A retrospective study of laparoscopic unilateral adrenalectomy for primary hyperaldosteronism caused by unilateral adrenal hyperplasia

Objective

To evaluated the long-term outcomes of laparoscopic unilateral adrenalectomy for primary aldosteronism (PA) caused by unilateral adrenal hyperplasia (UAH).

Methods

One hundred and sixty-four patients who underwent laparoscopic unilateral adrenalectomy for UAH from January 2004 to December 2011 were entered in this retrospective analysis. Patients demographics, perioperative parameters, and follow-up results were recorded and analyzed statistically.

Results

All 164 cases suffered hypertension with biochemical evidence of hyperaldosteronism prior to operation. Hypokalemia was observed in 52/164 (37.14 %) patients. UAH was proved by multi-slice computed tomography (MSCT). All operations were completed successfully without any conversions or complications. Postoperative pathology confirmed that 164 cases were cortical nodular hyperplasia, of which 4 cases coexist with medullary hyperplasia and 7 with micro-adenoma. At the median follow-up of 48 months, hypertension was cured in 88 (53.7 %) patients, improved in 71 (43.3 %) patients, and refractory in 5 (3.05 %) patients. Hypokalemia and hyperaldosteronism were cured in all patients except re-elevation of blood pressure and plasma aldosterone in two patients 1 month after adrenalectomy.

Conclusions

As an underestimated subtype of PA, UAH is accepted gradually. Laparoscopic unilateral adrenalectomy is nowadays the preferred approach to treat patients with PA caused by UAH. When adrenal venous sampling is not allowed, high-resolution MSCT is a reliable test for lateralization of aldosterone hypersecretion in carefully selected patients and 97 % had either cure or improvement in blood pressure control.     

shRNA-mediated GSTP1 gene silencing enhances androgen-independent cell line DU145 chemosensitivity

Purpose

Design short hairpin RNA (shRNA) interference sequence to silence glutathione S-transferase P1 (GSTP1) gene of androgen-independent prostate cancer cell line DU145, and then to explore its effect on sensitivity to chemotherapeutics.

Methods

Target sequence was picked up to form the shRNA. DU145 cell was divided into five groups according to the shRNA added for transfection: shRNA255, shRNA554, shRNA593, negative-shRNA and blank group. Fluorescence microscope was used to pick up the shRNA with the highest transfection ratio. Western blotting and RT-PCR were taken to pick up the shRNA with the best gene silencing result. 3-(4,5-Dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay and terminal de-oxynucleotidyl transferase-mediated dUTP nick end-labeling assay were used to detect survival ratio and apoptosis ratio of DU145 administered of fluorouracil (5-FU) or paclitaxel (PA) at different concentrations before and after shRNA transfection.

Results

Three different shRNA oligonucleotides (shRNA255; shRNA554; shRNA593) targeting the coding sequence of GSTP1 mRNA and one negative control shRNA were constructed. The transfection ratio of shRNA554 (76.2 ± 0.68 %) was higher than that of shRNA255 (63.3 ± 1.04 %) (P < 0.01) or shRNA593 (72.7 ± 0.33 %) (P < 0.01). After transfection of shRNA554, the mRNA and protein of level were the lowest, P < 0.01. The survival ratio of DU145 administered with 5-FU of different concentrations (30, 60, 120, 240 μg/ml) declined after transfection (P < 0.01). Besides, the apoptosis ratio increased after transfection (P < 0.01). Similarly the survival ratio of DU145 administered with PA of different concentrations (0.2, 2, 10, 20 μg/ml) declined (P < 0.01) and the apoptosis ratio increased (P < 0.01) after transfection.

Conclusions

The gene GSTP1 silence via shRNA transfection to androgen-independent prostate cancer cell line DU145 enhances the sensitivity to chemotherapeutics.     

The interrelated effects of 2D angiographic morphological variables and aneurysm rupture

Objective:

To investigate the correlations between morphological parameters and rupture status in cerebral aneurysm patients.

Methods:

We conducted a retrospective study of 34 patient records from March 2010 to December 2012. The morphological parameters of 34 ruptured and 42 unruptured cerebral aneurysms in 34 patients (males: female, 15:19; mean age 55.79±10.64 years) leading to subarachnoid hemorrhage were examined using 3D (dimension) digital subtraction angiography (DSA) models, to identify the correlation between 2D morphological parameters and risk factors of rupture status with univariate and multivariate analysis.

