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Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) in renal allografts is a rare, renal-limited disease. No study has reported the long-term outcomes and prognostic features of PGNMID in renal allografts in the Chinese population.We retrospectively included transplant patients diagnosed with PGNMID who underwent renal allograft biopsy at three transplant centers from April 2012 to July 2020. We observed the clinicopathologic features, explored the long-term graft survival, and investigated the characteristics associated with the prognosis.A total of 13 transplant patients with PGNMID were included, out of 3821 biopsies. The mean follow-up time was 55 months since kidney transplantation (KTx). At diagnosis, all patients presented with proteinuria (100%) and most of them with hematuria (92%). IgG3κ (69%) was the main immunofluorescence (IF) subtype. The median graft survival of the total cohort was 17 months from diagnosis and 49 months from kidney transplantation. During follow-up, 9 patients needed dialysis and 2 out of 9 patients who progressed to dialysis died of infection. Primary membranoproliferative glomerulonephritis (MPGN) (P = 0.014) and MPGN pattern at diagnostic biopsy (P 0.001) were associated with a higher risk of graft loss.The long-term outcome of allograft PGNMID was relatively poor in the Chinese population. Primary MPGN and MPGN pattern in renal allograft were associated with poor outcomes.

Visual inspection techniques for rail surface defects have become prevalent approaches to obtain information on rail surface damage. However, uneven illumination leads to illegibility of local information, and the change of the wheel-rail area results in the changeful background of the rail surface, both of which pose challenges to the visual inspection. This paper proposes a novel algorithm that detects rail surface defects via partitioned edge features (PEF). PEF eliminates the effect of uneven illumination by effectively extracting edge features and building homogeneous background on the rail surface. In the process of edge feature extraction, the thresholding based on adaptive partition of rail surface (APRS) plays an indispensable role. In APRS, the rail surface is adaptively partitioned into three types of regions according to the wheel-rail contact degree. After that, the dynamic threshold is set adaptively for each region type on the basis of the prior information of defect proportion. Subsequently, based on neighborhood information and fuzzy decision, the spatial information of adjacent pixels and the direction information of fracture edges are utilized to realize the effective recovery of incomplete defect contours. In addition, defect contours are precisely filled via a flexible combination of morphological hole filling operation and defect region extraction based on improved background difference. The accuracy of this PEF algorithm was confirmed by experiments and comparisons with related algorithms. The experiment results show that PEF detects defects with 92.03% recall and 88.49% precision, which achieves higher accuracy than the established detection algorithms for rail surface defects.

Rail surface defect inspection based on machine vision faces challenges against the complex background with interference and severe data imbalance. To meet these challenges, we regard defect detection as a key-point estimation problem and present the attention neural network for rail surface defect detection via CASIoU-guided center-point estimation (CCEANN). CCEANN contains two crucial components. One is the stacked attention Hourglass backbone via cross-stage fusion of multi-scale features (CSFA-Hourglass), in which the convolutional block attention module with variable receptive fields (VRF-CBAM) is introduced, and a two-stage Hourglass structure balancing the network depth and feature fusion plays a key role. Furthermore, the CASIoU-guided center-point estimation head module (CASIoU-CEHM) integrating the delicate coordinate compensation mechanism regresses detection boxes flexibly to adapt to defects' large-scale variation, in which the proposed CASIoU loss, a loss regressing the consistency of Intersection-over-Union (IoU), central-point distance, area ratio, and scale ratio between the targeted defect and the predicted defect, achieves higher regression accuracy than state-of-the-art IoU-based losses. The experiments demonstrate that CCEANN outperforms competitive deep learning-based methods in four surface defect datasets.

