Variable expression of heparan sulfate epitopes in crescents of human glomerulonephritis

 Crescentic glomerulonephritis leads to a rapid loss of renal function. Although glomerular crescents are rich in extracellular matrix (ECM), the composition and genesis of the ECM are incompletely understood. Heparan sulfate (HS) is a major ECM molecule and has polymeric structure of great variability. Recent findings that alterations in HS epitopes are associated with renal pathology prompted us to hypothesize that specific HS epitopes might be expressed in the evolution of crescents. We reviewed clinical records of 724 patients who underwent renal biopsy and found 21 patients with rapidly progressive glomerulonephritis. Immunohistochemistry was performed using monoclonal antibodies (mAbs) against well-defined HS epitopes. One mAb was directed against unsaturated uronic acid residues generated during the selective removal of HS by heparitinase (a), and a further two different mAbs against N-sulfate-enriched and O-sulfate-poor portions of HS (b). Results showed that mAb (a) reacted to ECM of normal, sclerosed and crescentic glomeruli and that mAbs (b) reacted strongly to ECM of fibrocellular crescents but not to fibrous crescents, the periglomerular areas and noncrescentic intraglomerular areas. We concluded there are regional differences in HS epitope expression, although HS are ubiquitous components of glomerular ECM. N-sulfate-enriched and O-sulfate-poor portions of HS might play a role in crescent formation. Received: 2 April 1998 / Accepted: 26 October 1998     

Treatment of non anti-GBM-antibody mediated,rapidly progressive glomerulonephritis by plasmapheresis and immunosuppression

Summary A retrospective study was conducted to evaluate the efficacy of plasmapheresis in combination with different immunosuppressive drugs (pulse therapy, azathioprine or cyclophosphamide together with steroids) in nine patients presenting with rapidly progressive glomerulonephritis (RPGN) not mediated by antibody to glomerular basement membrane. Six of these patients had to be initially dialysed. All patients underwent renal biopsy, which revealed that seven patients had a minimum of 80% crescents and five had interstitial fibrosis. Recovery of renal function was observed in seven patients (78%). All patients without interstitial fibrosis were recompensated for at least 14 months after the acute onset of RPGN. Those who presented with interstitial fibrosis declined to endstage renal failure after 13 months requiring chronic hemodialysis treatment or cadaveric kidney transplantation. On the basis of these findings interstitial fibrosis seems to be a limiting factor for the prognosis of non-anti-GBM-antibody mediated RPGN.Abbreviations bw body-weight - d day - dl deciliter - f female - GBM glomerular basement membrane - kg kilogrammc - m male - mg milligramme - MHC major histocompatibility complex - RPGN rapidly progressive glomerulonephritis - SLE systemic lupus erythematosus - yr year     

Polymorphisms and microvariant sequences in the Japanese population for 25 Y-STR markers and their relationships to Y-chromosome haplogroups

Y-chromosomal short tandem repeat (Y-STR) markers have been used for forensic purposes such as kinship analysis of male-linage and detection of a male DNA component in a mixture of male and female DNA. Recently, rapidly mutating Y-STR (RM Y-STR) markers were reported that are expected to help distinguish close male relatives. This study provides data of Y-chromosomal haplotypes for 25 Y-STR markers, including six RM Y-STR markers (DYS576, DYS627, DYS518, DYS570, DYS449 and DYF387S1) typed with the Yfiler™ Plus kit in 1299 males of the Japanese population. Discrimination capacity increased from 87.2% for 16 Y-STR markers with the Yfiler™ kit to 99.6% for 25 Y-STR markers with the Yfiler™ Plus kit. We characterized sequences of observed microvariant alleles of eight Y-STR markers and a low-amplified allele of DYS390 by Sanger sequencing. DYF387S1, a multi-locus Y-STR marker that is located at two positions on the human Y-chromosome, was observed in tri-allelic patterns in 51 of 1299 samples (3.9%) and we found an extremely high frequency of the tri-allelic pattern of DYF387S1 in haplogroup C-M131. We also analyzed Y-STR gene diversity in each haplogroup and its relevance to mutation rates.     

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

We aimed to investigate the efficacy of plasma exchange on severe anti‐neutrophil cytoplasmic antibody‐associated vasculitis (AAV). Of 182 patients with AAV in our hospital, 12 patients with life‐threatening organ damage (rapidly progressive glomerulonephritis and/or diffuse alveolar hemorrhage) underwent centrifuge‐based therapeutic plasma exchange and immunosuppressive therapy. Twenty‐four patients matched for age, serum creatinine, and severity of vasculitis, who received high‐dose glucocorticoids with or without immunosuppressants, were included in the nonplasma exchange group. Renal survival rate at 2 years from induction treatment was not significantly different between the plasma and nonplasma exchange groups (P = 0.524). Mortality rate at 5 years from induction treatment was not significantly different between the plasma and nonplasma exchange groups (P = 0.631). In this retrospective study, we could not show the significant differences in the renal survival rate and survival rate between the two groups.     

荧光PCR快速检测从业人员肠道致病菌结果分析

目的了解荧光PCR快速检测从业人员肠道致病菌效果。方法采集从业人员肛拭子样本用实时荧光PCR法检测沙门氏菌和志贺氏菌,检出的疑似阳性样本按国标法进行培养鉴定,分析荧光PCR检测方法的阳性检出率。结果采用实时荧光PCR方法共检测从业人员77 476人次,其中沙门氏菌阳性71例,阳性率0.916‰,志贺氏菌阳性62例,阳性率0.80‰。肠道致病菌合计阳性133例,阳性率1.717‰。结论荧光PCR快速检测方法用于从业人员体检,具有沙门氏菌、志贺氏菌的阳性检出率高、省时的效果。     

Blue Toe Syndrome Associated with Rapidly Progressive Glomerulonephritis: Ultimately Revealed Essential Mixed Cryoglobulinemia

The blue toe syndrome is a rare presentation in a number of medical disorders. We report a 35-year-old woman who initially presented with blue toe syndrome and rapidly progressive glomerulonephritis. Essential mixed cryoglobulinemia with vasculitis and renal failure was documented by laboratory tests and renal biopsy. She was on maintenace hemodialysis as renal failure persisted after steroid and immunosuppresive agents therapy. Her gangrenous changes of bilateral toes were autoamputated symmetrically and uneventfully.     

Disseminated Mycobacterium chelonae infection in a patient with T-cell lymphoma

Infections with rapidly growing mycobacteria are rare and most often seen in immunocompromised patients. We herein present the case of a 69-year-old man with a T-cell lymphoma treated by chemotherapy and mogamulizumab with a 6-month history of febrile episodes and subcutaneous nodules in both arms and arthritis of metacarpophalangeal joints. Blood cultures and DNA sequencing results demonstrated the growth of Mycobacterium chelonae. The patient was successfully treated with clarithromycin, moxifloxacin, and tobramycin, but died shortly after due to lymphoma progression.     

Prevalence of non tuberculous mycobacterial infection in surgical site infections and their antibiotic susceptibility profile

BackgroundSurgical site infections (SSIs) are one of the leading causes of hospital-acquired infections contributing to about 20% of all cases, thereby causing an increase in morbidity and financial burden. Causative organisms associated with SSIs have not changed greatly over the last 10–15 years; however, the proportions of different types of causative organisms have changed with an increase in case reports of rare organisms such as non-tuberculous mycobacteria (NTM).MethodsSamples received from patients with SSI were simultaneously cultured for the isolation of NTM along with routine bacteriological examination. On isolation of NTM, identification was carried out by biochemical tests, and further antibiotic susceptibility profile was determined by using RAPMYCO kit.ResultsSSI occurred in 3.95% of the 7675 surgeries performed during the study period of which 10.9% were caused owing to NTM. Only rapidly growing NTM were isolated of which, Mycobacterium fortuitum was the most common (51.51%) and had least resistance to drugs. Other isolates were Mycobacterium abscessus and Mycobacterium chelonae having high degree of antimicrobial resistance.ConclusionNTM are an important cause of SSI having delayed presentation, are difficult to diagnose and often not treated correctly. Identification and susceptibility testing is important as different species respond differently to antimicrobial agents.     

Anti-melanoma differentiation-associated gene 5 antibody is a diagnostic and predictive marker for interstitial lung diseases associated with juvenile dermatomyositis

The presence of the anti-melanoma differentiation-associated gene 5 antibody was evaluated in 13 patients with juvenile dermatomyositis (JDM). The antibody was positive in 5 of the 6 patients with JDM-associated interstitial lung disease (ILD), but not in the 7 patients without ILD. This antibody is a useful marker for early diagnosis of JDM-associated ILD.