Results:

The 2D morphological parameters in ruptured aneurysms were significantly different from those observed in unruptured aneurysms (p<0.05), though only size and height-width ratios independently predicted rupture status. Dmax, Hmax, bottleneck factor, and size ratio significantly correlated with height-width ratio in ruptured but not unruptured aneurysms.

Conclusions:

A specific set of morphological characteristics, most notably size and height-width ratios, may help to understand rupture risk by indicating arterial stretch character in cerebral aneurysms patients.Cerebral and intracranial aneurysms occur when weak blood vessel walls give way in the brain, producing a bulging or ballooning effect that may or may not be symptomatic or lead to rupture.1,2 The pathophysiological mechanisms associated with rupture occurrence remain poorly understood, and rupture risk is most commonly assessed using aneurysm size, location, and shape.1 With CT technique application on imaging of intracranial aneurysms, more detailed measurements on aneurysm morphologies have become available to better assess rupture risk in diverse cerebral aneurysms. In one of the largest international studies of cerebral aneurysms to date, the International Study of Unruptured Intracranial Aneurysms (ISUIA) reported in 1998-1999 that 0.1-0.2% of intracranial aneurysm patients experienced rupture, with the risk of morbidity and mortality related to surgery greatly exceeding the 7.5-year risk of rupture in patients with relatively small diameters (<10 mm).3,4 Thus, preventative surgical treatment may not be appropriate for many patients, despite a mortality rate of 40-50%, and a morbidity rate of 10-20%5-7 in patients that develop rupture leading to aneurysmal subarachnoid hemorrhage. Over the last decade, numerous strategies have been proposed for assessing rupture risk;7-9 however, these broad guidelines may not consistently predict outcomes and rupture risk in many patient subpopulations. Thus, detailed stratification of intracranial aneurysm patients with aneurysm morphology and patient status such as gender, age, and the clinical condition (namely, hypertension, body mass index, smoking habits) help to understand the prevention of potentially life-threatening aneurysmal subarachnoid hemorrhage occurrence.The geometrical morphological characteristics of aneurysm rupture are mostly location, shape, and size.1 More recently, aspect ratios greater than 1.6 have been shown to be significantly associated with rupture, with 80% of patients that experienced rupture exhibiting greater aspect ratios.10 Similarly, increased bottleneck factor and height-width ratio were consistently associated with rupture.11 The increasingly wide availability of 3 dimensional (3D) angiography imaging has also led to the employment of advanced computations and hemodynamics models for rupture assessment, that carefully consider individual physiological and morphological parameters related to aneurysm rupture.12,13 In these models, trends toward simple stable patterns, large impingement regions, and jet sizes have been associated with unruptured aneurysms, while disturbed flow patterns, small impingement regions, and narrow jets were indicative of rupture.Due to the diversity in morphological and clinical characteristics and methodologies in these reports; however, accurate meta-analysis is all but impossible.14 Though comprehensive reviews have been conducted on strategies for assessing rupture in aneurysm patients,14 few clinical studies have examined aneurysm morphology and clinical status in a single patient cohort. Thus, most reports on aneurysm rupture risk fail to account for confounding variables between diverse patient cohorts, potentially overlooking the impact of key clinical parameters. Therefore, improved cerebral aneurysm patient stratification requires comprehensive assessment of key clinical and morphological characteristics in a single group of patients, which may yield valuable information on the interrelationships between these parameters of rupture risk. The current study investigated the relationship between morphological and clinical parameters and rupture status in cerebral aneurysm patients using 3D models produced by digital subtraction angiography (DSA). Notably, clinical performance was minimized in order to most effectively assess morphological parameters.     

Multi-label classification of retinal lesions in diabetic retinopathy for automatic analysis of fundus fluorescein angiography based on deep learning

Graefe's Archive for Clinical and Experimental Ophthalmology - To automatically detect and classify the lesions of diabetic retinopathy (DR) in fundus fluorescein angiography (FFA) images using...     

Intravitreal aflibercept for submacular hemorrhage secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

Graefe's Archive for Clinical and Experimental Ophthalmology - To evaluate the efficacy of intravitreal aflibercept monotherapy for submacular hemorrhage secondary to neovascular age-related...     

A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

ObjectiveTo propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study.MethodsThe proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included.ResultsWe found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery.ConclusionOur results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring.