The Risk Factors of mTORi-Associated Posttransplant Proteinuria.

Treatment with mammalian target of rapamycin inhibitors (mTORi) has been associated with an increased incidence of proteinuria after kidney transplantation as compared to other immunosuppressive agents. Proteinuria after mTORi use may occur in different clinical conditions and the precise mechanism remains unclear. The objective of this study was to investigate the related risk factors for proteinuria after mTORi treatment in kidney transplant recipients. This retrospective observational study population consisted of kidney transplant recipients followed up in a medical center in Southern Taiwan from January 1999 to April 2016. The baseline characteristics and transplantation-related profiles were collected at the time of enrollment. We examined risk factors for mTORi-associated proteinuria using a multivariate logistic regression analysis. P < .05 was considered as statistically significant. Hyperlipidemia and obesity at the initiation of mTORi treatment were strong predictors for proteinuria. Earlier identification of these risk factors may assist physicians in deciding the best candidate for mTORi conversion in order to optimize transplantation outcomes.

Risk Factors Associated With Mammalian Target of Rapamycin Inhibitor Withdrawal in Kidney Transplant Recipients.

BACKGROUND: Mammalian target of rapamycin inhibitors (mTORi) play an essential role as novel immunosuppressive agents in kidney transplantation (KT). Treatment cessation usually occurs after adverse effects occur. We investigated the risk factors associated with withdrawal of mTORi in KT recipients and evaluated the outcomes related to the withdrawal. METHODS: The study enrolled KT recipients being followed up in a medical center in southern Taiwan from January 1999 through December 2014. RESULTS: Risk factors associated with mTORi withdrawal were initial proteinuria level, higher initial serum creatinine level posttransplantation, and history of glomerulonephritis as the primary etiology of renal failure. mTORi withdrawal was associated with increased risk of graft failure (hazard ratio [HR], 9.97 [95% confidence interval (CI), 1.03-96.8]; P = .047). Higher body mass index (HR, 11.2 [95% CI, 1.63-76.6]; P = .01) and tacrolimus usage (HR, 8.30 [95% CI, 1.14-60.7]; P = .037) were associated with increased risk of new-onset diabetes after transplantation in mTORi withdrawal groups. CONCLUSIONS: Proteinuria, poor graft function, and primary glomerulonephritis were associated with cessation of mTORi treatment. Earlier identification of these risk factors may prevent further adverse events and optimize transplantation outcomes after mTORi conversion.

The mediating effects of depressive symptoms on nutritional status of older adults in long-term care facilities.

OBJECTIVE: To test whether depressive symptoms mediate the effects of activities of daily living (ADLs) on nutritional status of older adults living in long-term care (LTC) facilities in Taiwan. DESIGN: A cross-sectional study. SETTING: Seventy-three community-based LTC facilities in northern Taiwan. PARTICIPANTS: This study sampled 306 adults ranging in age from 65 to 97 years who were free of acute infection or disease and who were able to communicate. MEASUREMENTS: Nutritional status was assessed by the Mini-Nutritional Assessment (MNA) scale and depressive symptoms were assessed by the short form of the Geriatric Depressive Scale (GDS-SF). RESULTS: MNA scores revealed that 65% of the subjects were at risk for malnutrition (17 to 23.5 points). In addition, depressive symptoms partially mediated the relationship between ADLs and nutritional status, with 10.7% of the effect of depressive symptoms on nutritional status going through the mediator. CONCLUSION: Interventions to reduce depressive symptoms among institutionalized older adults should focus on improving nutritional status rather than promoting ADLs, which are believed to be difficult to change.

Formation of hydrides in (Ti(1-x)Zr(x))Co(2.00) (0 < x < 1) pseudobinary alloys.

The exposure of (Ti(1-x)Zr(x))Co(2.00) intermetallic alloys to hydrogen at high pressure caused (Ti(1-x)Zr(x))Co(2.00) (x = 0.50-0.90) hydrides in the alloy. The crystalline structural, electronic, and magnetic properties of parent alloys and of their hydrides were determined by using XRD (X-ray powder diffraction) and XAS (X-ray absorption spectrometry) and by the use of SQUID (a superconducting quantum interference device). Hydrogenation did not alter the crystal structure of the parent alloy, but it did increase the volume of the unit cell. An in situ Co K-edge XAS study of the hydride revealed that the valence state of Co increased during discharge (which is the release of hydrogen from the hydride). Hydrogenation of the parent alloy also reduced the magnetic moment. A possible mechanism of discharge for the hydride is also proposed.

Structural transformation of LiVOPO4 to Li3V2(PO4)3 with enhanced capacity.

