The role of the altruistic unbalanced chain in exchange living donor renal transplantation: single-center experience.

BACKGROUND: The exchange donor program in renal transplantation is an efficient solution for recipients with a blood type or crossmatch-incompatible donor. However, this program has some difficulties to define unacceptable human leukocyte antigen matches, deteriorating clinical potential recipient condition, and withdrawal of donor consent. We analyzed the outcomes of exchange donor renal transplantation through the altruistic unbalanced chain. METHODS: Among 152 cases of exchange donor renal transplantation from 1991 to 2010 in our hospital, we performed 58 procedures through altruistic unbalanced chains. We compared their outcomes with the direct and balanced chain group. We analyzed retrospectively whether this program expanded the donor pool, seeking better immunologic, size, and age matching. RESULTS: The graft survival and acute rejection rates did not differ significantly in the two groups. Of 152 cases, 58 (38.2%) renal transplantations were performed through an unbalanced chain. Seventeen waiting list recipients were transplanted through an altruistic unbalanced chain. In blood type O recipients (n = 32), the causes of registration in the exchange program were ABO incompatibility (93.3%), and positive crossmatch (6.7%). Nine altruistic blood type O donors and 9 (28.1%) type O recipients underwent transplantations through this chain. CONCLUSIONS: We suggest the altruistic unbalanced chain may expand the donor pool with advantages for difficult-to-match pairs. The disadvantages of type O recipients may be overcome through the use of an unbalanced chain. The altruistic unbalanced exchange transplantation program can help easy-to-match subjects, shortening the waiting periods.

Incidence of chickenpox in young South Korean soldiers and correlation with atopic dermatitis.

BACKGROUND: In South Korea, military service is compulsory for all healthy young men and provides specific environmental factors, with groups working and living together in specific places for several years making varicella more transmissible to susceptible individuals. Studies of people serving in the South Korean military may provide information about the young adult male population in Korea. AIM: To determine the relationship between chickenpox and atopic dermatitis (AD) in young adults over a period of 3 years. METHODS: The computerized database of the Armed Forces Medical Command was examined to identify the number of reported cases of chickenpox, AD, and AD associated with chickenpox. RESULTS: In total, 588 cases of chickenpox (183, 182 and 223 in the periods November 2004 to October 2005, November 2005 to October 2006, and November 2006 to October 2007, respectively) were reported. A greater number of patients were found to be infected with chickenpox in January and November, with fewer patients in August and September (P < 0.0001). Within the same periods, 1890, 2417 and 2779 patients diagnosed with AD were recorded in the Defense Medical Information System. Only 3 of 588 patients with chickenpox also had AD (0.5%). CONCLUSION: In this population-based study, the epidemiological trend of chickenpox and AD over a period of 3 years within the military personnel of South Korea is shown.

Effects of radiotherapy on different histopathological types of rectal carcinoma.

BACKGROUND: Down staging by pre-operative chemoradiotherapy is currently considered part of the standard therapeutic approach to rectal carcinoma. The aim of this study was to assess the response to chemoradiotherapy of different histopathological types of rectal carcinoma with emphasis on the mucinous variant. METHOD: Between 1997 and 2002, 71 patients who received pre-operative chemoradiotherapy followed by surgery for rectal carcinoma were enrolled in the study. Staging of the rectal carcinoma was performed according to transrectal ultrasound findings (TN score) prior to the chemoradiotherapy. The chemoradiotherapy was followed by radical resection with mesorectal excision. All surgical specimens were examined by a single pathologist (MB). Pathological TN staging was assessed and tumour regression was graded according to a standard method (TRG1, complete response - TRG5 no response). Tumours were classified as mucinous or nonmucinous according to pre- and post-operative biopsy and specimen histopathological types. TN score change and TRG differences between groups were assessed. RESULTS: Tumour regression was seen after chemoradiotherapy in 94.4% of the patients, while in 5.6% of the patients no response was found. The change in TN score and TRG were correlated. Higher TRG was associated with a smaller decrease in TN staging. TRG was significantly lower in the nonmucinous compared to the mucinous group and the decrease in TN grade was significantly larger in the nonmucinous group. CONCLUSION: Mucinous carcinoma was associated with a lower response to pre-operative chemo-radiotherapy in this group of rectal carcinoma patients. Further studies are needed to determine its prognostic value.

Long-term graft outcome of living donor renal transplantation: single center experience.

UNLABELLED: The number of potential renal transplant recipients far exceeds the number of cadaveric donors. For this reason, living-related donors (LRD) and living-unrelated donors (LURD) have been used to decrease the cadaveric donor shortage. We analyzed 571 living donor transplants for 25 years in our center. MATERIALS AND METHODS: From 1978 to 2003, 571 patients underwent LRD (n = 253), or LURD (n = 318) kidney transplantation. The patients were divided into precyclosporine era (from 1978 to 1987, n = 44; era I), cyclosporine era (from 1988 to 1997, n = 367, era II), and cyclosporine plus mycophenolate-mofetil era (from 1998 to 2003, n = 160, era III). We compared the graft survival rate of the recipients according to the immunosuppressants, analyzing the variables of donor and recipient age, sex, HLA matching, and acute rejection rate. We also compared long-term survival rates between LRD and LURD. RESULTS: The 1- and 10-year graft survival rates of all patients were 93.4% and 77.4%, respectively. The 1- and 10- year graft survival rates were 75.0% and 36.3% in era I; and 94.8 % and 80.2% in era II. The 1- and 5-year graft survival rates were 96.6% and 93.3% in era III (P < .001). The occurrence rate of an acute rejection episode was 11.4% (era I), 21.8% (era II), and 14.4% (era III) (P = .056). The 1- and 5-year graft survival rates were 92.3% and 81.7% among LRD transplants, and 94.2% and 86.9% among LURD transplants, respectively (P = .122). DISCUSSION: The graft survival rates of living-donor transplants are improving due to advances in patient care and new immunosuppressive agents.