Tumor suppressor gene BRCA1, known for its vital roles in regulating DNA damage, is frequently mutated in hereditary breast and ovarian cancer (HBOC), whose mutation also increases susceptibility to intestinal, prostatic and pancreatic cancers of patients. As the main subtype of lymphoma, non-Hodgkin lymphoma (NHL) is malignant disorders arising from immune cells and displays predominantly as lymphadenopathy or solid tumors, which is rarely considered hereditary. However, the relationship between BRCA1 mutation and NHL is rarely reported. Here, we present a primary NHL and recent second primary tumor rectum adenocarcinoma. Considering the hereditary factors in developing colorectal cancer, we investigated her family history and found her sister died with ovarian cancer. Meanwhile, her genetic testing identified a pathologic germline mutation in BRCA1 (c.1115G＞A). Taken into account the strong evidence between BRCA1 mutation and HBOC occurrence, we also did genetic test for her daughter and found the same BRCA1 mutation. Although strong evidence between BRCA1 mutation and HBOC exists, the patient harboring pathogenic BRCA1 mutation did not suffer from HBOC but NHL and rectum adenocarcinoma which required further investigations and modifications of current screening criteria for HBOC. And great attention should also be paid to her daughter with BRCA1 mutation carrier.

Rail corrugation is the geometric structure of the rail top surface, and it directly related to the safety and comfort of rail transportation. The monitoring of rail corrugation is the key work for rail maintenance department. Currently, the 2D laser displacement sensor is being used to measure the rail corrugation. However, the 2D sensor is easily affected by pitching vibration under complex measurement environment, which leads to large errors in the final measurement results. For solving the problem of pitching vibration in dynamic measuring rail corrugation, a data splicing method based on deviation recognition and calibration is proposed in this study. Firstly, the blind recognition of sensor deviation is applied to identify the measurement state of sensor in each data sampling. Then, a mapping method is proposed to position the actual repeated measurement interval according to geometric relationship between the deviation angle and the offset in the longitudinal direction. Finally, the modified DTW model is proposed for data registration and the data splicing can be achieved according to the registration results. Extensive experiments are carried on both indoor experimental platform and outdoor platform. The experimental results indicate that our proposed method can accurately recognize the deviation of sensor and can calibrate the deviated data set, and its performance on the rail corrugation measurement under the pitching vibration case outperforms previous data splicing work. Thus, it is with the potential engineering application.

Xuefeng Ni,1 Li Jiao,1 Ye Zhang,1 Jin Xu,2 Yunqing Zhang,2 Xiaona Zhang,2 Yao Du,2 Zhaoyong Sun,2 Shitian Wang2 1Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China; 2Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Li JiaoDepartment of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86-010-69156114Email jiaoli_569@163.comObjective: The present study aimed to explore the relationship between non-alcoholic fatty liver disease (NAFLD) and abdominal and pericardial adipose tissue in middle-aged and elderly subjects.Methods: Between July 2019 and July 2020, 471 subjects attending the Health Care Medical Department of Peking Union Medical College Hospital for a medical examination were enrolled in the study. The volume and distribution of abdominal adipose tissue together with the volume of pericardial adipose tissue were calculated according to the results of the abdominal computed tomography. The differences between subjects with NAFLD and the normal population were analyzed.Results: The volume of pericardial adipose tissue, abdominal visceral and subcutaneous adipose tissue, the total volume of abdominal adipose tissue, and volume of pelvic visceral adipose tissue were all significantly increased in subjects with NAFLD. For every 100 cm3 increase in the volume of abdominal visceral adipose tissue, the incidence of developing NAFLD increased by 9.4%. According to the results of the receiver operating curve, the cut-off point of abdominal visceral adipose tissue for the diagnosis of NAFLD was 2691.1 cm3.Conclusion: Overall, the risk of NAFLD increases significantly with the increase in the volume of adipose tissue.Keywords: fatty liver, abdominal adipose tissue, abdominal visceral adipose tissue, abdominal subcutaneous adipose tissue

Transplant renal artery stenosis (TRAS) has been shown to reduce kidney perfusion leading to post-operative hypertension. We aimed to measure the perfusion and oxygenation changes in TRAS with arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) imaging, respectively.In this single-center prospective study, a total of seven patients with TRAS and seven age- and sex-matched normal kidney transplant recipients underwent both ASL and BOLD imaging. Moreover, measurements of ASL and BOLD were also performed in five patients after successful angioplasty for TRAS.Allograft cortical perfusion as measured by ASL in the TRAS group was significantly decreased as compared with normal control group (129.9 ± 46.6 ml/100 g vs. 202.4 ± 47.7 ml/100 g, P = .01). Interestingly, allograft oxygenation as indicated by R2* derived from BOLD in both the cortex (16.42 ± 1.90 Hz vs. 18.25 ± 4.34 Hz, P = .33) and the medulla (30.34 ± 2.35 Hz vs. 30.43 ± 6.85 Hz, P = .97) showed no statistical difference between the TRAS and normal control group. In addition, both cortical and medullary oxygenation remained unchanged despite significantly improved cortical perfusion in those undergone successful angioplasty.Cortical and medullary oxygenation were preserved in the presence of reduced allograft perfusion in clinically significant TRAS. Prospective larger studies are needed to conclusively establish perfusion and oxygenation changes in TRAS.

