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| 1 | Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients显示文摘Hepatocellular carcinoma(HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation(LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC(i.e., 'non-oncological factors'), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of nononcological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival. | Xiang-Qian Gu Wei-Ping Zheng Da-Hong Teng Ji-San Sun Hong Zheng | 2016 | World Journal of Gastroenterology2016，22，9： | 7 |
| 2 | Immunosuppressive Treatment of Non-infectious Uveitis:History and Current Choices显示文摘Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosuppressive treatment for uveitis since first introduced in 1950 s,its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control. Conventional immunosuppressive drugs,classified into alkylating agent,antimetabolites and T cell inhibitors,have been widely used as corticosteroid-sparing agents,each with characteristic safety/tolerance profiles on different uveitis entities. Recently,biologic agents,which target specific molecules in immunopathogenesis of uveitis,have gained great interest as alternative treatments for refractory uveitis based on their favorable safety and effectiveness in a variety of uveitis entities. However,lack of large randomized controlled clinical trials,concerns about efficacy and safety of long-term usage,and economic burden are limiting the use of biologics in non-infectious uveitis. Local administration of immunosuppressive drugs(from corticosteroids to biologics) through intraocular drug delivery systems represent another direction for drug development and is now under intense investigation,but more evidences are needed to support their use as regular alternative treatments for uveitis. With the numerous choices belonging to different treatment modalities(conventional immunosuppressive agents,biologics and local drug delivery systems) on hand,the practice patterns have been reported to vary greatly from center to center. Factors influence uveitis specialists' choices of immunosuppressive agents may be complex and may include personal familiarity,treatment availability,safety/tolerability,effectiveness,patient compliance,cost concerns and suggestions from related specialists such as rheumatologists and pediatricians. The focus of this review is to provide an overview of each treatment modality on safety/tolerability and effectiveness,which are believed to be the two most important factors affecting treatment decision making. | Chan Zhao Meifen Zhang | 2017 | Chinese Medical Sciences Journal2017，32，1： | 6 |
| 3 | Polyomavirus-associated nephropathy显示文摘Polyomaviruses BK and JC are ubiquitous viruses with high seroprevalence rates in general population.Following primary infection,polyomaviruses BK and JC persist latently in different sites,particularly in the reno-urinary tract.Reactivation from latency may occur in normal subjects with asymptomatic viruria,while it can be associated to nephropathy(PVAN)in kidney transplantat recipients.PVAN may occur in 1%-10%of renal transplant patients with loss of the transplanted organ in 30%up to 80%of the cases.Etiology of PVAN is mainly attributable to BK virus,although approximately5%of the cases may be due to JC.Pathogenesis of PVAN is still unknown,although viral replication and the lack of immune control play a major role.Immunosuppression represents the condicio sine qua non for the development of PVAN and the modulation of anti-rejection treatment represents the first line of intervention,given the lack of specific antiviral agents.At moment,an appropriate immunemodulation can only be accomplished by early identification of viral reactivacation by evaluation of polyomavirus load on serum and/or urine specimens,particularly in the first year post-trasplantation.Viro-immunological monitoring of specific cellular immune response could be useful to identify patients unable to recover cellular immunity posttransplantation,that are at higher risk of viral reactivation with development of PVAN.Herein,the main features of polyomaviruses BK and JC,biological properties,clinical characteristics,etiopathogenesis,monitoring and diag-nosing of PVAN will be described and discussed,with an extended citation of related relevant literature data. | Cristina Costa Rossana Cavallo | 2012 | World Journal of Transplantation2012，2，6： | 6 |
