Transformation from Tubulointerstitial Nephritis to Crescentic Glomerulonephritis: An Unusual Presentation of ANCA-Associated Renal Vasculitis

A 44-year-old man with acute renal failure and antineutrophil cytoplasmic antibodies (ANCA) positivity was described. The first renal biopsy specimen showed tubulointerstitial nephritis (TIN) with normal glomeruli. However, delayed recovery of renal function with low-dose steroid treatment for TIN prompted a second renal biopsy 1 month later; and the specimen demonstrated a dramatically different morphology, with necrotizing and crescentic glomerulonephritis. Improvement in renal function occurred, together with reduction of ANCA titers, following intensive immunosuppressive therapy. This case illustrates an unusual presentation of TIN in ANCA-associated renal vasculitis. The possible pathogenetic mechanism are discussed.     

Hypotensive Effect of Plasma Exchange in Immune Complex Nephritis

Abstract: The effect of plasma exchange (PE) on blood pressure (BP) in 20 hypertensive patients (9 with mixed cryoglobulinemia, 7 with systemic lupus erythematosus, and 4 with idiopathic glomerulonephritis) was evaluated retrospectively. In each PE 1.5–2.5 L of plasma was replaced with an equal volume of 4% albumin polysaline solution. The frequency of PE was three times per week for the first 2 weeks and twice per week subsequently. Sixteen patients were on hypotensive treatment at the onset of PE. Their systolic/diastolic BP was 171 ± 4.7/ 102 ± 3.0 mm Hg ( ± 1 SEM). After 4 weeks, BP decreased to 141 ± 2.8/89 ± 2.3 mm Hg (p < 0.001), although in 10 patients antihypertensive drug therapy had been reduced or discontinued. The most marked decrease of BP occurred after the first week (152 ± 5.3/92 ± 2.9 mm Hg), and this decrement correlated remarkably well with pressure levels before PE despite the great heterogeneity of the individual patients (for diastolic BP, r = 0.87, p < 0.001; for systolic BP, r = 0.60, p < 0.01). A mild decrease of serum creatinine was observed during PE, but its time course was different from that of BP, and did not correlate with this parameter.     

Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome in a 52-Year-Old Female: A Case Report and Review of the Literature

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare entity first described in 1975, affecting mainly young women and adolescents. We present a case of a 52-year-old female patient (one of the oldest in the literature) who complained of fever, anorexia, nausea, and vomiting. After she was admitted to our hospital, laboratory tests revealed tubular proteinuria, elevated erythrocyte sedimentation rate (ESR), anemia, and renal insufficiency (serum creatinine 4.2 mg/dL) with metabolic acidosis. Ophthalmologic examination revealed anterior uveitis (iritis) and renal biopsy showed acute tubulointerstitial nephritis. The diagnosis of TINU syndrome was established and the patient was treated with oral corticosteroids. All symptoms and ophthalmologic abnormalities disappeared after 6 weeks of treatment. Renal function also recovered completely and remained stable at follow-up. TINU syndrome should be considered in the differential diagnosis of unexplained tubulointerstitial nephritis, especially in the presence of ocular findings. Corticosteroid therapy is still controversial, but it helps in the quick resolution of renal and mainly eye abnormalities.     

首选后腹腔镜治疗复杂性输尿管上段结石的可行性分析

目的：探讨首选后腹腔镜切开取石术治疗复杂性输尿管上段结石的可行性。方法：回顾性分析2008年11月～2010年6月术前确诊为复杂性输尿管上段结石并行后腹腔镜输尿管切开取石术24例患者的临床资料。结果：23例手术获得成功,手术时间65～130rain,平均79．6min;术中出血10～50ml,平均20．1ml。术后随访3～22个月,平均9．1个月,恢复良好。1例因ESWI。后1周内行后腹腔镜左输尿管切开取石术,术中见输尿管周围粘连明显,不易分离,损伤左肾下极迷走动脉而改行开放手术。结论：后腹腔镜输尿管切开取石术可安全有效地治疗复杂性输尿管上段结石,有望作为治疗复杂性输尿管上段结石的首选方法。     