For the safety of railways, well-trained workers are required to check the fastener constantly, which shows the disadvantage of large time cost, huge labor cost and might being dangerous to workers. To address this and achieve automatic detection, an inspection model based on deep convolutional neural network (DCNN) is adopted in this paper. However, the inspection model suffering from the unbalanced training samples of defective vs normal due to defective fasteners are far less than normal fasteners in real railways. To tackle this problem, a novel sample generation method is proposed to generate defective fastener samples using the normal fasteners to realize sample augmentation. The comprehensive experiments are conducted on the collected real fastener samples and generated samples. The experimental results show that our method has good performance for fastener inspection on unbalanced samples and outperforms other state-of-the-art methods.

Xuefeng Ni,1 Li Jiao,1 Ye Zhang,1 Jin Xu,2 Yunqing Zhang,2 Xiaona Zhang,2 Yao Du,2 Zhaoyong Sun,2 Shitian Wang2 1Department of Healthcare, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China; 2Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of ChinaCorrespondence: Li JiaoDepartment of Healthcare, Peking Union Medical College Hospital, No. 1 of Shuaifuyuan Street, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86 10 69157229Email li_jiao24@163.comObjective: The present study aimed to explore the relationships between the distribution of abdominal fat and muscle and age and gender in a middle-aged and elderly population.Methods: The levels of abdominal (visceral and subcutaneous) fat, pericardial fat, and psoas major muscle were measured in subjects who had physical examinations at the Health and Medical Department of Peking Union Medical College Hospital from July 2019 to June 2020. The relationship between fat in different areas (ie, different types of fat) and the relationship between different types of fat and the psoas major muscle were investigated in the context of different genders and ages.Results: The distribution of fat and muscle differed between males and females of the middle-aged and elderly study sample. Volumes of pericardial fat, total abdominal fat, and visceral fat were significantly lower in females than in males, and the area of the psoas major muscle was also significantly lower in females than in males. Levels of subcutaneous fat and total abdominal fat showed no significant correlation with age. The level of muscle showed a significant negative correlation with age.Conclusion: 1) Within the middle-aged and elderly sample, male subjects had higher levels than females of all types of fat except for abdominal subcutaneous fat, and had higher levels of psoas muscle than females. 2) Pericardial fat increased with age, whereas levels of abdominal fat did not change significantly with age. 3) The area of psoas major muscle appears to be positively correlated with volumes of all types of fat: subjects with more fat tended to have higher levels of psoas major muscle.Keywords: middle-aged and elderly, abdominal fat, pericardial fat, psoas major muscle, age, gender

Cetuximab (CET) resistance in colorectal cancer (CRC) is responsible to poor prognosis to some extent. M2 macrophage polarization is closely correlated with drug resistance to cancers. Therefore, this study aims to investigate whether the mechanism of HCG18 on CET resistance to CRC involving in M2 macrophage polarization.Clinic samples and SW620 cells with/without M0 macrophage co-culture served as experimental subjects. CET treatment was performed to induce SW620 cell resistant to CET. qRT-PCR and western blot were employed to evaluate the mRNA and protein expression of genes. The capabilities of cell viability, proliferation, migration and invasion were examined using CCK-8, clone formation assay and transwell. ELISA was employed to examine the protein concentrations of IL-10 and TGF-β1. StarBase and luciferase activity assay were conducted to consolidate the interactions among HCG18, miR-365a-3p and FOXO1.In clinical samples and CRC cells, the abundance of HCG18 was enhanced whereas miR-365a-3p was reduced. Besides, HCG18 expression in CET-resistant tumor tissues was higher than that in CET-sensitive tumor tissues and the trend of miR-365a-3p was opposite to that of HCG18. HCG18 knockdown attenuated macrophage-induced CET resistance in SW620 cells and suppressed M2 polarization of THP-1 cells. Mechanistically, HCG18 interacted with miR-365a-3p and miR-365a-3p targeted FOXO1. MiR-365a-3p inhibitor abolished HCG18 knockdown-mediated inhibition of CET resistance, while FOXO1 knockdown compromised the influences of miR-365a-3p inhibitor. FOXO1 could positively regulate CSF-1 expression to promote M2 macrophage polarization and macrophage-induced CET resistance.Our results revealed that HCG18 promoted M2 macrophage polarization to facilitate CET resistance to CRC cells through modulating miR-365a-3p/FOXO1/CSF-1 axis.