| 4 | Reactivation of hepatitis B virus infection in patients with hemolymphoproliferative diseases, and its prevention显示文摘Reactivation of hepatitis B virus(HBV)replication is characterized by increased HBV-DNA serum values of about 1 log or by HBV DNA turning positive if previously undetectable in serum,possibly associated with liver damage and seldom life-threatening.Due to HBV reactivation,hepatitis B surface antigen(HBsAg)-negative/anti-HBc-positive subjects may revert to HBsAg-positive.In patients with hemo-lymphoproliferative disease,the frequency of HBV reactivation depends on the type of lymphoproliferative disorder,the individual's HBV serological status and the potency and duration of immunosuppression.In particular,it occurs in 10%-50%of the HBsAg-positive and in 2%-25%of the HBsAg-negative/anti-HBc-positive,the highest incidences being registered in patients receiving rituximab-based therapy.HBV reactivation can be prevented by accurate screening of patients at risk and by a pharmacological prophylaxis with anti-HBV nucleo(t)sides starting 2-3 wk before the beginning of immunosuppressive treatment and covering the entire period of administration of immunosuppressive drugs and a long subsequent period,the duration of which depends substantially on the degree of immunodepression achieved.Patients with significant HBV replication before immunosuppressive therapy should receive anti-HBV nucleo(t)sides as a long-term(may be life-long)treatment.This review article is mainly directed to doctors engaged every day in the treatment of patients with onco-lymphoproliferative diseases,so that they can broaden their knowledge on HBV infection and on its reactivation induced by the drugs with high immunosuppressive potential that they use in the care of their patients. | Caterina Sagnelli Mariantonietta Pisaturo Federica Calò Salvatore Martini Evangelista Sagnelli Nicola Coppola | 2019 | World Journal of Gastroenterology2019，25，26： | 6 |
| 5 | Adherence to immunosuppressor medication in renal transplanted patients显示文摘Non-adherence is a priority public health concern. Non-adherence means not taking medications, missing medications, taking too much, not taking enough, wrongtiming, wrong dose and/or wrong pill, but may also refer to missing appointments, not booking appointments, not doing blood work, not returning calls and/or refusal to follow the treatment regimen. In renal transplantation, adherence to immunosuppressive medication is a fundamental requisite in order to preserve graft function, since non-adherence is one of the main causes for late acute rejection, incomplete recovery after rejection treatment, chronic graft dysfunction, graft loss, and death. Transplantation failure due to treatment nonadherence is economically, socially, ethically and morally unjustifiable. This is a very prevalent issue: in some studies, its incidence is as high as 70% of patients. The self-reported nonadherence levels found in certain studies, including those performed immediately after transplantation show the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. There is not a single method to assess non adherence, thus combining several measures increases diagnostic accuracy. Electronic monitoring with a microdevice that records each time a pill bottle is opened is considered the 'gold standard' for measuring adherence, but selfreport at a confidential interview was the best measure of adherence. Thus non-adherence risk can be effectively assessed using clinically available assessment tools. Medication Adherence Scale, Brief Medical Questionnaire, Immunosuppressant Therapy Adherence Scale, Immunosuppressant Therapy Barrier Scale, Long-Term Medication Behavior Self-Efficacy Scale and Simplified Medication Adherence Questionnaire are some of the self-reported questionnaires. There are multiple factors associated with non-adherence in immunosuppressant therapy: Younger patients(adolescent, especially), poor health coverage, poor social support, unmarried, no family, non-Caucasian, immigrant, lower income, lower socioeconomic class, greater parental distress and lower family cohesion; complex medical regimens, higher number of drugs, longer time after transplant, toxicity, side effects, poor tolerance to medication, higher number of physicians involved, poor provider-patient rapport; psychological(dependency, high levels of anxiety and hostility, poorer behavioral functioning and greater distress in children) and psychiatric(depression) illnesses, low self-efficacy with medicine intake, perception of immunosuppressive therapy as not been necessary to preserve kidney function, forgetfulness, rebelliousness, poor perception of health, poor satisfaction, low Health-related quality of life, addictions, lack of coping strategies and avoidance behavior; patient morbidity: comorbidity, receiving a transplant from a live donor, retransplantation, and noninsulin-dependent