Encapsulating peritoneal sclerosis after kidney transplantation: a single-center experience from 1982 to 2010

Encapsulating peritoneal sclerosis (EPS), a severe complication of long-term peritoneal dialysis (PD), produces a 50% mortality rate. EPS is characterized by progressive and excessive fibrotic thickening of the peritoneum, leading to encapsulation of the bowel and intestinal obstruction which may present after kidney transplantation (KT), a condition known as posttransplantation EPS. In this study we reviewed 1,500 KT performed in our center from 1982 to 2010, seeking to evaluate the influence of EPS incidence on kidney recipient and graft survival. We detected severe posttransplantation EPS among 16 adult single-kidney cadaveric-donor recipients. The EPS patients (age, 46.68 ± 10.62 years; female/male 5/11) were initially compared with a strictly selected group (n = 48) of non-EPS patients (age, 46.35 ± 10.26 years; female/male, 18/30). Peritoneal dialysis (PD) duration was significantly higher in the EPS group (47.75 ± 9.77 vs. 25.87 ± 10.43 months; P < .0001). This relationship was not only evident on univariate analysis, but also in a multivariate logistic regression model that entered previously selected variables: age (P = .518), sex (P = .796), serum creatinine (P = .441), estimated glomerular filtration rate (P = .566), and diagnostic category (P = .804). Diagnostic plots confirmed the reliability of the logistic regression models. In conclusion, EPS which negatively influences the outcome and quality of life of kidney recipients, was related to PD duration before to KT.     

Are Caucasian-European men delaying fatherhood? Results of a 7 year observational study of infertile couples with male factor infertility

This study was aimed at assessing presence and predictors of a trend towards more advanced paternal age at presentation in a cohort of 1283 Caucasian-European infertile couples with male factor infertility (MFI) over a short time frame. Multivariate linear regression analysis tested the association between predictors [namely, partners' age, length of infertility at first presentation, patients' comorbidities as scored with the Charlson Comorbidity Index (CCI) and educational status] and patient's age at presentation. Using anova, patient's age at presentation (F ratio: 2.43; p = 0.024) and patients' educational status (χ(2) trend: 142.38; p < 0.001) significantly increased over time. In contrast, length of infertility at first presentation, CCI and partners' age did not significantly change over time (all p ≥ 0.05). Linear regression analyses showed that CCI, educational status and year of presentation were not correlated with patients' age at presentation (all p ≥ 0.05), whereas partners' age (β = 0.170; p < 0.001) and length of infertility (β = 0.123; p = 0.004) were independent predictors of delayed fatherhood. These results showed a significant shift towards advanced paternal age, but a non-significant increase of maternal age at first presentation among Caucasian-European infertile couples with MFI over a short time frame.     

Preoperative circulating sex hormones are not predictors of positive surgical margins at open radical prostatectomy

Purpose

To examine the association between positive surgical margins (PSMs) and preoperative circulating estradiol (E₂), total testosterone (tT), and sex hormone–binding globulin (SHBG) in patients undergoing retropubic radical prostatectomy (RRP).

Methods

A cohort of 665 non-screened patients who underwent RRP at a single institute was studied. Serum tT, E₂, and SHBG were measured the day before surgery (8–10 am) in all cases. Logistic regression models tested the association between predictors [e.g., PSA, clinical stage, biopsy Gleason sum, body mass index (BMI), tT, E₂, and SHBG] and PSM. Circulating tT was included in the model as both a continuous variable and a categorized variable [according to the definition of hypogonadism (<3?ng/ml)].

Results

PSMs were found in 175 patients (26.3%) within the whole cohort of men and in 78 (16.2%) of the pT2 patients. Patients with PSMs had significantly higher PSA, a higher proportion of more advanced clinical stage, and a lower rate of well-differentiated biopsy Gleason sum than those without PSMs (all P?≤?0.03). Conversely, no significant differences were found regarding age, BMI, preoperative tT, E₂, and SHBG between patients with and without PSMs. At multivariate analysis, tT, hypogonadism, E₂, and SHBG were not significantly associated with PSMs, after accounting for routinely available preoperative parameters.

Conclusions

In contrast to previously published data, preoperative tT was not an independent predictive factor for PSM at RRP. Likewise, hypogonadism, E₂, and SHBG did not achieve independent predictor status for PSM, after accounting for routinely available preoperative parameters.     

A patient with multiple brown tumors due to secondary hyperparathyroidism: A case report

Brown tumor is an uncommon non-neoplastic radiolucent bone lesion due to a rapid bone loss replaced by haemorrhage and reparative granulation tissue. It is a manifestation of hyperparathyroidism related to the high level of parathyroid hormone and represents a problem linked to the adherence to therapy. We present a case of a 44 years-old Caucasian female with hemodialysis-dependent chronic kidney disease in poor sanitary condition with CT evidence of innumerable and widespread bone tumors. At first, we considered these bone lesions strongly suspicious for metastasis, so we recommended an oncological consultation and laboratory studies, that showed a secondary hyperparathyroidism with elevated serum parathormone level of 923 pg/mL (normal range: 10-70 pg/mL). According to our experience, in case of radiological evidence of multiple bone lesions, a correct medical history is mandatory. When the patient has a history of chronic kidney disease and dialysis and high blood levels of parathyroid hormone are present, secondary hyperparathyroidism should always be considered in the differential diagnosis.     

Acoustophoretic contactless transport and handling of matter in air

Levitation and controlled motion of matter in air have a wealth of potential applications ranging from materials processing to biochemistry and pharmaceuticals. We present a unique acoustophoretic concept for the contactless transport and handling of matter in air. Spatiotemporal modulation of the levitation acoustic field allows continuous planar transport and processing of multiple objects, from near-spherical (volume of 0.1–10 μL) to wire-like, without being limited by the acoustic wavelength. The independence of the handling principle from special material properties (magnetic, optical, or electrical) is illustrated with a wide palette of application experiments, such as contactless droplet coalescence and mixing, solid–liquid encapsulation, absorption, dissolution, and DNA transfection. More than a century after the pioneering work of Lord Rayleigh on acoustic radiation pressure, a path-breaking concept is proposed to harvest the significant benefits of acoustic levitation in air.