The measurement data of rail corrugation is an important data source used by railway maintenance departments to monitor the safety of running rails. The accuracy of rail corrugation measurement and the integrity of data play a great decisive role in the strategy of rail maintenance. However, due to the complex measurement environment, the missing of rail corrugation measurement data is common problem for dynamic measurement. In order to solve the negative impact of data loss on the accuracy of the overall measurement data, a network model based on improved LSTM (Bi-LSTM) neural network is proposed to fill the missing data. The network model is trained by using the historical rail corrugation data, and the missing data of the measurement data of the laser displacement sensor is filled by the trained Bi-LSTM model. The experimental results effectively prove the effectiveness and accuracy of the data imputation method proposed in this paper, and the performance is better than some state-of-art prediction models. Furthermore, the extensive experiments also prove the proposed data imputation method has high robustness and can still maintain high filling accuracy in the case of high loss rate.

To map time-dependent cardiac structural and functional change patterns after renal transplantation (KT) using cardiac magnetic resonance (CMR).Fifty-three patients with pre-KT and post-KT CMR exams were retrospectively analyzed. Patients were divided into three groups according to the time of post-KT CMR: group 1 (3 months post-KT, n = 16), group 2 (6 months post-KT, n = 21), and group 3 (over 9 months post-KT, n = 16). Twenty-one age- and sex-matched healthy controls (HC) were recruited for the study. CMR-derived left ventricular (LV) volumes, LV mass index (LVMi), LV ejection fraction (LVEF), global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and native T1 value were compared. The association between the changes of CMR parameters was assessed.LVMi post-KT decreased in groups 2 (p0.001) and 3 (p = 0.004) but both groups had higher LVMi values compared to HC (both p0.001). GLS post-KT was decreased in group 1 (p = 0.021), but slightly increased in group 2 (p = 0.728) and group 3 (p = 0.100) without significant difference. GLS post-KT in group 3 was not different from HC (p = 0.104). LVEF, GRS, and GCS post-KT in groups 2 and 3 significantly increased and showed no significant difference from HC. The post-KT native T1 value in all three groups significantly decreased; however, no group showed any significant difference from HC. The change of LVEF was associated with the change of GCS, GRS, and GLS.Although GRS, GCS, GLS, and native T1 values reversed to normal level, LVMi remained impaired in median 14 months after KT.• Kidney transplantation has favorable effects on cardiac structure and function. • In a median 14 months of follow-up after KT, left ventricle strain and native T1 value reversed to normal level while LV mass index (LVMi) did not. Left ventricular hypertrophy may help to explain why KT recipients are still at increased cardiovascular risk. • The reason for the decrease of native T1 value after KT may be more than myocardial fibrosis and needs to be further studied.

Objective To characterize capillary perfusion and tissue diffusion changes in transplant renal artery stenosis (TRAS) with diffusion-weighted imaging (DWI). Materials & methods We retrospectively identified 30 patients with non-contrast enhanced magnetic resonance angiography-proven TRAS. Another 20 kidney transplant recipients without TRAS were prospectively recruited to serve as control group. DWI parameters were compared among various groups with one-way analysis of variance and post hoc Tukey test. Additionally, DWI parameters were compared in 7 severe TRAS patients before and after successful angioplasty using paired Student t-test. Receiver-operating characteristic (ROC) curves were generated to evaluate the diagnostic performance of various DWI parameters. Results All DWI parameters of renal cortex and medulla were not statistically different between normal allografts and allografts with mild TRAS. Nonetheless, cortical total apparent diffusion coefficient (ADCT) of allografts with moderate TRAS was significantly decreased compared with normal allografts. All cortical and medullary DWI parameters were significantly reduced in severe TRAS compared with normal allografts. ROC curve analysis indicated ADCT could identify severe TRAS with 93.8% sensitivity, 82.4% specificity and an area under the curve of 0.930. ADCT increased significantly after successful angioplasty while it showed no significant change in a patient with unsuccessful angioplasty. Conclusion DWI is a robust technique that revealed no tissue diffusion and perfusion impairment in mild TRAS. ADCT has good sensitivity and specificity for identifying patients with severe TRAS. DWI is potentially an alternative radiologic biomarker for assessing microstructural and perfusion alterations in TRAS. DWI is useful in detecting renal functional recovery following successful angioplasty.

