Efficacy of tolvaptan on advanced chronic kidney disease with heart failure: a randomized controlled trial

Clinical and Experimental Nephrology - Tolvaptan (TLV) is reported to improve diuretic effects in patients with chronic kidney disease (CKD) when furosemide (FUR) is not sufficiently effective....     

Endodermal sinus tumour of stomach--a case report

This is a case report of an endodermal sinus tumour arising in the stomach of a 1 1/2 years male child. The tumour occupied full thickness of fundus and part of the body of the stomach. H&E sections of the tumour tissue showed endodermal sinus tumour with predominantly reticular and endodermal sinus patterns. Elevated level of alpha-fetoprotien was detected in the serum of the patient and within the tumour tissue by immunohistochemical technique.     

Disseminated nodular granulomatous perifolliculitis

Nodular granulomatous perifolliculitis is a well-recognized infection of the dermal and subcutaneous tissue caused by dermatophytes, which normally do not invade beyond the epidermis. We report here one such case that occurred in an immunosuppressed individual. The patient was a 35-year-old farmer who presented with small pruritic eruption that had initially appeared on the lower leg and then had gradually spread to hair-bearing areas of the body, finally producing nodular and pustular inflammatory lesions with exacerbations and remissions. Fungal examination by direct potassium hydroxide mount and culture revealed Trichophyton rubrum. Granulomatous changes were seen on histopathological examination. The patient completely responded to systemic antifungal therapy.     

A Bio-Inspired Multi-Population-Based Adaptive Backtracking Search Algorithm

Cognitive Computation - Backtracking search algorithm (BSA) is a nature-based optimization technique extensively used to solve various real-world global optimization problems for the past few...     

Role of tumor necrosis factor inhibitor in granulomatous interstitial nephritis secondary to Crohn’s disease

A 17-year-old male with attention deficit hyperactivity disorder was admitted to the hospital with generalized weakness. Vital signs and physical examination were normal. Laboratory data were notable for a creatinine of 4.5 mg/dL (baseline 0.6 mg/dL), estimated glomerular filtration rate of 18 ml/min/1.73 m² and hemoglobin 10 g/dL. Urinalysis revealed only 30 mg/dL protein. Serology for autoimmune workup was negative. Renal ultrasound was normal. Kidney biopsy showed noncaseating granulomas and acute on chronic tubulointerstitial nephritis (TIN) with lymphocytes, macrophages, plasma cells and no eosinophils. Acid fast bacilli and Grocott’s methenamine silver stains were negative. Granulomatous interstitial nephritis (GIN) was diagnosed. Prednisone at 60 mg/day was started and tapered. He was then noted to have diarrhea. Colonoscopy showed active enteritis with granulomatous inflammation consistent with Crohn’s disease (CD). Azathioprine was started but due to worsening renal function and diarrhea, it was discontinued. He did not tolerate continued higher doses of prednisone because of mood swings and cushingoid features. Infliximab was initiated with improvement in renal function. There was rapid worsening of renal function when infliximab therapy was interrupted but improved when both prednisone and inflixamb were reinitiated.     

High bone density masks architectural deficiencies in an individual with spinal cord injury

Context

Spinal cord injury (SCI) causes a decline of bone mineral density (BMD) in the paralyzed extremities via the gradual degradation and resorption of trabecular elements. Clinical tools that report BMD may not offer insight into trabecular architecture flaws that could affect bone''s ability to withstand loading. We present a case of a woman with a 30-year history of SCI and abnormally high distal femur BMD.

Findings

Peripheral quantitative-computed tomography-based BMD for this subject was ∼20% higher than previously published non-SCI values. Computed tomography (CT) revealed evidence of sclerotic bone deposition in the trabecular envelope, most likely due to glucocorticoid-induced osteonecrosis. Volumetric topologic analysis of trabecular architecture indicated that the majority of the bone mineral was organized into thick, plate-like structures rather than a multi-branched trabecular network. Visual analysis of the CT stack confirmed that the sclerotic bone regions were continuous with the cortex at only a handful of points.