Altered glycosylation of surfactant and brush border membrane of the small intestine in response to surgical manipulation

BACKGROUND: Surgical stress can lead to bacterial translocation from the intestine into systemic circulation. Adherence of bacteria onto the glycoconjugates of the brush border membrane (BBM) and surfactant coat (SLP) of the mucosal cells is the first step in the translocation of luminal bacteria. Our earlier study showed that surgical manipulation of the intestine results in oxidative stress leading to structural and functional alterations in the mucosa. This study looks at the effect of surgical manipulation on the glycoconjugate alterations of SLP and BBM. MATERIALS AND METHODS: SLP and BBM were isolated from control and after surgical manipulation and the sugar composition was analyzed. Bacterial adherence using E. coli isolated from cecum was compared after coating microtiter plates with SLP or BBM isolated from control and after surgical manipulation. RESULTS: An increase in various sugars was seen after surgical manipulation both in SLP and BBM and this increase was maximum at 12 h after surgery. These alterations increased bacterial adherence onto SLP and BBM. Inhibiting superoxide generation by allopurinol treatment prior to surgical manipulation prevented glycosylation alteration and bacterial adherence. CONCLUSION: Surgical manipulation results in altered glycoconjugates of SLP and BBM which leads to increased bacterial adherence. These alterations are probably brought about by oxygen-free radicals. This is clinically significant because postsurgical complications such as sepsis may be brought about by altered glycosylation.     

Immune parameters relevant to neural xenograft survival in the primate brain

Cicchetti F, Fodor W, Deacon TW, van Horne C, Rollins S, Burton W, Costantini LC, Isacson O. Immune parameters relevant to neural xenograft survival in the primate brain. Xenotransplantation 2003: 10: 41–49. © Blackwell Munksgaard, 2003
The lack of supply and access to human tissue has prompted the development of xenotransplantation as a potential clinical modality for neural cell transplantation. The goal of the present study was to achieve a better understanding of the immune factors involved in neural xenograft rejection in primates. Initially, we quantified complement mediated cell lysis of porcine fetal neurons by primate serum and demonstrated that anti-C5 antibody treatment inhibited cell death. We then developed an immunosuppression protocol that included in vivo anti-C5 monoclonal antibody treatment, triple drug therapy (cyclosporine, methylprednisolone, azathioprine) and donor tissue derived from CD59 or H-transferase transgenic pigs and applied it to pig-to-primate neural cell transplant models. Pre-formed αGal, induced αGal and primate anti-mouse antibody (PAMA) titers were monitored to assess the immune response. Four primates were transplanted. The three CD59 neural cell recipients showed an induced anti-αGal response, whereas the H-transferase neural cell recipient exhibited consistently low anti-αGal titers. Two of these recipients contained surviving grafts as detected by immunohistochemistry using selected neural markers. Graft survival correlated with high dose cyclosporine treatment, complete complement blockade and the absence of an induced PAMA response to the murine anti-C5 monoclonal antibodies.     

