Background The optimal use of induction therapy in low-immunological-risk kidney transplant recipients (KTRs) remains uncertain. While Basiliximab (BSX) is widely utilized, its comparative outcomes with no induction therapy require further evaluation.Method This single-center retrospective cohort study included 182 low-immunological-risk KTRs who underwent transplantation between January 2022 and March 2023. Patients were assigned to either no induction (n = 41) or BSX induction (n = 141) groups. Propensity score matching (PSM) minimized selection bias and controlled for confounding factors. Primary outcomes included the incidence of first acute rejection (AR) within 12 months, while secondary outcomes encompassed graft function, infection rates, and adverse events.Result After 12 months, the cumulative AR incidence was comparable between groups (p = 0.46). The no induction group demonstrated superior renal function, with consistently higher estimated glomerular filtration rates (eGFR) at early postoperative intervals. Additionally, this group exhibited reduced infection-related hospitalizations (respiratory infections: 7.32 vs. 29.1%, p = 0.008) and hematological complications (thrombocytopenia: 0.00% vs. 12.8%, p = 0.014). Mortality and graft loss rates were similar between groups.Conclusion In low-immunological-risk KTRs, no induction therapy achieves comparable AR prevention and renal function outcomes to BSX while reducing infection and hematological complications. These findings challenge the necessity of universal induction therapy in this population and support a personalized approach to immunosuppression protocols.

ObjectiveThis study aimed to examine the benefit-finding experiences of liver transplant recipients who undergo perioperative extracorporeal membrane oxygenation (ECMO) treatments in order to provide targeted nursing care and promote mental health among these patients.MethodsThis study employed the phenomenological research approach within the framework of qualitative research. The determination of the sample size was predicated on achieving information saturation. Between June 2023 and March 2024, eight liver transplant recipients who underwent perioperative ECMO treatment at a qualified liver transplantation hospital in Guangxi were purposively selected for semi-structured interviews. In line with the cognitive adaptation theory, this study employed template analysis as the analytical approach, wherein each word in the text content was meticulously examined and categorized into their respective structures based on the theory's three frameworks. Throughout the analysis process, the researchers continuously refined and adjusted abstract content placed within templates while exploring the potential emergence of new themes.ResultsThe study involved a total of eight participants, comprising seven male and one female patient, aged between 43 and 68 years. Among the eight patients, seven had grade 3 or higher coronary artery disease, and one had severe arrhythmia, all of which were attributed to heart conditions necessitating ECMO support during liver transplantation. The ECMO types used were exclusively VA, with auxiliary durations varying between 5 h and 9.5 h. Three overarching themes and seven corresponding sub-themes were extracted: (1) the search for meaning, including a strong desire to survive, recognize the meaning of therapy; (2) gaining a sense of mastery, including a sense of control over one's body and psychological; (3) self-enhancement, including perceiving social support, strengthening self-management, and affirming self-worth.ConclusionsLiver transplant recipients who undergo preoperative ECMO treatment can have benefit-finding experiences. This study indicates that medical professionals should not only focus on timely and accurate treatment but also prioritize addressing patients' psychological needs while caring for critically ill individuals. Clinical medical staff can guide patients in engaging in positive psychological construction, exploring and providing effective social support resources, fostering patients' self-health management, and enhancing the level and patients' ability of benefit-finding by strengthening knowledge, education, and establishing psychological mutual assistance platforms after liver transplantation.

BackgroundKidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease (ESRD); however, postoperative hyperamylasemia (HA) remains common and has been associated with acute rejection (AR), infection, and impaired graft function. Early identification of HA risk factors is essential to improve outcomes of kidney transplant recipients (KTR). This study aimed to develop and internally validate a novel nomogram for predicting the risk of HA after KT, thereby supporting personalized monitoring, prevention and intervention strategies.MethodsWe retrospectively analyzed KTR treated at the Transplant Medicine Institution of the Second Affiliated Hospital of Guangxi Medical University from July 2021 to June 2022. Based on admission dates, patients were assigned to a training cohort (n=243, July 2021 to March 2022) and a validation cohort (n=107, April 2022 to June 2022). In the training cohort, risk factors of HA were identified using logistic regression, Lasso regression and clinical consideration. Subsequently, a nomogram was developed to predict HA risk in patients who underwent KT based on the identified variables. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).ResultsA total of 350 KTR and their corresponding 182 donors were enrolled in this study. The nomogram incorporated six predictive factors: recipient preoperative white blood cell (WBC) count, induction, tacrolimus (FK506) trough concentration, AR, donor age, and donor total bilirubin (TBIL) level according to results of logistic regression, Lasso regression and clinical consideration. The nomogram showed moderate predictive performance, with an area under the ROC curve (AUC) of 0.730 (Youden index = 0.683) in the training cohort and 0.731 (Youden index = 0.767) in the validation cohort. Furthermore, calibration plots indicated close agreement between predicted and actual outcomes, and DCA confirmed net clinical benefit across a range of threshold probabilities.ConclusionsA novel nomogram was established to predict HA after KT, which may support early risk stratification and personalized management of KTR. External multicenter validation is needed before clinical implementation.

BACKGROUND:Glioma is the most common brain tumor. IDH mutations occur frequently in glioma, indicating a more favorable prognosis. We aimed to explore energy metabolism-related genes in glioma to promote the research and treatment. METHODS:Datasets were obtained from TCGA and GEO databases. Candidate genes were screened by differential gene expression analysis, then functional enrichment analysis was conducted on the candidate genes. PPI was also carried out to help determine the target gene. GSEA and DO analysis were conducted in the different expression level groups of the target gene. Survival analysis and immune cell infiltrating analysis were performed as well. RESULTS:We screened 34 candidate genes and selected GLUD1 as the target gene. All candidate genes were significantly enriched in 10 KEGG pathways and 330 GO terms. GLUD1 expression was higher in IDH-mutant samples than IDH-wildtype samples, and higher in normal samples than tumor samples. Low GLUD1 expression was related to poor prognosis according to survival analysis. Most types of immune cells were negatively related to GLUD1 expression, but monocytes and activated mast cells exhibited significantly positive correlation with GLUD1 expression. GLUD1 expression was significantly related to 119 drugs and 6 immune checkpoint genes. GLUD1 was able to serve as an independent prognostic indicator of IDH-mutant glioma. CONCLUSION:In this study, we identified an energy metabolism-related gene GLUD1 potentially contributing to favorable clinical outcomes of IDH-mutant glioma. In glioma, GLUD1 related clinical outcomes and immune landscape were clearer, and more valuable information was provided for immunotherapy.

The shortage of liver grafts is still an unsolved challenge for the transplantation community, and the development of new approaches for liver preservation and reconditioning is urgently needed. Machine perfusion techniques hold great promise for increasing the number of donor livers and reducing post-transplantation complications. These techniques can not only preserve donor livers, but also repair and maintain liver function of marginal donors.1Eden J Sousa Da Silva R Cortes-Cerisuelo M et al.Utilization of livers donated after circulatory death for transplantation—an international comparison.J Hepatol. 2023; 78: 1007-1016Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Despite these advancements, many liver grafts fail to meet the viability test thresholds required for transplantation. Improved perfusion devices are therefore required to extend the perfusion duration for assessing, recovering, and modifying marginal livers before transplantation. This highlights new methods for ameliorating donor organ shortages and permitting targeted therapies.2Eshmuminov D Becker D Bautista Borrego L et al.An integrated perfusion machine preserves injured human livers for 1 week.Nat Biotechnol. 2020; 38: 189-198Crossref PubMed Scopus (197) Google Scholar, 3Clavien PA Dutkowski P Mueller M et al.Transplantation of a human liver following 3 days of ex situ normothermic preservation.Nat Biotechnol. 2022; 40: 1610-1616Crossref PubMed Scopus (53) Google Scholar To preserve the metabolic activity of the liver during long-term perfusion, the devices must mimic the human body to maintain the organ's physiological environment through integrating multiple core functions. However, device optimisation processes and viability test approvals take a long time. Various additional therapeutics to repair and regenerate marginal livers are currently being tested, such as defatting cocktails, cell-based therapies, genetic modulation, senolytics, and functional liver scaffolds.4Schlegel A Mergental H Fondevila C Porte RJ Friend PJ Dutkowski P Machine perfusion of the liver and bioengineering.J Hepatol. 2023; 78: 1181-1198Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Despite many innovative bioengineering technologies being developed, most that can be combined with machine perfusion are still flawed and in their infancy. Extensive clinical trials are also required before their use in clinical practice. In addition to clinical benefits, economic benefits need to be considered in fully establishing and implementing new technologies. We declare no competing interests. This Correspondence was funded by the National Natural Science Foundation of China (81670596; awarded to XS) and the High-Level Medical Expert Training Program of Guangxi “139” Plan Funding (G202002016; awarded to XS).

