ABSTRACT
Objective:To explore the clinical value of peripheral blood lymphocyte subsets in the differential diagnosis of BK virus nephropathy (BKVN) in renal transplantation recipients.Methods:From 2014 to 2018, a total of 172 renal transplant recipients were recruited. Their peripheral blood lymphocyte subsets were detected. According to the pathological puncture results of transplanted kidney, they were divided into acute rejection group (AR, n=68), BKVN group ( n=73) and stable graft function group (STA, n=31). The proportion and absolute number of peripheral blood lymphocyte subsets in each group were measured by flow cytometry and the proportion and absolute count of peripheral blood lymphocyte subsets in each group compared. Results:The proportion and absolute number of CD19 + B cells were markedly lower in BKVN group than those in AR group ( P=0.005, 0.003; 8.5% vs 13.2%, 0.094×10 9/L vs 0.202×10 9/L) and STA group ( P=0.005, 0.003; 8.5% vs 14.8%, 0.094×10 9/L vs 0.198×10 9/L); the proportion of CD3 + CD8 + T cells was significantly higher in BKVN group than that in AR group ( P=0.013; 36.9% vs 31.2%). In addition, no obvious difference existed in the proportion and absolute number of lymphocytes, CD3 + T, CD3 + CD4 + T and CD16 + CD56 + natural killer (NK) among three groups ( P>0.05). No obvious difference existed in the proportion of CD3 + CD4 + / CD3 + CD8 + T cells among three groups ( P>0.05). Conclusions:No difference exists in T cell-related lymphocyte subsets between BKVN and acute rejection recipients. However, the number and proportion of CD19 + B cells decrease markedly in BKVN.
ABSTRACT
Objective@#To explore the clinicopathological features and the renal biopsy process of a case of IgG4-related chronic interstitial nephritis with perirenal capsule involved and review associated literature to improve the clinician's understanding for this disease and to perform a better renal biopsy.@*Methods@#The onset, diagnosis and treatment course of the disease were described and associated literature were reviewed to summary the clinicopathologic features and key points in renal biopsy.@*Results@#The data of the patient showed that the urine specific gravity was 1.011, with urine protein ± and urine sugar 3+. The concentration of hemoglobin was 53 g/L, serum creatinine was 1665 μmol/L, and IgG4 was 9.39 g/L. Computed tomography showed that both kidneys enlarged slightly with decreased density and low density shadow around the kidneys. On contrast-enhanced scan, irregular low-density enhancement areas were found in both kidneys, and the edge of the boundary was not clear. For the first renal biopsy, no renal parenchyma was found except mainly hyaline collagen fibrils. At the second time, 3 pieces of tissues were obtained, which showed chronic interstitial glomerulonephritis. The IgG4 positive plasma cells were about 60/HPF and the IgG4+/IgG+cells ratio was more than 40%. The diagnosis of IgG4-related chronic interstitial glomerulonephritis was confirmed. After corticosteroid treatment, the serum creatinine decreased to 502 μmol/L after the patient got rid of dialysis.@*Conclusions@#There are various manifestations of renal damage caused by IgG4-related disease. It is necessary to pay attention to the involvement of the perirenal capsule, and to balance the risk of bleeding and poor sampling in renal biopsy.
ABSTRACT
Objective To improve clinicians’ understanding of post transplant lymphoproliferative disorder (PTLD) after renal transplantation,a rare case of this disease was reported and literature was reviewed.Method The clinical data and pathological changes of the allograft,immunohistochenmistry (IHC) and in situ hybridization (ISH) were analyzed.In addition,the relevant literature was reviewed.The clinicopathological features and differential diagnoses of PTLD were discussed.Result A renal mass (5.6 cm × 5.4 cm),which was suggestive of primary renal malignancy,had been detected on the patient after received renal transplantation for a year and a half.Grossly,the mass was 7cm in diameter,with fleshy texture.Microscopically,the renal parenchyma was destructed and infiltrated with massive inflammatory cells,mostly lymphoid cells and occasionally Reed-Steruberg-like cells.IHC showed CD20 and CD79a were predominantly expressed in lymphoid cells.ISH showed diffused Epstein-Barr virus encoded RNAs (EBERs) positivity.The above findings were consistent with PTLD,polymorphic B cell hyperplasia (polymorphic PTLD),with concurrent EpsteinBarr virus infection.Conclusion Lymphoid infiltration in a renal allograft needs to be differentiated from T-cell rejection,viral infection,nephropyelitis,as well as PTLD.Early detection and proper management of PTLD may help improve the graft survival rate.