In the present investigation, we report the transformation of alpha-LiVOPO 4 to alpha-Li 3V 2(PO 4) 3, leading to an enhancement of capacity. The alpha-LiVOPO 4 sample was synthesized by a sol-gel method, followed by sintering at 550-650 degrees C in a flow of 5% H 2/Ar. The structural transformation of a triclinic alpha-LiVOPO 4 structure to a monoclinic alpha-Li 3V 2(PO 4) 3 structure was observed at higher sintering temperatures (700-800 degrees C in a flow of 5% H 2/Ar). The alpha-Li 3V 2(PO 4) 3 phase was characterized by X-ray diffraction, scanning electron microscopy, transmission electron microscopy, thermal gravimetric analysis, and X-ray absorption near edge spectrum (XANES) techniques. The valence shift of vanadium ions from +4 to +3 states was observed using in situ XANES experiments at V K-edge. The structural transformation is ascertained by the shape changes in pre-edge and near edge area of X-ray absorption spectrum. It was observed that the capacity was enhanced from 140 mAh/g to 164 mAh/g via structural transformation process of LiVOPO 4 to Li 3V 2(PO 4) 3.

Effect of Co2P on electrochemical performance of Li(Mn0.35Co0.2Fe0.45)PO4/C.

In this paper, we report the synthesis of carbon coated Li(Mn0.35Co 0.2Fe0.45)PO4 and discuss the effect of Co2P formation during the carbothermal reduction process, which enhances the electrochemical performance of cathode material for lithium ion batteries. It was observed that Co2P was favorably formed in 5% H2/Ar than in Ar atmosphere. The conductivity of Li(Mn0.35Co0.2Fe0.45)PO4/C sintered at 600-800 degrees C in 5% H2/Ar is increased as the temperature is increased. The O K-edge X-ray absorption near edge spectrum (XANES) demonstrates that content of hole carriers is increased in Li(Mn0.35Co0.2Fe0.45)PO4/C as the amount of Co2P increased. We also observed that the capacity of Li(Mn0.35Co0.2Fe0.45)PO4/C is increased with sintering temperature, and it exhibited a maximum capacity of 166 mAh/g at 700 degrees C. It was found that the enhancement in the discharge capacity of sintered Li(Mn0.35Co0.2Fe0.45)PO4/C was as a result of its higher electrical conductivity under 5% H2/Ar atmosphere as compared with Ar atmosphere.

Investigation on mechanism of catalysis by Pt-LiCoO2 for hydrolysis of sodium borohydride using X-ray absorption.

The synthesis of platinum nanoparticle loaded LiCoO2 (Pt-LiCoO2) was carried out successfully by an impregnation method followed by sintering at different temperatures. The catalytic role of Pt-LiCoO2 composite in hydrogen generation during hydrolysis of sodium borohydride (NaBH4) was studied for fuel cell applications. X-ray diffraction (XRD), transmission electron microscopy (TEM), and inductively coupled plasma-atomic emission spectroscopy (ICP-AES) have been used to elucidate the structural and catalytic properties of Pt-LiCoO2. It was found that the 15 wt % of Pt nanoparticles on LiCoO2 sintered at 450 degrees C support showed the maximum efficiency for the catalysis reaction of hydrogen production. X-ray absorption near edge structure (XANES) analysis and extended X-ray absorption fine structure (EXAFS) analysis using a synchrotron radiation source were performed to carry out ex situ measurements in order to understand the mechanism of the catalytic process for the production of hydrogen during the hydrolysis of NaBH4. Co K-edge XANES showed a small percentage of cobalt in the metallic form after hydrogen generation which suggests the reduction of the cobalt during the hydrolysis of NaBH4.

Poor response to 18-month lamivudine monotherapy in chronic hepatitis B patients with IgM anti-HBc and acute exacerbation.

BACKGROUND: Appearance of immunoglobulin class M antibody against hepatitis B core antigen is a predictor of beneficial response to interferon-alpha therapy in chronic hepatitis B patients, but its relationship with the efficacy of lamivudine therapy remains unclear. AIM: To investigate the outcome of lamivudine therapy in chronic hepatitis B patients with immunoglobulin class M antibody against hepatitis B core antigen and acute exacerbation. METHODS: Chronic hepatitis B patients with acute exacerbation receiving a national-wide therapeutic trial of 18-month lamivudine monotherapy were enrolled for the analysis. Four consecutive seronegative patients were recruited as individual matching controls of one positive subject. Immunoglobulin class M antibody against hepatitis B core antigen in serum was assayed monthly by an automated microparticle enzyme immunoassay. RESULTS: Fifteen (8.9%) of 167 chronic hepatitis B patients with acute exacerbation were seropositive for IgM anti-HBc. Thus 60 seronegative patients were consecutively recruited as control group. At the end of therapy, two (13.3%) of the 15 seropositive patients achieved a sustained response, significantly lower than 26 (43.3%) of the control group. CONCLUSIONS: Appearance of immunoglobulin class M antibody against hepatitis B core antigen in chronic hepatitis B patients with acute exacerbation is a predictor of poor response to lamivudine monotherapy. This is clinically relevant to the decision-making in treating chronic hepatitis B patients with acute exacerbation.