Background: The aim of this study was to explore the evaluation and use of donor organs from donors with brain death caused by acute severe organophosphorus pesticides and provide a basis for the use of such donor organs.Material/Methods: Seven cases of brain dead donors caused by acute organophosphorus pesticide poisoning from January 2014 to December 2018 in the hospital were collected, and a retrospective analysis was made of the donors' age, race, physiological and pathological changes, donor organ function changes and the organ use, liver or kidney function recovery, and complications of the recipients. The 18 recipients were followed up until June 31, 2022.Results: We found that 71.42% of organ donors were male, and 71.42% of organ donors were under 50 years old. The main cause of death was respiratory failure caused by organophosphorus pesticide poisoning. The liver and kidney functions of 7 donors were damaged, and 3 livers could not be used due to severe functional damage, but the liver or kidney function of 18 recipients gradually recovered after transplantation. Delayed recovery of graft function occurred after transplantation accounted for 21.43%, and the grafts had good short-term to medium-term performance.Conclusions: Although the function of organs from donor with brain death due to acute severe organophosphorus pesticide poisoning is seriously damaged, most of the organs can still be used for transplantation. Individualized functional maintenance according to the situation of donors is conducive to improving the quality of organs.

Background: The role of the cellular level in kidney transplant rejection is unclear, and single-cell RNA sequencing (scRNA-seq) can reveal the single-cell landscape behind rejection of human kidney allografts at the single-cell level. Methods: High-quality transcriptomes were generated from scRNA-seq data from five human kidney transplantation biopsy cores. Cluster analysis was performed on the scRNA-seq data by known cell marker genes in order to identify different cell types. In addition, pathways, pseudotime developmental trajectories and transcriptional regulatory networks involved in different cell subpopulations were explored. Next, we systematically analyzed the scoring of gene sets regarding single-cell expression profiles based on biological processes associated with oxidative stress. Results: We obtained 81,139 single cells by scRNA-seq from kidney transplant tissue biopsies of three antibody-mediated rejection (ABMR) patients and two acute kidney injury (AKI) patients with non-rejection causes and identified 11 cell types, including immune cells, renal cells and several stromal cells. Immune cells such as macrophages showed inflammatory activation and antigen presentation and complement signaling, especially in rejection where some subpopulations of cells specifically expressed in rejection showed specific pro-inflammatory responses. In addition, patients with rejection are characterized by an increased number of fibroblasts, and further analysis of subpopulations of fibroblasts revealed their involvement in inflammatory and fibrosis-related pathways leading to increased renal rejection and fibrosis. Notably, the gene set score for response to oxidative stress was higher in patients with rejection. Conclusion: Insight into histological differences in kidney transplant patients with or without rejection was gained by assessing differences in cellular levels at single-cell resolution. In conclusion, we applied scRNA-seq to rejection after renal transplantation to deconstruct its heterogeneity and identify new targets for personalized therapeutic approaches.

目的 探讨宏基因组二代测序技术(mNGS)在肾移植术后肺部感染中的应用价值.方法 回顾性分析2016年1月—2020年1月在中国人民解放军联勤保障部队第九二三医院器官移植中心因肺部感染入院治疗的肾移植受者58例的病史资料,分为传统病原体检测组(对照组)和mNGS组.通过比较两种不同的病原学检测方法的结果以及治疗前后各组的临床指标进行分析.结果 mNGS组检测需要时间和阳性检出率明显高于对照组,差异有统计学意义(P<0.05);mNGS组抗菌药物使用强度明显少于对照组,差异有统计学意义(P<0.05);在治疗后CD4、CD4/CD8和谷丙转氨酶值明显少于对照组,差异有统计学意义(P<0.05);治疗后mNGS组患者的住院时间明显短于对照组(P<0.05).两组的住院费用、治疗后两组CD4、CD8,血糖值3项指标间的差异无统计学意义(P>0.05).结论 与传统检测方法相比,mNGS可明显提高病原菌检出率和缩短检测时间,在肾移植术后肺部感染的治疗中应用价值高,值得在临床上推广应用.

为研究广西汉族终末期肾病(End Stage Renal Disease,ESRD)与人类白细胞抗原(Human Leukocyte Antigen,HLA)等位基因及单倍体的关联性,本研究采用聚合酶链反应-序列特异性寡核苷酸(Polymerase Chain Reaction-Sequence Specific Oligonucleotides,PCR-SSO)技术对广西汉族578例终末期肾病患者(ESRD组)进行HLA-A、B和DRB1基因分型,HLA等位基因频率用直接计数法来计算,采用Arlequin 3.5.2.2软件计算单倍型频率,并与1644例广西汉族健康造血干细胞捐献者(对照组)比较.结果显示,ESRD组HLA-A*11:01、A*02:01、B*13:01、DRB1*12:02、DRB1*04:05、DRB1*14:54和DRB1*11:01的基因频率大于对照组(P<0.05),HLA-A*11:02、A*30:01、A*32:01、B*13:02、B*07:02、DRB1*07:01和DRB1*13:02的基因频率小于对照组(P<0.05).ESRD组和对照组中频率最高的三位点单倍型都是A*33:03-B*58:01-DRB1*03:01.实验结果表明,广西汉族ESRD患者H LA-A、B和DRB1高频率的等位基因及单倍型与广西汉族健康人基本相同,其中HLA-A*11:01、A*02:01、B*13:01、DRB1*12:02、DRB1*04:05、DRB1*14:54和DRB1*11:01可能与广西汉族ESRD高发病风险相关;HLA-A*11:02、A*30:01、A*32:01、B*13:02、B*07:02、DRB1*07:01和DRB1*13:02可能与广西汉族ESRD低发病风险相关.

目的:分析肾移植术后微小病毒感染的危险因素及免疫功能变化,为早期预防性治疗人类微小病毒B19(HPV B19)感染提供前期研究基础.方法:收集2018年5月至2020年5月本院22例肾移植术后受者的临床资料,对应捐献供体11例,其中HPV B19阳性受者14例、同一供体对侧供肾HPV B19阴性受者8例.回顾性分析HPV B19阳性受者治疗前、后的临床资料.对同一供体受者间术前的因素和不同受者间的供体的因素进行统计学分析.比较HPV B19阳性受者治疗前、后与阴性受者的免疫功能变化.结果:双侧受体感染阳性的供体年龄大于单侧受体阳性和全阴受体的供体(P<0.05).HPVB19阳性受者治疗后血红蛋白(HGB)水平、CD4+T细胞数和CD8+T细胞数均较治疗前升高(均P<0.05).结论:高龄供体和免疫功能低可能是HPV B19感染的潜在危险因素;及早免疫功能监测和预防治疗有利于防控受者HPV B19感染.