Objectives: BK virus (BKV) infection has become one of the main complications in renal transplant recipients (RTRs) with the arrival of newer potent immunosuppressive agents. However, reports on the epidemiology of BKV infection and risk factors in Chinese population after renal transplantation are scarce. Methods: From June 2015 to July 2016, living-donor renal transplant recipients (LDRTRs) who routinely received the quantitative BKV DNA testing of urine and plasma samples using quantitative real-time polymerase chain reaction (PCR) for the first time after transplantation were selected, while dialysis patients and healthy living donors during that period served as controls. Potential variables were compared and analyzed using logistic regression model multivariate analysis to assess the BKV infection related factors in LDRTRs. Results: Among the 52 LDRTRs identified, BKV DNA was detected in 16 urine samples (30.8%), significantly higher than that of dialysis patients (6.3%) and healthy living donors (4.2%) (p

Background It has been suggested that C3 glomerulonephritis (C3GN) and atypical hemolytic-uremic syndrome (a stereotypical phenotype of thrombotic microangiopathy), two rare entities caused by complement alternative pathway dysregulation share overlapping genetic origin and can be triggered by infections. Case presentation We report a case of concomitant C3GN and thrombotic microangiopathy (TMA) after pulmonary infection in a young male receiving kidney transplantation. Genetic assessment revealed two missense variations in compound heterozygous form in CFI gene (complement factor I). These two variations are segregated with disease in the core family member of this patient. Plasma CFI levels of the patient and family members were all in normal range. We considered that these two variations only impair CFI function rather than its quantity in the serum. Conclusion Our case supports that C3GN and TMA shared overlapping genetic variations and might be triggered by infection in genetically susceptible patients after kidney transplantation.

Antibody-mediated rejection (ABMR) is a major cause of kidney transplant failure which requires donor-specific antibodies (DSA) for a definitive diagnosis. Donor-derived cell-free DNA (ddcfDNA) is an emerging biomarker used to assess kidney allograft injury. However, current data is limited to predict the accuracy of ddcfDNA in ABMR diagnosis. This study was conducted to compare the performance of DSA with plasma ddcfDNA for the diagnosis of ABMR.In this retrospective single-center observational study, we enrolled 50 kidney transplant recipients who were diagnosed with the suspicion of rejection between June 2018 and May 2019 at the Jinling Hospital. Plasma ddcfDNA was measured by using a novel target region capture sequencing methodology. A total of 37 patients who were tested with DSA and biopsy were divided into four subgroups (ABMR+/DSA+, ABMR+/DSA-, ABMR-/DSA+, ABMR-/DSA-) for the distribution of ddcfDNA (%) by ABMR and DSA.The median level of ddcfDNA in biopsy showed that the ABMR group (1.66%, IQR 1.34-3.76%) was significantly higher than the median level (0.63%, IQR 0.43-0.74%) in non-ABMR (p 0.001). With a ddcfDNA cutoff of 0.96%, the AUC was 0.90 (95%CI, 0.86-0.95), which was associated with a sensitivity of 90.5% (95%CI, 69.6-98.8%) and specificity of 96.6% (95%CI, 82.2-100%), a PPV of 95% (95%CI, 73.4-99.2%) and NPV of 93.3% (95%CI, 78.9-98.1%) were also observed. Among the four subgroups, ddcfDNA had no significant difference in both DSA+ group and DSA-group (p 0.05). In the diagnosis of ABMR, the specificity, sensitivity, PPV and NPV of DSA were 50%, 74.1%, 41.7%, 80%, respectively.ddcfDNA levels in the blood could highly distinguish (biopsy-supported) ABMR occurrence, irrespective of whether this method is accompanied by DSA or not.