Downregulation of JNK/SAPK activity is associated with the cross-resistance to P-glycoprotein-unrelated drugs in multidrug-resistant FM3A/M cells overexpressing P-glycoprotein.

In the present study, cross-drug resistance in multidrug-resistant (MDR) cells, which overexpress P-glycoprotein (Pgp), a mdr1 gene product, against Pgp-unrelated drugs, and its relevance to c-Jun N-terminal kinase (JNK)/stress-activated protein kinase (SAPK) activity were examined. The multidrug-resistant FM3A/M cells overexpressing Pgp were resistant to apoptotic cell death induced either by Pgp-related drugs including vincristine and vinblastine, which are pumped out by Pgp, or by the Pgp-unrelated drugs including 5'-fluorouracil (5-FU) and bleomycin, which are not targets for Pgp, compared with the parental FM3A cells. Verapamil reversed the resistance of FM3A/M cells to apoptosis induced by the Pgp-related drugs but not that induced by the Pgp-unrelated drugs. Interestingly, FM3A/M cells have shown significantly lower basal and drug-stimulated JNK/SAPK activities than FM3A cells. After transfection with pEBG-SEK or pEBG-SAPK constructs, FM3A/M cells recovered the basal and Pgp-unrelated drug-stimulated activities of JNK/SAPK and the susceptibility to Pgp-unrelated drug-induced apoptotic cell death comparable to those of FM3A cells. Furthermore, FM3A cells became resistant to apoptotic cell death induced by vincristine and 5-FU after transfection with pEBG-SEK(K --> R), a dominant negative inhibitory mutant of SEK. These results suggest that downregulation of JNK/SAPK activity appears to confer on Pgp-associated FM3A/M cells a cross-resistance to Pgp-unrelated drugs.

Role of Ras/ERK-dependent pathway in the erythroid differentiation of K562 cells.

The chronic myelogenous leukemic K562 cell line carrying Bcr-Abl tyrosine kinase is considered as pluripotent hematopoietic progenitor cells expressing markers for erythroid, granulocytic, monocytic, and megakaryocytic lineages. Here we investigated the signaling modulations required for induction of erythroid differentiation of K562 cells. When the K562 cells were treated with herbimycin A (an inhibitor of protein tyrosine kinase), ras antisense oligonucleotide, and PD98059 (a specific inhibitor of MEK), inhibition of ERK/MAPK activity and cell growth, and induction of erythroid differentiation were observed. The ras mutant, pZIPRas61leu-transfected cells, K562-Ras61leu, have shown a markedly decreased cell proliferation rate with approximately 2-fold doubling time, compared with the parental K562 cells, and about 60% of these cells have shown the phenotype of erythroid differentiation. In addition, herbimycin A inhibited the growth rate and increased the erythroid differentiation, but did not affect the elevated activity of ERK/MAPK in the K562-Ras61leu cells. On the other hand, effects of PD98059 on the growth and differentiation of K562-Ras61leu cells were biphasic. At low concentration of PD98059, which inhibited the elevated activity of ERK/MAPK to the level of parental cells, the growth rate increased and the erythroid differentiation decreased slightly, and at high concentration of PD98059, which inhibited the elevated activity of ERK/MAPK below that of the parental cells, the growth rate turned down and the erythroid differentiation was restored to the untreated control level. Taken together, these results suggest that an appropriate activity of ERK/MAPK is required to maintain the rapid growth and transformed phenotype of K562 cells.

Hyaluronidase-bound membrane as a biomaterial for implantable fuel cells.

A new biomaterial containing covalently bound hyaluronidase was prepared. An application of this enzyme membrane is to improve the performance of an implantable fuel cell. Hyaluronic acid is a contributor to the viscosity of tissue fluids but can be a potential fuel source because of its sugar content. The incorporation of immobilized hyaluronidase would not only contribute to a more available fuel supply by splitting hyaluronic acid but, perhaps more importantly, enhance the rate of mass transport of fuel, O2, and reaction products by reducing the viscosity near the electrode membranes. Hyaluronidase was bound to Sepharose gel and its thermoplastic membrane after activation by cyanogen bromide. Fourteen and 22% of the activities were recovered from the gel and membrane, respectively. The activity of the bound enzyme was stable for six months at 0 degrees C. The addition of hyaluronic acid, 1 mg/ml, to a typical implantable type bioautofuel cell in vitro increased external solution viscosity from 1.1 to 2.5-2.8 cP and reduced voltage output under 10 komega by 60% in 3 hr. When the hyaluronidase bound membrane was placed at the anode, viscosity of the glucose-hyaluronic acid solution was lowered to 1.8 cP and the cell output increased to the original level of a glucose-fueled cell in 3 hr. Glucosamine-equivalent released from hyaluronic acid at the electrode was 3.1 mg after 22.5 hr. This represents 90% of the theoretical consumption. Restoration of the cell output was probably a combination of the enhanced transport of fuel, O2 and products, and/or appearance of a new fuel, glucosamine-equivalent.