[Non-surgical local treatment for pulmonary aspergilloma]

Pulmonary aspergilloma (PA) is usually secondary to pulmonary cavities. The main purpose of PA treatment is to prevent life-threatening hemoptysis. Many patients cannot tolerate surgical resection, which is considered the preferred treatment. Oral or intravenous antifungal therapy is less effective because PA usually does not invade the blood vessels of the pulmonary cavity. In this case, arterial embolization, local injection with drugs, and radiation therapy can be considered. This article will summarized various non-surgical local treatments for PA (hemoptysis) to refer clinical decision-making.

Continuous Veno-Venous Hemofiltration in the Treatment of Acute Severe Hyponatremia: A Report of 11 Cases

Objectives

To evaluate the treatment effect of continuous veno-venous hemofiltration (CVVH) in patients with acute severe hyponatremia.

Methods

Eleven patients with severe acute hyponatremia, including 6 males and 5 females, aged 25–61 years (mean age 48.36), were treated with CVVH. Hyponatremia occurred 38–48 hours prior to the initiation of CVVH.

Results

All patients tolerated CVVH well, with an average treatment duration of 57.19 (45.6–86) hours. During CVVH, the serum sodium concentration increased significantly from 100.9±3.99 mmol/L at initiation of CVVH to 140.3±1.6 mmol/L after 48 hours of treatment (P<0.01). The serum osmolarity increased concurrently, from 216.7±7.4 mOsm/kgH2O to 295.0±4.2 mOsm/kgH2O (P<0.01). The Glasgow scores and APACHE II scores in these patients improved significantly during treatment.

Conclusions

CVVH is a safe and effective option for the treatment of patients with severe acute hyponatremia due to its slow and continuous nature.

Strain dynamics of ultrathin VO₂ film grown on TiO₂ (001) and the associated phase transition modulation

Tuning the metal insulator transition (MIT) behavior of VO2 film through the interfacial strain is effective for practical applications. However, the mechanism for strain-modulated MIT is still under debate. Here we directly record the strain dynamics of ultrathin VO2 film on TiO2 substrate and reveal the intrinsic modulation process by means of synchrotron radiation and first-principles calculations. It is observed that the MIT process of the obtained VO2 films can be modulated continuously via the interfacial strain. The relationship between the phase transition temperature and the strain evolution is established from the initial film growth. From the interfacial strain dynamics and theoretical calculations, we claim that the electronic orbital occupancy is strongly affected by the interfacial strain, which changes also the electron-electron correlation and controls the phase transition temperature. These findings open the possibility of an active tuning of phase transition for the thin VO2 film through the interfacial lattice engineering.

C4d-positive acute humoral renal allograft rejection: Rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil

OBJECTIVE

We investigated the efficacy of immunoadsorption (IA) in combination with tacrolimus (FK506) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants.

METHODS

Six of 185 cadaveric renal allograft recipients developed AHR at a mean of 4.8 +/- 0.8 days after the operation. C4d deposits were observed in peritubular capillaries (PTC) with accumulation of granulocytes. IA with staphylococcal protein A and FK506-MMF combination therapy were administered.

RESULTS

After treatment with IA for 6.3 +/- 1.03 sessions combined with FK506 (0.14 to 0.16 mg.kg(-1).d(-1)) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment to a serum creatinine decrease was 14 +/- 2.9 days. The pre-IA panel reactive antibody reactivity (PRA) peaked at 50.2% +/- 6.1%, and was significantly reduced to 8.3% +/- 2.9% after IA. In four of six patients repeat allograft biopsy revealed a remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100% and renal function remains stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL.

CONCLUSION

The optimal treatment for alloantibody-mediated AHR remains uncertain. Our findings suggest that a therapeutic approach combining IA and FK506-MMF rescue improves the outcome of AHR.

[Effects of baoshen pill in treating chronic renal failure with long-term hemodialysis]

A clinical trial, to evaluate the effects of Baoshen Pill (Rheum palmatum extract, RPE) on hemodialytic patients was conducted. 42 cases with terminal stage of renal failure (Scr < 10 ml/min) on HD were divided at random into RPE treated group and control group. The results showed there were no statistically significant differences between two groups for Scr or BUN. Serum levels of TC, LDL-c, apo B and apo B/apo A1 dropped down and HDL-c, apo A1, albumin, pro-albumin and fibrinectin increased during the follow-up period (P < 0.05) in the treated patients. It is considered that the mechanisms of RPE in preventing chronic renal failure were not the action of whole body. Improving serum levels of albumin, lipoprotein, apolipoproteins might play important role in treatment.

[Clinical studies of recombinant human erythropoietin in patients on long-term dialysis]

Recombinant human erythropoietin (r-HuEPO) was administered in 68 dialyzed patients (32 on acetate hemodialysis, 24 bicarbonate hemodialysis and 12 on hemo-filtration). The mean initial Hb 52.7 +/- 8.0g/L, Ht 19.4 +/- 2.2%, serum ferritin > 100ng/L. Each patients received r-HuEPO intravenously, at the dose of 300U/Kg/w for 6.2 +/- 4.3 months. Target range: Hb 100-120g/L, Ht 30-35%. After r-HuEPO treatment, blood transfusion was not needed for any of the patients, anemia was ameliorated with increase of Hb and Ht levels. It was found that the minimum effective dose of the r-HrEPO was 150-300U/Kg/w. We conclude that r-HuEPO is effective as treatment for the anemia of dialyzed patients. However, hypertension, clotted dialyzers and dialysis access thromboses were been developed in some patients after correction of anemia. There is now a general consensus that these side effects may be minimized if r-HuEPO is initially given in small doses with increments to avoid a too rapid correction of the anemia.

Primary glomerulonephritis in China. Analysis of 1001 cases

The morphologic classification and clinical spectrum of 1,001 cases of primary glomerulonephritis (GN) in Jinling Hospital during 1980-1988 were analysed. It was found that the incidence of mesangial type lesion including mesangial proliferative GN, IgA nephropathy and IgM nephropathy ranks first (21.5%, 32.1% and 10.1% respectively), which is not only the commonest cause of patients clinically manifesting nephrotic syndrome and gross hematuria but also the predominant type of nephritis causing uremia and hypertension.