Fastener needs to be detected periodically to maintain the railway safety. However, the detection performance of the existing methods is insufficient in the case of imbalanced fastener samples. To tackle this problem, a hierarchical learning approach which consists of fastener localization and fastener detection is proposed in this paper. Firstly, a multi-scale features-based deep detection network (MSF-DDN) is proposed to locate the fastener regions from railway images. Then, a region classification network is constructed to recognize the type of key sub-regions obtained from the located fastener region images. Finally, fastener detection is achieved by analyzing the recognition results of key sub-regions through the constructed decision tree. A large number of experiments are conducted on the collected real railway images. The experimental results indicate that the hierarchical learning approach achieves an average precision of 96.4% and recall of 96.3% on the detection of imbalanced fasteners, which outperforms state-of-the-art methods.

Phase unwrapping (PU) technology is an important component of fringe projection profilometry (FPP). The key of PU is to obtain accurate fringe order. The existing PU methods are hard to make a tradeoff between efficiency and accuracy. To reduce the number of stripes, a phase unwrapping method based on edge feature (EFPU) is proposed. For this method, we make full use of the properties of wrapped phase map rather than auxiliary fringe patterns. We firstly analyze an edge detection operator suitable for wrapped phase map. Furthermore, in order to improve the stability of the proposed method, the edge correction method is proposed to correct edge point and the reverse correction method is presented to further optimize the fringe order. The experimental results show that the absolute phase map obtained by EFPU is similar to that of multi-wavelength phase-shifting (MWPS) method, but the number of fringe patterns is only one-third of MWPS.

Background Although biopsy is essential for the diagnosis and management of kidney transplant recipients, it is invasive. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is a noninvasive technique that can assess both capillary perfusion and tissue diffusion. Purpose To evaluate the capability of IVIM-DWI as a differentiation of kidney transplant patients who need clinical intervention from those who need not. Study type Prospective. Subjects In all, 33 kidney transplant patients who needed clinical intervention and 19 who need not. Field strength/sequence 3.0T; IVIM-DWI with a single-shot echo planar imaging sequence. Assessment All patients underwent kidney transplant biopsy and IVIM-DWI scans. Patients were dichotomized into those who needed clinical intervention (CHANGE group) and those who need not (Non-CHANGE group) based on biopsy results. The values of total apparent diffusion coefficient (ADCT ), diffusion coefficient (D), and perfusion fraction (f) were acquired from renal cortex and medulla, respectively. The area under the curve (AUC) was calculated and compared. Statistical tests Independent Student's t-test, receiver-operating characteristic curve, and Spearman correlation analysis. Results All the cortical and medullary DWI parameters in the CHANGE group were significantly lower than those in the Non-CHANGE group (all P ≤ 0.012). Except for medullary fp, all DWI parameters in both the cortex and the medulla were inversely correlated with both the chronic (ρ ranging from -0.33 to -0.54, all P ≤ 0.02) and acute (ρ ranging from -0.35 to -0.60, all P ≤ 0.01) composite scores. Cortical ADCT and D had the largest AUC and specificity of 0.84 and 75.8%, respectively. Combined use of cortical D and medullary fp at each optimal cutoff point yielded a specificity of 90.9%. Data conclusion DWI demonstrated potential as a noninvasive biomarker to allow the stratification of patients into categories in which kidney allograft biopsy results are or are not likely to change clinical management. Level of evidence 1 TECHNICAL EFFICACY STAGE: 5 J. Magn. Reson. Imaging 2020;52:565-574.

