treatment, the maximum diameter and thyroid nodule volume of the intervention group were (31.87±3.84) mm and (17.32±0.94) cm3, which were significantly smaller than those of the control group [(34.01±3.72) mm and (24.25±1.21)cm3, P<0.05]. TSH in intervention group was lower than that in control group [(2.24±0.41) vs. (2.52±0.58) mIU/L, P<0.05] and free T4 (FT4) was higher than that in control group [(25.64 ± 3.85) vs. (16.39 ± 3.28) pmol/ L, P<0.05]. TC, TG and LDL?C in intervention group, were lower than those in the control group .The HDL?C level in intervention group was higher than that in control group (all P<0.05). After treatment, there were no malignant changes in the intervention group, while the malignant change rate in control group was 2.6％ (4/154). It is suggested that levothyroxine treatment can reduce TSH level in patients with benign thyroid nodules, inhibit the growth of thyroid nodules.
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Objective To evaluate the efficacy of tigecycline plus prolonged high-dose meropenem infusion in the prevention and treatment of early carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation .Methods From January 2016 to December 2018 ,clinical data were retrospectively analyzed for 13 renal transplant recipients with graft-carried CRKP .The relevant clinical data included treatments and outcomes of grafts and recipients .KPC-2 gene was the only resistance gene detectable in all isolates of CRKP . Among 13 CRKP positive recipients ,there were positive cultures of graft preservation solution ,recipient blood & urine (n=1) , positive cultures of graft preservation solution & urine (n=1) ,positive cultures of graft preservation solutions & peri-graft drainage (n=3) ,continuous positive cultures of peri-graft drainage more than twice (n= 3) and positive culture of graft preservation solution (n= 5).All patients received tigecycline plus prolonged high-dose meropenem infusion-based antibiotics .Results Five patients with CRKP positive in preservation solution were successfully prevented from infection after a treatment period of (12 .4 ± 2 .1)days .Among another 8 cases ,additional topical medications (n= 3) and surgical debridement (n= 1) were used .It took a median time of 16 (7～60) days until a negative culture and the total antibiotic treatment course was 20 (10～93) days .The average hospitalization duration was (50 ± 35) days .During a median follow-up period of 25 (6～28) months ,there was no onset of renal arterial rupture ,graft nephrectomy or death .The survival rate was 100％ for recipients and 92 .3％ for grafts .Conclusions For post-transplant infections due to graft-carried KPC-2 producing CRKP ,rapid diagnostics and tigecycline plus prolonged high-dose meropenem infusion may optimize clinical outcomes by decreasing the rate of graft nephrectomy and the recipient mortality .
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Vasoactive medications in clinical use exert their cardiovascular effects by interacting with adrenergic receptors and non-adrenergic receptors,including vasopressors,inotropes and vasodilators.A classi-fication of vasoactive drugs based on their direct effects on the heart(presence or absence of positive inotropic effects) and on vascular tone(vasoconstriction or vasodilation) include inodilators(dobutamine and milri-none),inoconstrictors(norepinephrine,epinephrine,and dopamine),pure vasoconstrictors(phenylephrine and vasopressin) and pure vasodilators(sodium nitroprusside).Selection of vasoactive medications based on de-sired pharmacologic effects that are matched to the patient′s underlying pathophysiology situation may opti-mize hemodynamics while reducing the potential of adverse effects.
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Objective To investigate the recurrence and satisfaction of paracentesis and segment resection on patients with early plasma cell mastitis,and to choose a more effective and cost-effective treatment.Methods Eighty-nine patients with early plasma cell mastitis received paracentesis in the treatment group and 101 cases received segment resection therapy in the comparison group.The recurrence and satisfaction of patients with early plasma cell mastitis in the two groups were compared.Results (1) The recurrence rates of patients with early plasma cell mastitis received paracentesis or segment resection were 29.21％ and 21.78％,without significant difference (x2 =5.437;P =0.285).(2) No significant differences in pain degree and time of therapy Were observed (P =0.323;P =0.102),but obvious difference in aesthetic measure was found between two groups (P =0.01).Conclusion Ultrasound guided puncture is used to treat patients with early plasma cell mastitis resulted in the therapeutic effect of segmental excision and better patient satisfaction,which has important significance and clinical promotion value for early plasma cell mastitis treatment.