7-84 parathyroid hormone fragments are proportionally increased with the severity of uremic hyperparathyroidism.

AIMS: Recent progress in PTH assay has revealed that the intact PTH assay kit in current use does not differentiate between the truncated 7-84 PTH molecule and the 1-84 PTH molecule. In our series, we examined the effectiveness of a new PTH assay as a noninvasive method of evaluating severity of uremic hyperparathyroidism. METHODS AND MATERIALS: Two hundred and seventy hemodialysis (HD) patients recruited from three HD centers were included and divided into subgroups according to the conventional iPTH assay results. Pre-dialysis blood samples were collected and subjected to two different PTH assays: "intact" PTH assay (iPTH) and "whole" PTH (wPTH) assay. Two biochemical markers of bone remodeling were also examined. RESULTS: In all cases, PTH levels determined by the wPTH assay were in the average 32.3% lower than those determined by the iPTH assay. The difference of the results of the two PTH assay methods, which indicated the portion of 7-84 PTH fragments of the total PTH molecules measured with the iPTH assay, was gradually increased while the severity of uremic hyperparathyroidism increased. Biochemical markers of bone formation/resorption showed a similar change. CONCLUSION: The portion of the 7-84 PTH fragments and markers of increased bone turnover increased in proportion to the severity of uremic hyperparathyroidism. This finding disproves the hypothetical role of 7-84 PTH fragments alone as the noninvasive marker of low-turnover bone disease in HD patients.

Increased glomerular and extracellular malondialdehyde levels in patients and rats with focal segmental glomerulosclerosis.

BACKGROUND: Evidence suggests an increase in oxidative stress in patients with chronic kidney disease, as glomerulosclerosis is the prerequisite for chronic kidney disease; whether the oxidative stress already exists early on is not known. MATERIALS AND METHODS: In this study we measured the plasma and urinary levels of malondialdehyde (MDA), the end product of lipid peroxidation, and assessed the immunoreactivity of MDA and superoxide dismutase (SOD) in glomeruli of patients and rats with primary focal segmental glomerulosclerosis (FSGS), and compared our findings with those of minimal change disease (MCD) and normal controls (NC). RESULTS: Our results showed that plasma MDA level was significantly increased in patients with FSGS compared with both patients with MCD and normal controls. The urinary MDA level was also significantly increased and was significantly correlated with plasma MDA level in patients with FSGS. The immunostaining for glomerular MDA and SOD was significantly higher in the patients with FSGS than in either the patients with MCD or NC, and was also significantly higher in rats with puromycin aminonucleoside (PAN)-induced FSGS than in rats with MCD. Glomerular MDA level was significantly correlated with the degree of glomerulosclerosis in the patients with FSGS. CONCLUSIONS: Our data suggest that oxidative stress occurs early on before the onset of renal failure, and may play an important role in the pathogenesis of glomerulosclerosis.

Fatal outcome after ingestion of star fruit (Averrhoa carambola) in uremic patients.

Clinical outcome of dialysis patients after eating star fruit (Averrhoa carambola) varies, but it may be fatal. In the past 10 years, 20 such patients were treated in our hospital when they developed clinical symptoms after eating the fruit or drinking star fruit juice. Their initial presentations included sudden-onset limb numbness, muscle weakness, intractable hiccups, consciousness disturbance of various degrees, and seizure. No other major events that might be responsible for these symptoms could be identified. Eight patients died, including one patient with a serum creatinine level of 6.4 mg/dL who had not yet begun dialysis. The clinical manifestations of the survivors were similar to those who died except for consciousness disturbance and seizure. Death occurred within 5 days despite emergent hemodialysis and intensive medical care. The survivors' symptoms usually became less severe after supportive treatment, and these patients subsequently recovered without obvious sequelae. The purpose of this article is to report that patients with renal failure who ingest star fruit may develop neurological symptoms and also run the risk for death in severe cases. Mortality may also occur in patients with chronic renal failure not yet undergoing dialysis.

Dimethylformamide-induced occupational liver injury--a case report.