ABSTRACT
Objective JC virus (JCV) infection is more common than BK virus (BKV) in general population.Systematic studies on the characteristics of JC virus nephropathy (JCVN) in renal transplant recipients are lacking.Therefore,we summarize 4 cases of JCVN in renal transplant recipients,which were diagnosed in our center in recent 10 years.Methods 165 cases of polyomavirus nephropathy (PVN) were diagnosed in our center from 2007 to 2017.Four cases of JCVN were diagnosed through the negative BKV but high JCV load in urine or blood,and positive SV40-T in the biopsy samples.Meanwhile,clinicopathological data were collected.Results At pathological diagnosis documented (87 ± 41 months after transplantation):the median levels of urinary decoy cells and JCV DNA in urine were 1/10 HPF and 5.35 × 108 copies/mL,respectively;only one patient's JC viremia was positive with 327 copies/mL.The mean level of serum creatinine (Scr) was 144 μmol/L,and the mean level of 24-h urinary protein was 0.94 g.Immunohistological staining showed SV40-T positive region of the 4 cases were all in the renal medulla.Other coexisting pathological features included IgA nephropathy in 2 patients,and suspicious chronic active antibody mediated rejection in one patients.In the latest follow-up,1 recipient got graft dysfunction while the others were in good function,the mean level of serum creatinine was 134μmol/L.Conclusion The difference between BK virus nephropathy and JCVN is that most of the JCVN are diagnosed in the late stage after kidney transplantation,the level of serum creatinine is not so high,viremia is very rare,and virus induced graft injury is not so significant.The overall prognosis of JCVN is relatively good.
ABSTRACT
Objective To investigate the effects of Peiyuan Shengjin Tongqiao Decoction, a Chinese herbal recipe with the actions of supplementing kidney to strengthen lung and dredging orifices , on traditional Chinese medicine (TCM) symptoms and lung function of childhood asthma complicated with allergic rhinitis. Methods Fifty-five childhood asthma complicated with allergic rhinitis were randomized into treatment group(N=28) and control group (N = 27). The two groups were treated with Budesonide and Formoterol Fumarate Powder for Inhalation, and the treatment group was given oral use of Peiyuan Shengjin Tongqiao Decoction additionally. After treatment, the clinical efficacy of the two groups was evaluated, and TCM symptom scores and lung function indexes [ the percentage of forced expiratory volume in the first second to the expected value (FEV1％) and the percentage of peak expiratory flow to the expected value (PEF％) ] were also observed before and after treatment. Results (1)After treatment for 3 months, the total effective rate of the treatment group was 92.86％, being superior to that of the control group (81.48％), and the difference was significant (P<0.01). (2) After treatment, the scores of cough plus asthma, rhinitis symptom scores and overall TCM symptom scores of the two groups were decreased (P < 0.01 compared with those before treatment) , and the rhinitis symptom scores and overall TCM symptom scores of the treatment group were lower than those of the control group (P < 0.01). (3) After treatment, PEF％ and FEV1％ were both improved in the two groups (P < 0.05 compared with those before treatment) , and the improvement in the treatment group was superior to that in the control group (P <0.05). Conclusion Peiyuan Shengjin Tongqiao Decoction is effective for the control of childhood asthmacomplicated with allergic rhinitis by improving rhinitis symptom scores, overall TCM symptom scores and lung function.
ABSTRACT
Objective: To investigate the effect of celastrol on the apoptosis of human osteosarcoma cell line HOS, and to explore the underlying mechanism. Methods: After treatment with different concentrations (0, 1.5, 2.5, 3.5 and 4.5 μmol/L) of celastrol for 24 h, the proliferation of HOS cells was detected by CCK-8 assay to determine the optimum experimental concentration (3.0 μmol/L). The cell morphology was observed by inverted phase contrast microscopy, and the apoptotic morphology was detected by fluorescence microscopy after Hoechst33258 staining. The apoptotic rate and Ca2+ concentration were analyzed by flow cytometry. The expressions of binding immunoglobulin protein (BIP), calnexin (CNX), endoplasmic reticulum oxidoreductin 1-L alpha (Ero1-Lα), protein disulfide isomerase (PDI), inositol-requiring enzyme 1alpha (IRE1α), protein kinaselike endoplasmic reticulum kinase (PERK), phosphorylated-PERK (p-PERK), CCAAT/enhancerbinding protein homologous protein (CHOP), cleaved-caspase-12 (c-caspase-12) and c-caspase-3 were determined by Western blotting. Results: The different concentrations of celastrol inhibited the proliferation of HOS cells in a dose-dependent manner (all P < 0.05). After treatment with 3 μmol/L celastrol for 24 h, the morphology of HOS cells was obviously atrophic and disordered, the floating cells increased, and the typical morphological changes of apoptotic cells such as nuclear pyknosis and fragmentation appeared. As compared with the untreated control group, the apoptotic rate and Ca2+ concentration in HOS cells treated with 3 μmol/L celastrol for 24 h were significantly increased (both P < 0.05), and the expressions of endoplasmic reticulum stressrelated marker proteins BIP, CNX, Ero1-Lα, PDI, IRE1α, p-PERK and endoplasmic reticulum stress-mediated apoptosis-related proteins c-caspase-12, CHOP and c-caspase-3 were upregulated (all P < 0.05). Conclusion: Celastrol can induce the apoptosis of human osteosarcoma HOS cells, and the mechanism may be related to endoplasmic reticulum stress-mediated apoptosis pathway.
ABSTRACT
This article narrates the present situation of hospital metrology management, enumerates all sorts of malpractices, and puts forward some corresponding measures in such aspects as the setting of hospital-metrology-management standard, the completion of hospital-metrology- management archives and the reinforcement of metrology appraisal.