Objective:To explore the clinical characteristics of pneumocystis carinii pneumonia (PCP) after kidney transplantation.Methods:From January 2020 to January 2022, clinical data were retrospectively reviewed for 13 renal transplant recipients with pneumocystis pneumonia diagnosed by metagenomics next generation sequencing (mNGS). There were 3 females and 10 males with an age range of (46±10) years.The median time of postoperative onset was 10(2-21) months; The major clinical manifestations included fever ( n=11), cough ( n=7), expectoration ( n=6) and dyspnea ( n=11). Paired t-test was employed for analyzing the laboratory results at admission and discharge. Results:The diagnosis was confirmed by the detection of NGS in alveolar lavage fluid or venous blood.The levels of G test, LDH test, total T lymphocyte absolute count (CD3+ Abs), inhibitory/cytotoxic T lymphocyte count (CD3+ CD8+ Abs) and auxiliary/induced T lymphocyte absolute count (CD3+ CD4+ Abs) were (543.27±440.49) pg/ml, (529.98±222.43)U/L and (191.92±119.42)/μl, (87.33±50.59)/μl and (106.92±87.42)/μl at admission and (69.58±50.21) pg/ml, (285.38±46.62 U/L), (888.58±672.99)/μl, (336.83±305.21)/μl and (520.08±388.76)/μl at discharge.The differences were statistically significant ( P<0.001, P=0.002, 0.006, 0.017, 0.005). All of them received compound sulfamethoxazole and caspofungin.Except for one death due to septic shock after 21-day treatment, 12 cases were cured. Conclusions:mNGS test is one of the important tool for an early diagnosis of PCP.Combined use of compound sulfamethoxazole and caspofungin is an effective anti-infective regimen.And immune function monitoring is vital for adjusting antibiotic and immunosuppressive regimens.

Objective:To explore the protective effect of hypothermia plus extracorporeal membrane oxygenation(ECMO)on kidney in brain-dead kidney transplant donors.Methods:From July 2017 to July 2018 at Institute of Transplantation Medicine, Hospital No. 923 of PLA, 29 patients with circulatory dysfunction brain death donors fulfilling the organ donation criteria were randomly divided into sub-hypothermia group according to the treatment of extracorporeal membrane oxygenation(body temperature 34.0~35.0℃, 15 cases)and normal temperature group(36.5~37.5℃, 14 cases). Hemodynamic profiles and renal function changes were compared between two groups during ECMO.And renal complications of two groups were followed up.Results:The hemodynamic parameters of two groups remained stable during ECMO period.Heart rate of 5 MO-organs was lower in hypothermia group than that in normal temperature group( P<0.05). Systolic and diastolic pressures before ECMO 3 h-organ acquisition were higher than normal temperature group( P<0.05). No significant difference existed between PaO 2 and normal temperature groups( P>0.05). Donor serum creatinine(SCr)and blood urea nitrogen(BUN)were lower in hypothermia group than in normal temperature group( P<0.05). The postoperative recipient levels of BUN were lower in mild hypothermia group than those in normothermia group( P<0.05)and no significant difference between SCr and normal temperature groups( P>0.05). The postoperative hospital stay was(16.52±3.59)days in mild hypothermia group. And it was lower than that in normal temperature group( P<0.05). Delayed renal function was lower than normal temperature group(3.45% and 21.43%, P<0.05). Conclusions:Mild hypothermia plus ECMO can reduce hemodynamic fluctuations in circulatory unstable donors after brain death, improve renal function and lower the incidence of delayed functional recovery after renal transplantation.

局灶节段性肾小球硬化(focal segmental glomerulosclerosis，FSGS)在肾移植术后具有较高的复发率，在移植早期即可导致移植物功能丧失，5年的移植物存活率明显降低，本文将从肾移植术后复发性FSGS的概述、病理改变、发病机制及治疗进展进行阐述，以期为临床预测FSGS患者在肾移植术后复发的风险提供参考。

