A rapid plasma neutrophil gelatinase-associated lipocalin assay for diagnosis of acute pyelonephritis in infants with acute febrile urinary tract infections: a preliminary study

In infants with febrile urinary tract infection (UTI), the accurate rapid diagnosis of acute pyelonephritis (APN) would be valuable because early aggressive treatment reduces the risk of renal scarring. The objective of the study was to evaluate whether rapid plasma neutrophil gelatinase-associated lipocalin (NGAL) assay could be used as a diagnostic biomarker of renal parenchymal injury in infants with acute febrile UTI to distinguish APN at the bedside. This prospective observational study included 47 infants, who were admitted with a first episode of acute febrile UTI. Total UTI group was divided into the Cortical defect (UTI-CD, n?=?24) group and Non-cortical defect (UTI-ND, n?=?23) group, according to the result of renal scan. For the Control group, 15 infants who presented a febrile episode without any focus of bacterial infection were included. On admission, the median NGAL level (106.5 [60–476]?ng/mL) in the UTI-CD group was significantly higher than that (60 [60–196]?ng/mL) in the UTI-ND group and that (60 [60–197]?ng/mL) in the Control group and was significantly decreased to 60 [60–306]?ng/mL after an antibiotic treatment. The area under the receiver operating characteristic curves was 0.748 (95 % CI, 0.610–0.887; P?=?0.003) for NGAL levels and 0.724 (95 % CI, 0.579–0.868; P?=?0.009) for CRP levels. The best cutoff of NGAL level for detection of APN was founded to be 61.0 ng/mL (sensitivity, 75.0 %; specificity, 78.3 %). Although not a stand-alone test, the rapid determination of plasma NGAL level provides valuable information quickly, concerning the distinction of APN, for determining the clinical course of acute febrile UTI.     

Composite pullulan–dextran polysaccharide scaffold with interfacial polyelectrolyte complexation fibers: A platform with enhanced cell interaction and spatial distribution

Hydrogels are highly preferred in soft tissue engineering because they recapitulate the hydrated extracellular matrix. Naturally derived polysaccharides, like pullulan and dextran, are attractive materials with which to form hydrophilic polymeric networks due to their non-immunogenic and non-antigenic properties. However, their inherent hydrophilicity prevents adherent cell growth. In this study, we modified pullulan–dextran scaffolds with interfacial polyelectrolyte complexation (IPC) fibers to improve their ability to support adherent cell growth. We showed that the pullulan–dextran–IPC fiber composite scaffold laden with extracellular matrix protein has improved cell adhesion and proliferation compared to the plain polysaccharide scaffold. We also demonstrated the zero-order release kinetics of the biologics bovine serum albumin and vascular endothelial growth factor (VEGF) incorporated in the composite scaffold. Lastly, we showed that the VEGF released from the composite scaffold retained its capacity to stimulate endothelial cell growth. The incorporation of IPC fibers in the pullulan–dextran hydrogel scaffold improved its functionality and biological activity, thus enhancing its potential in tissue engineering applications.     

Augmented Eradication Rates of Helicobacter pylori by New Combination Therapy with Lansoprazole, Amoxicillin, and Rebamipide

The aim of the present study was to determinethe efficacy of a new combination regimen including anantioxidant, a proton pump inhibitor, and antibioticsagainst Helicobacter pylori and to document the changes of oxidative stress and cytokinesinvolved in H. pylori-associated gastric inflammation.From 57 patients with endoscopically diagnosed gastricand/or duodenal ulcers associated with H. pylori infection five gastric antral biopsy specimenswere taken for the diagnosis of H. pylori and for theexperimental measures. The patients were then treatedeither with lansoprazole 30 mg + amoxicillin 1.5 g (LAgroup; 21 patients) or lansoprazole 30 mg amoxicillin1.5 g + rebamipide 300 mg (LAM group; 36 patients) fortwo weeks. Four weeks after the initiation of treatment,the patients were endoscoped again and biopsy specimens were obtained. Mucosalmalondialdehyde (MDA) levels; myeloperoxidase (MPO)activities; superoxide dismutase; catalase; glutathioneperoxidase; cytokines IL-1, IL-6, TNF-; andchemokines IL-8, GRO-, RANTES (regulated onactivation normal T expressed and secreted) weremeasured. Using paraffin-embedded tissue sections, insitu terminal deoxyribonucleotide transferase (TdT)mediated dUTP nick end labeling (TUNEL) for apoptosisand immunohistochemical staining for inducible nitricoxide synthase (iNOS) were performed. Two weeks oftreatment with the LA regimen resulted in 57.4%eradication rates of H. pylori, whereas two weeks oftreatment with the LAM regimen resulted in 75.0%eradication rates. Eradication rates between these twogroups were statistically significantly different (P< 0.05). Mucosal MDA levels and MPO activities weresignificantly lower in the LAM group than the LA group.Mucosal levels of cytokines IL-1, IL-6, and TNF-and of chemokines IL-8, GRO-, and RANTES were all significantly decreased after the treatmentof H. pylori, especially so in the LAM group. Theapoptotic index and iNOS score were significantlyreduced after the eradication of H. pylori. The addition of an antioxidative drug to the eradicationregimen against H. pylori has advantages either inaugmenting the eradication rates of H. pylori or indecreasing the oxidative stress and cytokines levelsgenerated by H. pylori infection.     

Is aortic lymphadenectomy necessary in the management of endometrial carcinoma?