diabetes. The most frequent strategies to promote medication-taking must focus on modifiable risk factors. Reasons for non-adherence are complex and diverse and any successful intervention aimed at improving adherence must be multidimensional. Although effective intervention strategies are needed to improve immunosuppressant therapy adherence, few intervention studies have been conducted in the adult renal transplant population. In this study, we perform an exhaustive review of the different strategies reported in the literature. A number of key reasons for non-adherence are also provided. | Francisco Ortega Carmen Díaz-Corte Covadonga Valdés | 2015 | World Journal of Clinical Urology2015，4，1： | 5 |
| 6 | Structural shifts in the intestinal microbiota of rats treated with cyclosporine A after orthotropic liver transplantation显示文摘Understanding the effect of immunosuppressive agents on intestinal microbiota is important to reduce the mortality and morbidity from orthotopic liver transplantation (OLT). We investigated the relationship between the commonly used immunosuppressive agent cyclosporine A (CSA) and the intestinal microbial variation in an OLT model. The rat samples were divided as follows:(1) N group (normal control);(2) I group (isograft LT, Brown Norway [BN] rat to BN);(3) R group (allograft LT, Lewis to BN rat);and (4) CSA group (R group treated with CSA). The intestinal microbiota was assayed by denaturing gradient gel electrophoresis profiles and by using real-time polymerase chain reaction. The liver histopathology and the alanine/aspartate aminotransferase ratio after LT were both ameliorated by CSA. In the CSA group, the numbers of rDNA gene copies of Clostridium cluster I, Clostridium cluster XIV, and Enterobacteriaceae decreased, whereas those of Faecalibacterium prausnitzii increased compared with the R group. Cluster analysis indicated that the samples from the N, I, and CSA groups were clustered, whereas the other clusters contained the samples from the R group. Hence, CSA ameliorates hepatic graft injury and partially restores gut microbiota following LT, and these may benefit hepatic graft rejection. | Junjun Jia Xinyao Tian Jianwen Jiang Zhigang Ren Haifeng Lu Ning He Haiyang Xie Lin Zhou Shusen Zheng | 2019 | Frontiers of Medicine2019，13，4： | 5 |
| 7 | Tuberculosis in Takayasu arteritis: a retrospective study in 1105 Chinese patients显示文摘Background Tuberculosis (TB) infection has been reported to have a possible relationship with the occurrence and clinical course of Takayasu arteritis (TA). We aimed to describe the characteristics of TB in a large population of TA patients. Methods We included a total of 1105 patients with TA, who were hospitalized between January 1992 and December 2017. Comparisons of clinical features were made according to the presence of TB. Results Among the 1105 patients, 109 (9.9%) had TB, including 53 patients (48.6%) diagnosed with TB before the onset of TA, 23 (21.1%) with a concurrent diagnosis of TB and TA, and 24 patients (22.0%) who developed TB after TA. Pulmonary TB was the most frequently identified (97 patients, 89.0%). Patients with TB had more frequent involvement of the pulmonary artery and experienced more chest discomfort and constitutional symptoms but had less interventional treatment. Demographic characteristics, comorbid diseases, and use of steroids were similar between patients with and without TB. Conclusions The proportion of Chinese TA patients with TB was not low, and about half of the patients had TB before TA. Pulmonary TB was the most common. Pulmonary artery involvement and pulmonary hypertension was more frequent in TA patients with TB. | Ying ZHANG Peng FAN Fang LUO Hui-Min ZHANG Lei SONG Wen-Jun MA Hai-Ying WU Jun CAI Lin-Ping WANG Xian-Liang ZHOU | 2019 | Journal of Geriatric Cardiology2019，16，8： | 4 |
| 8 | Combining cytochrome P-450 3A4 modulators and cyclosporine or everolimus in transplantation is successful显示文摘AIM: To describe the long term follow-up of kidney allograft recipients receiving ketoconazole with calcineurin inhibitors(CNI) alone or combined with everolimus. METHODS: This is an open-label, prospective observational clinical trial in low immunologic risk patients who, after signing an Institutional Review Board approved consent form, were included in one of two groups. The first one(n = 59) received everolimus(target blood level, 3-8 ng/m L) and the other(n = 114) azathioprine 2 mg/kg per day or mycophenolate mofetyl(MMF) 2 g/d. Both groups also received tapering steroids, the cytochrome P-450 3A4(CYP3A4) modulator, ketoconazole 50-100 mg/d, and cyclosporine with C0 targets in the everolimus group of 200-250 ng/mL in 1 mo, 100-125 ng/m L in 2 mo, and 50-65 ng/m L thereafter, and in the azathioprine or MMF group of 250-300 ng/mL in 1 mo, 200-250 ng/mL in 2 mo, 180-200 ng/m L until 3-6 mo, and 100-125 ng/mL thereafter. Clinical visits were performed monthly the first year and quarterly thereafter by treating physicians and all data was extracted by the investigators.RESULTS: The clinical characteristics of these two cohorts were similar. During the follow up(66 + 31 mo), both groups showed comparable clinical courses, but the biopsy proven acute rejection rate during the full follow-up period seemed to be lower in the everolimus group(20% vs 36%; P = 0.04). The everolimus group did not show a higher surgical complication rate thanthe other group. By the end of the follow-up period, the everolimus group tended to show a higher glomerular filtration rate. Nevertheless, we found no evidence of a consistent negative slope of the temporal allograft function estimated by the modification of the diet in renal disease formula in any of both groups. At 6 years of follow-up, the uncensored and death-censored graft survivals were 91% and 93%, and 91% and 83% in the everolimus plus cyclosporine, and cyclosporine alone groups, respectively. The addition of ketoconazole saved 80% of cyclosporine and 56% of everolimus doses. CONCLUSION: Combining CYP3A4 modulators with CNI or mammalian target of rapamycin inhibitor, in low immunological risk kidney transplant recipients is feasible, effective, safe and affordable even in the long term. | Fernando González Ricardo Valjalo | 2015 | World Journal of Transplantation2015，5，4： | 4 |
| 9 | B cells with regulatory properties in transplantation tolerance显示文摘Induction of tolerance remains a major goal in transplantation. Indeed, despite potent immunosuppression, chronic rejection is still a real problem in transplantation. The humoral response is an important mediator of chronic rejection, and numerous strategies have been developed to target either B cells or plasma cells. However, the use of anti-CD20 therapy has highlighted the beneficial role of subpopulation of B cells, termed regulatory B cells. These cells have been characterized mainly in mice models of auto-immune diseases but emerging literature suggests their role in graft tolerance in transplantation. Regulatory B cells seem to be induced following inflammation to restrain excessive response. Different phenotypes of regulatory B cells have been described and are functional at various differentiation steps from immature to plasma cells. These cells act by multiple mechanisms such as secretion of immuno-suppressive cytokines interleukin-10(IL-10) or IL-35, cytotoxicity, expression of inhibitory receptors or by secretion of non-inflammatory antibodies. Better characterization of the development, phenotype and mode of action of these cells seems urgent to develop novel approaches to manipulate the different B cell subsets and the response to the graft in a clinical setting. | Justine Durand Elise Chiffoleau | 2015 | World Journal of Transplantation2015，5，4： | 4 |
| 10 | Effect of different immunosuppressive drugs on calcineurin and its mutants显示文摘Several mutants in Loop7 region and near Loop7 region of calcineurin A (CN A) subunit have been constructed and purified using site-directed mutagenesis. Their phosphatase activity and the corresponding solution conformation were examined. Their phosphatase activities between wild-type CN and mutants were compared to identify the interaction of different immuno-suppressive drugs with CN. The results showed that the phosphatase activities of the mutants at Loop7 were much higher than the one of wild-type CN. Furthermore, circular dichroism spectra of the mutants revealed that their solution conformations gave rise in changes in native structure of the protein. Cyclophilin-CyclosporinA (CyP-CsA) significantly inhibited the phosphatase activity of wild-type CN, and had no effects on the phosphatase activity of mutants in Loop7 region, which indicates that the site-directed mutagenesis at Loop7 region made a significant change in the interaction between CyP-CsA and CN. Examination of the activities of | 阎力君 于翠娟 张丽芳 魏群 | 2000 | Science China(Life Sciences)2000，43，1： | 3 |
| 11 | Hepatitis B reactivation related to everolimus显示文摘Reactivation of hepatitis B virus (HBV) during chemotherapy is a well known complication in patients with chronic hepatitis B and cancer.The clinical manifestations range from subclinical elevation of liver enzymes to severe,potentially fatal fulminant hepatitis.Reactivation can occur in a patient with previous inactive HBV infection;either an inactive carrier or a patient with resolved hepatitis.Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved in renal cell carcinoma,neuroendocrine tumours and breast cancer.mTOR inhibitors are a new generation of drugs for targeted treatment;therefore,little about their side effects is known.Here,we report a patient with renal cell carcinoma who experienced a flare of hepatitis B infection during treatment with everolimus.Clinicians should be aware of HBV reactivation in patients who are undergoing treatment with everolimus,and screening for hepatitis B infection and prophylactic antiviral treatment should be considered. | Sema Sezgin Gksu Serife Bilal Hasan Senol Coskun | 2013 | World Journal of Hepatology2013，5，1： | 3 |
| 12 | Pneumatosis intestinalis with obstructing intussusception:A case report and literature review显示文摘Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and review the literatures regarding PI with intussusception. A 20-year-old man presented at our hospital with a 3-d intermittent lower abdominal pain history. He underwent steroid therapy for membranoproliferative glomerulonephritis for 4 years. Computed tomography revealed ascending colon intussusception with air within the wall. Intraoperative colonoscopy revealed numerous soft polypoid masses with normal overlying mucosa and right hemicolectomy was performed. Histological examination of colonic wall sections revealed large cysts in the submucosal layer. The pathological diagnosis was PI. Nine cases of intussusception associated with primary PI have been reported. Although primary PI often represents a benign condition that should not be considered as an argument for surgery,if the case involves intussusception and obstruction,emergent laparotomy should be considered. | Yujiro Itazaki Hironori Tsujimoto Nozomi Ito Hiroyuki Horiguchi Shinsuke Nomura Kyohei Kanematsu Shuichi Hiraki Suefumi Aosasa Junji Yamamoto Kazuo Hase | 2016 | World Journal of Gastrointestinal Surgery2016，8，2： | 2 |
| 13 | Efficacy of the vaccination in inflammatory bowel disease显示文摘Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence. | Elisa Carrera Rebeca Manzano Elena Garrido | 2013 | World Journal of Gastroenterology2013，19，9： | 2 |
| 14 | New treatments for inflammatory bowel disease显示文摘INTRODUCTIONAlthoughinflammatoryboweldisease(IBD)isapparentlystilrelativelyrareintheEast,evidencefromHongKongsuggeststhatover... | David S. Rampton and D.Phil | 1998 | World Journal of Gastroenterology1998，4，5： | 2 |
| 15 | Relapsing polychondritis with p-ANCA associated vasculitis: Which triggers the other?显示文摘Relapsing polychondritis(RP) is a rare autoimmune disease with chronic inflammatory/destructive lesions of the cartilaginous tissues. In one third of the cases it is associated with other autoimmune disorders, mostly with anti-neutrophil cytoplasmic antibody(ANCA) associated vasculitis(AAV). We report three cases of RP with p-ANCA positive AAV. In the first patient RP developed 1.5 years after the onset of AAV. In the others the signs of RP were present before the onset of severe crescent glomerulonephritis. Patients responded well on steroid and cyclophosphamide. In dialysis dependent cases plasmapheresis was also used successfully. During the 2 and 1.5 years of follow up, they were symptom-free, and had stable glomerular filtration rate. The first patient died after four years of follow-up due to the complications of sudden unset pancytopenia,which raises the possibility of associated hemophagocytic syndrome. In the setting of RP or AAV physicians should always be aware of the possibility of sudden or insidious appearance of the other disease. | Ibolya File Csilla Trinn Zsolt Mátyus László Ujhelyi József Balla János Mátyus | 2014 | World Journal of Clinical Cases2014，2，12： | 1 |
| 16 | Effect of Diallyl Trisulfide on the Activation of T Cell and Macrophage-mediated Cytotoxicity显示文摘(冯作化)(张桂梅)(郝天玲)(周斌)(张慧)(姜志尧)EffectofDiallylTrisulfideontheActivationofTCellandMacrophage-mediatedCytotoxicity￥FENGZuo-hua;ZHANGGui-... | 冯作化 张桂梅 郝天玲 周斌 张慧 姜志尧 | 1994 | Journal of Huazhong University of Science and Technology(Medical Sciences)1994，14，3： | 1 |
| 17 | Recent Advancements in Nanomedicine for‘Cold’Tumor Immunotherapy显示文摘Although current anticancer immunotherapies using immune checkpoint inhibitors(ICIs)have been reported with a high clinical success rate,numerous patients still bear‘cold’tumors with insufficient T cell infiltration and low immunogenicity,responding poorly to ICI therapy.Considering the advancements in precision medicine,in-depth mechanism studies on the tumor immune microenvironment(TIME)among cold tumors are required to improve the treatment for these patients.Nanomedicine has emerged as a promising drug delivery system in anticancer immunotherapy,activates immune function,modulates the TIME,and has been applied in combination with other anticancer therapeutic strategies.This review initially summarizes the mechanisms underlying immunosuppressive TIME in cold tumors and addresses the recent advancements in nanotechnology for cold TIME reversal-based therapies,as well as a brief talk about the feasibility of clinical translation. | Qinjun Chen Tao Sun Chen Jiang | 2021 | Nano-Micro Letters2021，13，6： | 1 |
| 18 | Challenges in pediatric renal transplantation显示文摘Transplantation in children is the best option to treat renal failure. Over the last 25 years the improvements in therapy have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Tolerance of the graft and minimization of side effects are the challenges for improving the outcome of children with a grafted kidney. Notwithstanding the difficulties in settling in children large multicenter trials to derive statistically useful data, many important contributions in the last years brought important modifications in the immunosuppressive therapy, including minimization protocols of steroids and calcineurin inhibitors and new induction drugs. New methods for diagnosis of anti HLA antibodies and some new protocols to improve both chance and outcome of transplantation in immunized subjects represent area of ongoing research of extreme interest for children. | Licia Peruzzi Alessandro Amore Rosanna Coppo | 2014 | World Journal of Transplantation2014，4，4： | 1 |
| 19 | Giant cell arteritis: Current treatment and management显示文摘Glucocorticoids remain the cornerstone of medicaltherapy in giant cell arteritis(GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. Other targeted treatments, such as the use of abatacept, are also now under investigation in GCA. The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers(C-reactive protein and erythrocyte sedimentation rate). Imaging techniques(e.g., ultrasound) are clearly important screening tools for aortic aneurysms and assessing patients with largevessel involvement, but may also have an important role as biomarkers of disease activity over time or in response to therapy. Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain. | Cristina Ponte Ana Filipa Rodrigues Lorraine O'Neill Raashid Ahmed Luqmani | 2015 | World Journal of Clinical Cases2015，3，6： | 1 |
| 20 | Protective effect of glucocorticoid-free immunosuppressive regimen in allogenic islet transplantation显示文摘BACKGROUND: The most common complication after allogenic islet transplantation is rejection. This study was to evaluate the effect of anti-rejection of glucocorticoid-free immunosuppressive regimen on allogenic islet transplantation. METHODS: Tacrolimus(FK506)+mycophenolate mofetil (MMF) and FK506+MMF+prednisone (Pred) were administered respectively for 2 weeks to inhibit rejection after allogenic islet transplantation in rats, which were compared with the control group. The concentrations of blood glucose, insulin and C-peptide were determined dynamically in recipients and the sites of transplantation were observed morphologically. RESULTS: As compared with the control group without immunosuppressive agents, FK506+MMF and FK506+MMF+Pred could prolong the survival time of grafts significantly. There were many morphologically intact islets in the liver of recipients 2 months after transplantation. Group FK506+MMF kept normal levels of blood glucose, insulin and C-peptide beyond 60 days after transplantation. In contrast, group FK506+MMF+Pred secreted less C-peptide(P<0.05) and maintained a higher level of blood glucose concentration (P<0.01) after the operation. There was no significant difference in insulin concentrations between the two groups. The level of blood glucose beyond the first 2 weeks after drug withdrawal in group FK506+MMF+Pred decreased obviously (P<0.05), and the secretion of insulin and C-peptide increased. These results were compared with those the first 2 weeks after transplantation and the first 2 weeks after drug withdrawal. CONCLUSIONS: Both regimens of FK506+MMF and FK506+MMF+Pred could provide effective immunosup-pression. Moreover the combined glucocorticoid-free immunosuppressive strategy of low-dose FK506 and MMF could protect islet grafts in islet transplantation without diabetogenic side-effects. | Cheng-You Du and Er-Kan Xu Department of Hepatobiliary Surgery & Liver Transplantation, First Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400016, China | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，1： | 1 |
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