体外循环对T淋巴细胞细胞免疫功能的影响

目的观察体外循环（CPB）对T淋巴细胞细胞免疫功能的影响，以探讨CPB致机体免疫功能失调的内在机制。方法在我科2006年3～9月收治的500例手术患者中，随机抽取30例在CPB下行二尖瓣置换术的风湿性心瓣膜病患者为CPB组；30例动脉导管未闭在非CPB下行动脉导管结扎术患者为非CPB组。于术前、停机前或手术结束时、术后24h取血分离T淋巴细胞，对T淋巴细胞的数量、凋亡、细胞杀伤能力进行检测。结果停机前CPB组T淋巴细胞计数较术前减少（50．9％±6．8％VS．58．5％±9．1％，P〈0．05）；停机前和术后24hT淋巴细胞凋亡率较术前升高（6．5％±2．2％VS．0．9％±1．1％，5．6％±1．8％VS．0．9％±1．1％；P〈0．01）；停机前和术后24hT淋巴细胞对肿瘤细胞的杀伤能力较术前降低（30．4％±6．0％VS．37．3％±8．6％，29．0％±4．9％VS．37．3％±8．6％；P〈0．05）。停机前CPB组T淋巴细胞对肿瘤细胞杀伤能力明显低于非CPB组（30．4％±6．0％VS．33．6％±5．3％，P〈0．05）。结论CPB可抑制T淋巴细胞的细胞免疫功能，CPB过程中机体处于短暂的免疫抑制状态。     

The Blood Supply to the Nipple-Areola Complex of the Human Mammary Gland

The main sources of blood supply to the breast are described in textbooks as the internal thoracic, lateral thoracic, and posterior intercostal arteries. Textbooks, however, do not describe the contribution of each to the nippie-areoia complex (NAC), nor do they describe the pattern of supply. To investigate this issue, 15 female cadavers were injected intraarterially with latex, and dissections were performed on 27 breasts.The results were as follows: In all the dissected breasts (27/27), the NAC received at least one or more vessels from the internal thoracic artery. In 20 of 27 dissected breasts, the NAC received vessels from the anterior intercostal arteries, In 19 of the 27 dissected breasts, the NAC received vessels from the lateral thoracic artery. Direct branches from the axillary artery supplied the NAC in 2 of the 27 breasts. The posterior intercostal arteries supplied the NAC in only 1 of the 27 dissected breasts. An underlying segmental pattern could be detected that can be explained by the embryological development. According to this study, the internal thoracic arteries are to be considered the main and constantly reliable source of blood supply to the NAC.     

Complex PTSD in Victims Exposed to Sexual and Physical Abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.     

Antiproliferative Effect of Calcitriol on Human Prostatic Cancer Cell Lines: Unrelated to the Expression of Major Histocompatibility Complex Antigens or Intercellular Adhesion Molecule-1 (ICAM-1)

Background: In addition to its role in calcium and phosphorus metabolism, calcitriol (1,25-dihydroxyvitamin D; 1,25-D3) demonstrates multiple effects on cell proliferation/differentiation by expressing major histocompatibility complex (MHC) antigens and intercellular adhesion molecule-1 (ICAM-1). It has recently been reported that 1,25-D3 inhibits the growth of prostatic cancer (PCa) cells. In this study we examined the effect of 1,25-D3 on both the growth and expression of HLA-ABC, HLA-DR and ICAM-1 antigens in PCa cells.
Methods: Four human PCa cell lines (PC-3, PPC-1, ALVA-41 and ALVA-101) were examined. The cell numbers were enumerated, and the effects of interferon-y (IFN-y) and 1,25-D3 on the expression of HLA-ABC, HLA-DR and ICAM-1 were quantitated by flow cytometry.
Results: A dose-dependent antiproliferative effect of 1,25-D3 was found in all PCa eel Is lines except ALVA-41. 1,25-D3 was approximately 10 times as potent as its analogue 24,25-dihydroxyvitam in D₃ in inhibiting the growth of PC-3 cells. Also, the relative inhibitory ability of these compounds paralleled the strength of their binding affinities for the 1,25-D3 receptor, indicating that the antiproliferative effect may require a receptor-ligand interaction. HLA-ABC was expressed in PC-3, ALVA-41 and ALVA-101, but not in PPC-1 cells, while HLA-DR was not expressed on any of the tested cells. IFN-y could enhance or induce HLA-ABC but not HLA-DR expression in the tested cells. ICAM-1 was expressed in all cells and slightly up-regulated by IFN-y.
Conclusion: In this study 1,25-D3 had an antiproliferative effect on 3 of the 4 examined PCa cell lines.