Conclusions

Conventional clinical BMD analysis could have led to erroneous assumptions about this subject''s bone quality. CT-based analysis revealed that this subject''s high BMD masked underlying architectural flaws. For patients who received prolonged glucocorticoid therapy, excessively high BMD should be viewed with caution. The ability of this subject''s bone to resist fracture is, in our view, extremely suspect. A better understanding of the mechanical competency of this very dense, but architecturally flawed bone would be desirable before this subject engaged in activities that load the limbs.     

Gender and willingness to undergo invasive cardiac procedures

To explore the role of patient preferences in explaining gender differences in the use of invasive cardiac procedures, we surveyed 174 patients presenting for cardiac stress testing at a university hospital. Controlling for sociodemographic factors, health status, symptom severity, and history of prior procedures, women expressed greater willingness than men to accept a physician's recommendation of cardiac catheterization (odds ratio 7.1; 95% confidence interval 1.1, 45.3) and similar willingness to accept a recommendation for coronary angioplasty or coronary artery bypass graft surgery. We conclude that patient preferences are unlikely to explain gender disparities in the use of invasive cardiac procedures.     

Activation of prophage P4 by the P2 Cox protein and the sites of action of the Cox protein on the two phage genomes.

Phage P2 induces the unrelated prophage P4. In this paper we show that this is due to the activation of the P4 late promoter PII by the P2 Cox protein. This is in contrast to the effects of Cox on P2, for which it is known from previous work that it acts as a repressor of the promoter Pc, which is responsible for expression of the immunity repressor C. The activator role of Cox was revealed by its effect on replication of P4 DNA and on the formation of chloramphenicol acetyltransferase when a promoterless cat gene was inserted downstream of the P4 PII promoter. DNase I protection studies revealed that the Cox protein binds to the repressor promoter Pc of phage P2 and to the promoter PII of phage P4. In the latter case the Cox protein binds upstream of the -35 region, in analogy to several other activators of promoters. A weak binding was found in the promoters Pe of phage P2 and Ple of phage P4. The Cox protein is a case of viral transactivation of the replication genes of one phage by a control protein of the other. However, the effects of the Cox protein are totally different in the two phages, repressive in one case and activating in the other.     

Leishmanial lipid suppresses tumor necrosis factor alpha, interleukin-1beta, and nitric oxide production by adherent synovial fluid mononuclear cells in rheumatoid arthritis patients and induces apoptosis through the mitochondrial-mediated pathway

OBJECTIVE: Leishmanial lipid is a strong immunosuppressor of host cells. Inhibition of the inflammatory responses of synovial cells through induction of apoptosis is one of the main targets of therapeutic intervention in rheumatoid arthritis (RA). This study was undertaken to examine the antiinflammatory and apoptosis-inducing effects of leishmanial lipid on adherent synovial fluid mononuclear cells (SFMCs) in patients with RA. METHODS: Lipid was extracted from a Leishmania donovani promastigote (MHO/IN/1978/UR6) by the Bligh and Dyer method. Nitric oxide (NO) was measured using the Griess reaction, and enzyme-linked immunosorbent assays for cytokines, NF-kappaB, and cytochrome c were performed. Levels of cytokines, inducible nitric oxide synthase, caspases, Bcl-2, Bax, t-Bid, and cytochrome c in the cell lysate and of NF-kappaB p65 in the nucleus were determined by Western blotting. Microscopic analysis, nuclear staining, DNA fragmentation assay, fluorescence-activated cell sorting, colorimetric assay for caspases, and fluorescent probe for measurement of mitochondrial membrane potential were used to study the leishmanial lipid-induced apoptotic pathway in SFMCs. RESULTS: Leishmanial lipid inhibited the release of tumor necrosis factor alpha, interleukin-1beta, and NO in the culture, decreased their cytosolic protein levels, and decreased NF-kappaB p65 levels in SFMCs, in a dose-dependent manner. It had the reverse effect on interleukin-10 levels. Leishmanial lipid-induced apoptosis involved the activation of caspase 3, caspase 9, and Bax, the release of cytochrome c, the alteration of mitochondrial membrane potential, and the down-regulation of Bcl-2. CONCLUSION: These results suggest that leishmanial lipid has strong antiinflammatory and apoptosis-inducing effects on SFMCs from patients with RA, and that apoptosis occurs via the mitochondrial pathway.