Objectives: To investigate the immunohistochemical features of different stages of BK virus allograft nephropathy (BKVN) and further elucidate the underlying immunological mechanism involved in the evolution of BKVN. Methods: Fifty-two renal transplant recipients with biopsy proven BKVN were retrospectively selected. According to the third edition of the American Society of Transplantation Infection guidelines, 10 patients were categorized as having mild BKVN (stage A), 25 were moderate (stage B) and 17 were severe (stage C). The differential infiltrations of CD3+ (T lymphocytes), CD4+ (helper T lymphocytes), CD8+ (cytotoxic T lymphocytes), CD20+ (B lymphocytes), CD68+ (macrophages) and CD138+ (plasma cells) cells and the expression of interleukin-2 receptor (IL-2R) and human leukocyte antigen DR (HLA-DR) were compared among the three groups. Results: CD3+, CD4+, CD8+, CD20+, CD138+ and CD68+ cells infiltrations, IL-2R and HLA-DR expression were positive in the BKVN patients. Moreover, with increasing stages of BKVN, the numbers of positively stained inflammatory cells and the expression of IL-2R were significantly increased in the severe group compared to the mild group, whereas no statistically significant differences were observed with regard to HLA-DR expression. Eosinophil and neutrophil infiltration could also be observed in moderate to advanced BKVN. Conclusion: Renal allograft damage caused by BKVN involved T lymphocyte-, B lymphocyte- and mononuclear macrophage-mediated immune responses. Inflammatory cell infiltrations in the renal allograft were probably the driving force for BKVN progression. Additionally, eosinophils and neutrophils may be involved in the pathophysiological mechanism of BKVN.

Rationale Vulvar metastasis of colorectal cancer (CRC) and acquired resistance to cetuximab is a very rare phenomenon. To our knowledge, few cases have been reported in the English literatures. Patient concerns A 55-year-old woman was diagnosed as adenocarcinoma of the rectum and the primary tumor was detected to be Kirsten-RAS (KRAS) wild type. Diagnoses The patient was diagnosed with rectal adenocarcinoma by colonoscopy. Positron emission tomography/computed tomography (PET-CT) revealed multiple lymph node and bone metastases. Interventions The patient received a first-line course of palliative chemotherapy with FOLFOX combined with cetuximab. Outcomes After an initial response, acquired resistance to cetuximab occurred and vulvar metastasis was established by a second biopsy. Further molecular analysis showed that the KRAS mutation was detected in plasma samples and tumor tissues. Lessons Vulvar metastasis from CRC is relatively rare and indicates a poor prognosis. Routine physical examinations of cutaneous and subcutaneous may facilitate early detection of metastases and timely intervention of medical technology. Moreover, combining serial tumor biopsy, liquid biopsy, and radiologic imaging could help to define mechanisms of drug resistance and to guide selection of therapeutic strategies.

This manuscript has been withdrawn by the authors prior to final publication in the journal.

The purpose of this study was to investigate the effects of polymorphisms in CYP3A5*3, CYP3AP1, and MDR1, and of haplotype, on plasma levels of tacrolimus in Chinese patients after renal transplantation, and to assess the relationship between polymorphisms and the variability of concentration/dose of tacrolimus for optimization and individualization regimens.The MALDI-TOF method was used to detect the genotype of CYP3A5*3, CYP3AP1, and MDR-1 in kidney transplant recipients (n=63) receiving tacrolimus. Patients were assigned to 3 groups according to genotype. Peripheral blood was collected and the serum concentrations of tacrolimus were determined by EMIT 2000 after 12 hours of administration. Dose-adjusted concentrations of tacrolimus were calculated according to the different groups.We found that tacrolimus dose-adjusted C0 was larger in CYP3A5*3 and CYP3AP1 non-expressing renal transplant patients than in those who expressed the genes. In addition, wild-type homozygotes for MDR1 C3435T had a slightly lower dose-adjusted C0 compared with heterozygotes. However, no evidence was found that there was relationship between the MDR1 1236CT, 2677GT or haplotype polymorphisms and tacrolimus pharmacokinetics.The CYP3A5 genotype shows the most important association with tacrolimus concentrations. Our study suggests that a pharmacogenetic approach could be employed to predict individual drug availability differences in future.

In this paper the calculation formula about the effect of contamination resistance to the veracity of together-installed CVT with different rated capacitance and different section are given out though theoretical analysis. To see the effect more clearly, a lot of simulating work has been done in different conditions using ATP. Simulating results show that : to the CVT whose rating capacitance is 0.01 μ F, when the contamination resistance is smaller than 5 MΩ(3 MΩ to 0.02 μ F), the proportion of contamination resistance will induce error to CVT. Therefore when we use CVT to measure the line voltage in the area where the contamination problem is serious, the contamination resistance is a factor that can't be ignored. And the CVT should be clean regularly to make show it measure exactly. (5 pages)