Dimethylformamide(DMF), a widely used industrial solvent, has been reported to induce subtle to clinically overt hepatotoxicity. Liver injury due to occupational exposure through inhalation and skin contact have been sporadically reported. We reported a 42-year-old male Taiwanese who developed progressive, intermittent abdominal pain for 6 months after working in a synthetic leather factory. Acute hepatitis episode occurred after working in an enclosed and poorly-ventilated workplace for one day. Based on occupational history, pathological examination and serial liver function examinations, the case was compatible with DMF-induced acute chemical hepatitis.

Solitary ileal lipoma presenting with ileocolic intussusception: an unusual cause of enteritis cystica profunda.

We report a 63-year-old man who presented with a history of intermittent vague abdominal pain, diarrhea, and weight loss. Colonofibroscopic examination disclosed an ileocolic intussusception with a polypoid tumor on the leading edge of the intussusception. Both double contrast barium enema and computerized tomography of the abdomen confirmed this finding. The excised specimen had an ulcerated ileal lipoma with enteritis cystica profunda on the overlying epithelium.

Obstructive leiomyoma of the female urethra: report of a case.

We report a case of leiomyoma of the female urethra and review the literature. A mass protruding from the urethral meatus during voiding caused dysuria. Urodynamic study showed an obstructive pattern with low maximum urine flow and high detrusor pressure in initiating voiding. Cystourethroscopy revealed a mass extending from the proximal segment of the left lateral urethral wall into the bladder. At transurethral resection of the tumor 12.2 gm. of tissue were excised. Histopathological studies confirmed urethral leiomyoma. Surgery completely resolved the original symptoms of dysuria.

A case of intrathoracic extramedullary hematopoiesis with massive pleural effusion: successful pleurodesis with intrapleural minocycline.

Extramedullary hematopoiesis is a compensatory process for some hematologic diseases, such as spherocytosis, myelofibrosis and thalassemia. We report a 34-year-old man with beta-thalassemia intermedia who developed intrathoracic extramedullary hematopoiesis with recurrent pleural effusion. Diagnosis of extramedullary hematopoiesis of the pleura and soft tissue was established after thoracoscopic biopsy. Subsequently, the pleural effusion was controlled with intrapleural minocycline instillation. To our knowledge, this is the first case of extramedullary hematopoiesis described in the parietal pleura associated with massive pleural effusion and successfully treated with minocycline.

Polymorphonuclear neutrophil function in Kartagener's syndrome--report of two cases.

The clinical triad of Kartagener's syndrome (KS) includes situs inversus, sinusitis and bronchiectasis or at least chronic bronchitis. Immotile cilia with various ultrastructural defects have been seen in KS. Because the enhanced susceptibility to infections seen in KS it had been suspected due to significant abnormality of neutrophil function in addition to a defect of ciliary function. In this report, neutrophil functions such as PMN phagocytosis, PMN chemotaxis, Migration inhibition test and PMN bacterial killing test were studied in two cases of KS at a time when they were free of infection. The defects observed by us were only slight. We conclude that although neutrophil motility of patients is normal, the bactericidal activity is depressed in the early stage. Whether this abnormality enhances patient susceptibility to bacterial infections is not yet clear. The significance and actural mechanism for his delayed killing are now under investigation.

[A preliminary study for cellular, albumin and immunoglobulin components of bronchoalveolar lavage fluid in normal control, pulmonary T.B. and malignant lung diseases].

Bronchoalveolar lavage (BAL) is a new diagnostic tool which could be applied repeatedly to investigate the nature of lesion in pulmonary diseases. To evaluate the clinical significance of the difference in immunoglobulin content for the differential diagnosis between benign and malignant pulmonary diseases, we performed bronchoalveolar lavage for 64 patients. They included 12 patients with bronchogenic carcinoma, 12 patients with pulmonary tuberculosis, 20 patients with benign non-specific bronchopulmonary diseases (these including 6 patients with pneumoconiosis, 6 patients with bronchietasis, 2 patients with paraquate intoxication, 6 patients with pneumonia) and 20 healthy persons as of the control group. We analyzed the following items: (1) cell count (2) differential count (3) protein content (4) immunoglobulin content. The results showed that there were increase in PMN cells in paraquate intoxication, pnuenmonia and bronchiectasis. While there was lymphocytosis in pulmonary tuberculosis. In comparison with the control group, there was elevation of statistical significance in the IgA/Albumin ratio in bronchogenic carcinoma and pulmonary tuberculosis. Although the IgG/Albumin ratio would be elevated with statistical significance among a variety of pulmonary diseases, it was particularly high in pulmonary tuberculosis. In contrast, the IgA/IgG ratio was significantly increased only in bronchogenic carcinoma. In conclusion, there were differences in the cell number, differential cell count, protein content and immunoglobulin content among various pulmonary diseases. It may be useful in making differential diagnosis between benign and malignant pulmonary disease and the prediction of prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)