Objective:To compare the clinical data of expanded criteria donor (ECD) and standard criteria donor (SCD) kidney transplantation in the same period, and to observe the medium- and long-term curative effect of ECD renal transplantation.Methods:The clinical data of the kidney donors and corresponding recipients from donation after citizen′s death in the 923 Hospital of PLA from January 2008 to June 2018 were retrospectively analyzed. According to whether the donor met the criteria of ECD, the corresponding recipients are divided into ECD group (n=223) and SCD group (n=198). The starting point of observation was the day of transplantation, and the end point of observation was kidney failure, including return to dialysis, retransplantation or death, and the loss of transplant kidney caused by non-immune factors or death which was not caused by transplant kidney failure were not excluded. Wilcoxon signed rank sum test was used to compare non-normal distribution measurement data, and chi-square test was used to compare count data. Kaplan-Meier method was used to draw the survival curve, and the median survival time was calculated and compared by log-rank test. P<0.05 indicated that the difference was statistically significant.Results:Up to June 2021, the incidence of postoperative acute rejection (AR) in the ECD group and the SCD group was 21.5% (48/223) and 19.7% (39/198), respectively (χ2=0.214, P>0.05). The incidence of AR within 1 year after transplantation was 18.4% (41/223) and 7.6% (15/198), respectively (χ2=10.627, P<0.05). The incidence of pulmonary infection in the ECD group and the SCD group was 43.5% (97/223) and 33.3% (66/198), respectively (χ2=4.567, P<0.05). The incidence of pulmonary infection within 6 months after transplantation was 30.9% (69/223) and 22.7% (45/198), respectively (χ2=3.584, P>0.05). The mortality rates of the ECD group and the SCD group were 9.9% (22/223) and 8.6% (17/198), respectively (χ2=0.1929, P>0.05). The incidence of graft failure in the ECD group and the SCD group was 11.7% (26/223) and 5.1% (10/198), respectively (χ2=5.858, P<0.05). The median renal survival time in the ECD group and the SCD group was 120 and 146 months, respectively (χ2=4.352, P<0.05). The medians of serum creatinine minimum values in the ECD group and the SCD group during follow-up were 120 μmol/L (48-591 μmol/L) and 95 μmol/L (42-630 μmol/L), respectively (Z=-5.967, P<0.05).Conclusions:It is expected to obtain a better medium- and long-term prognosis in the ECD kidney transplantation through full evaluation, careful choice and individualized treatment.

Organ donation provides a life-saving opportunity for patients with organ failure. China, like most countries, is faced with organ shortages. Understanding public opinion regarding organ donation in China is critical to ensure an increased donation rate. Our study explored public concerns and attitudes toward organ donation, factors involved, and how the public pays attention to organ donation. Sixteen million users' public information (i.e. gender, age, and geographic information) and posts from January 2017 to December 2017 were collected from Weibo, a social media platform. Of these, 1755 posts related to organ donation were included in the analysis. We categorized the posts and coded the users' attitudes toward organ donation and the associations between the demographics. The most popular posts mentioning organ donation were "publicly expressing the willingness to donate organs." Furthermore, 87.62% of posts exhibited a positive attitude toward organ donation, whereas only 7.44% exhibited a negative attitude. Most positive posts were "saluting the organ donors," and most negative posts involved "fear of the family's passive medical decision." There was no significant gender difference in the users' attitudes, but older people generally had a more negative attitude. Users with negative attitudes mainly distrust the medical system and are worried that the donated organs may be used in improper trading. Social media may be an important channel for promoting organ donation activities, and it is important to popularize scientific knowledge related to organ donation in order to eliminate the public's misunderstanding of organ donation and transplantation.

Objective:To evaluate the efficacy and safety of continuous infusion of low-dose intravenous (Ⅳ) heparin during perioperative period of simultaneous pancreas-kidney (SPK) transplantation for donation after citizen death (DCD) donor to prevent pancreatic thrombosis post-transplantation.Methods:From January 2015 to August 2019, 46 DCD donors undergoing SPK were divided into retrospective cohort groups 1 ( n=27) and 2 ( n=19). Group 1 received aspirin enteric-coated tablets only at Day 1 post-SPK. In Group 2, 5-7 days of continuous infusion of heparin 260 IU per hour at Day 1 post-SPK was followed by a daily intake of aspirin enteric-coated tablets of 100 mg. Incidence of thrombus, recovery of graft function and adverse reactions of anticoagulant therapy were observed. Results:Thrombosis occurred in (5.3%, 1/19 vs 14.8%, 4/27) in heparin and non-heparin groups. Thrombosis and graft loss were significantly lower in heparin group than those in non-heparin group ( P<0.05). Conclusions:Continuous infusion of low-dose heparin vein is effective and safe in preventing thrombosis after SPK transplantation.