OBJECTIVE: To evaluate the role of aortic lymphadenectomy in the management of endometrial carcinoma. METHODS: Clinical notes of 163 patients with endometrial carcinoma were reviewed. All patients had peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy with or without aortic lymphadenectomy. RESULTS: Seventy-five (46.0%) patients had pelvic lymphadenectomy alone whereas 88 (54.0%) had both pelvic and aortic lymphadenectomy. Thirty-five (21.5%) patients had nodal metastases with positive pelvic and aortic nodes in 26 (16.0%) and 24 (27.3%) patients, respectively. Isolated aortic metastases were found in 17 cases (19.3%). Among 35 patients with nodal metastases, recurrence developed in 15 (42.9%) patients and all except one died within five to 50 months. The remaining patients had a median disease-free period of 55 months (13-93 months). The recurrence rate was higher (63.6%) among patients with upper aortic lymph node metastases, and all those who recurred died of disease within seven to 28 months. CONCLUSIONS: Our data suggest that aortic lymphadenectomy provides both diagnostic and therapeutic value in the management of endometrial carcinoma with high metastatic risk. After surgical removal and adjuvant radiotherapy, patients with nodal metastases achieved a better survival chance.     

Vitamin D deficiency and changes in serum vitamin D levels with treatment among tuberculosis patients in South Korea

Background and objective: Vitamin D deficiency has been reported to be associated with the development of active tuberculosis (TB), but many discrepancies exist among studies. The aims of this study were to compare the frequency of vitamin D deficiency in a Korean population of TB patients and control subjects, and to monitor the changes in vitamin D levels during TB treatment. Methods: Patients with newly diagnosed TB were prospectively enrolled. In addition, healthy volunteers or patients with diseases other than TB were enrolled as controls. Baseline serum 25‐hydroxyvitamin D (25‐OHD) levels were measured in both groups and compared. In the TB patients, measurements of serum 25‐OHD were repeated 1 month after the initiation of treatment and again after completion of treatment. Results: In total, 116 patients with TB and 86 control subjects were recruited. The median 25‐OHD concentration was not different in TB patients at diagnosis (13.9 ng/mL; interquartile range (IQR) 8.80–21.8) compared with control subjects (13.2 ng/mL; IQR 9.6–19.3) (P = 0.97). The frequency of vitamin D deficiency (≤10 ng/mL) was also not different in TB patients (36.2%) compared with controls (27.3%) (P = 0.21). In TB patients, the median 25‐OHD concentration decreased significantly during treatment, to 12.5 ng/mL at 1 month and 11.0 ng/mL on completion of treatment (P = 0.01). Conclusions: Vitamin D levels do not appear to be associated with the development of TB in the Korean population. The median 25‐OHD concentration decreased after treatment for TB.     

The potential use of type-5 phosphodiesterase inhibitors in coronary artery bypass graft surgery

Exaggerated vasospasm, platelet activation, and early graft occlusion are significant barriers to successful coronary artery bypass grafting (CABG). Interestingly, vascular smooth muscle and platelets are predominant sources of type-5 phosphodiesterase (PDE5) in the body, and this enzyme is specifically inhibited by PDE5 inhibitors (eg, sildenafil citrate). Together with endogenous nitric oxide, sildenafil can induce pulmonary and coronary vasodilation, precondition the myocardium, reduce platelet activation, and potentially reduce early graft occlusion. Currently, there are no published clinical trials investigating sildenafil in coronary surgery. Recent studies on the potential use of sildenafil strongly support its beneficial effects in a wide range of patients with cardiovascular diseases. Therefore, we sought to review the literature, explore the current hypothesis that the use of sildenafil in coronary surgery patients can be beneficial, and attempt to define its potential place in the setting of CABG.     

Thoracotomy is associated with significantly more profound suppression in lymphocytes and natural killer cells than video-assisted thoracic surgery following major lung resections for cancer.

Major surgery is immunosuppressive, and this could have an impact on postoperative tumor immunosurveillance and, therefore, long-term survival in cancer patients. Video-assisted thoracic surgery (VATS) lung resection is a new alternative surgical approach to thoracotomy for patients with early lung cancer. This is a pilot study to examine the postoperative changes in leukocytes, lymphocyte subsets, B cells, T cells, and natural killer (NK) cells in non-small-cell lung cancer (NSCLC) patients undergoing lung resection with VATS versus thoracotomy approaches. Twenty-one consecutive patients with resectable primary NSCLC were assigned to VATS or thoracotomy approach over a 3-month period. Blood samples were collected preoperatively and at postoperative days (POD) 1, 3, and 7 for flow cytometry determination of total leucocytes, B cells, NK cells, lymphocytes, total T cells, and T4 and T8 cell numbers. There were no demographic differences between the two groups. Compared with the preoperative values, significantly increased total white cell numbers were detected at POD 1, 3, and 7 in all patients. At POD 1, although T8 cells and NK cells were reduced in both groups, total T cell, T4 cell, and lymphocyte numbers were significantly reduced only in the thoracotomy group. At POD 7, NK cell numbers were significantly lower in the thoracotomy group than that in the VATS group. No significant intra- or intergroup differences were seen with B cells. No significant differences in survival or disease-free survival were found between the two groups. Thus, VATS major lung resection for NSCLC is associated with less, as well as quicker recovery from, postoperative immunosuppression compared with the thoracotomy approach. The clinical relevance of better preserved cellular immunity in the early postoperative period warrants confirmation from large randomized trials.