目的 探讨移植肾早期急性排斥反应患者血清微小RNA(miRNA)-21水平变化及其临床意义.方法 选取78例肾移植术后患者作为研究对象,根据肾移植术后1个月内是否发生移植肾排斥反应将其分为急性排斥组33例和非排斥组45例.比较两组患者手术前后的血清miRNA-21相对表达水平,并采用受试者工作特征(ROC)曲线评价术后血清miRNA-21预测移植肾早期急性排斥反应的临床价值.根据术后1周血清miRNA-21表达水平,将患者分为miRNA-21高表达和低表达组,比较两组的无急性排斥反应生存率.结果 术后1周,两组患者的血清miRNA-21相对表达水平均高于术前,且急性排斥组患者的血清miRNA-21相对表达水平高于非急性排斥组(均P<0.05).ROC曲线分析结果显示,术后血清miRNA-21预测移植肾早期急性排斥反应的曲线下面积为0.715(P<0.05),最佳临界值为2.04,特异度为81.93％,灵敏度为93.65％.生存分析结果显示,miRNA-21高表达组患者的肾移植术后30 d内无急性排斥反应生存率低于miRNA-21低表达组(P<0.05).结论 在移植肾早期急性排斥反应患者血清miRNA-21表达上调,其或可成为预测移植肾早期急性排斥反应的生物学标记物.

目的 探讨血清微小RNA(miRNA)-21在肾移植患者术后并发急性肾损伤(AKI)早期诊断中的应用价值.方法 选取84例肾移植患者作为研究对象,根据术后是否发生AKI将其分为AKI组和非AKI组,每组42例,另选取同期健康体检者42例作为对照组.比较3组研究对象术后第2天(对照组为体检当日)血清miRNA-21的表达水平,以及AKI组和非AKI组血清肌酐、尿酸、降钙素原及尿素氮水平;采用Pearson法分析急性肾损伤患者血清miRNA-21的相对表达水平与血清肌酐、尿酸、降钙素原及尿素氮水平的相关性,采用受试者工作特征(ROC)曲线分析血清miRNA-21相对表达量预测肾移植后并发AKI的临床价值.结果 AKI组的血清miRNA-21相对表达量高于非AKI组与对照组(P<0.05),而非AKI组与对照组的血清miRNA-21相对表达量差异无统计学意义(P>0.05).AKI组患者的血清肌酐、尿酸、降钙素原及尿素氮水平均高于非AKI组,肾小球滤过率低于非AKI组,Pearson分析结果提示血清miRNA-21相对表达量与血清肌酐、尿酸、降钙素原及尿素氮均呈正相关(均P<0.05).ROC曲线分析结果显示,血清miRNA-21相对表达量预测肾移植患者术后并发AKI的曲线下面积为0.875,敏感性为91.04％,特异性为86.17％.结论 miRNA-21在肾移植后并发AKI患者血清中呈高表达,其与患者病情严重程度密切相关,或可成为肾移植术后并发AKI的早期诊断指标.

现代战伤救治理念要求最大限度地降低伤死率.战场和灾难救援中危重伤病员的救治,要求尽早实施挽救生命的技术和处置.体外膜肺氧合(ECMO)是一种改良的体外心脏替代及气体交换系统,作为生命支持的有力手段,在平时临床医疗中发挥重要作用并积累了丰富经验.作者认为EC MO用于转运重症患者也具有可行性和安全性,在战时卫勤保障中适宜作为第二阶梯救护队伍的携行装备,进行伤员脱离火线后的前伸救护,可望在战伤救护中发挥积极作用.该文还从战伤救治理念和军事斗争准备需求出发,探讨了ECMO在我军未来卫勤保障中的应用潜力,提出了推进其用于战伤救治的措施建议.