Can the National Kidney Foundation guidelines for first-time arteriovenous fistula creation be met in underserved end-stage renal disease patients?

The aims of this study were to determine whether National Kidney Foundation (NKF) guidelines for native arteriovenous fistula (AVF) creation (at least 50% of all new end-stage renal disease [ESRD] patients and 40% of prevalent hemodialysis patients) could be met in an underserved population who presented in late stages of ESRD. We also sought to determine 1-year AVF patency rates and factors associated with early thrombosis. One hundred seventy-six patients underwent hemodialysis access surgery during the period 2003-2005 with a mean age of 51 years. Sixty-two percent were male, and 48% had diabetes mellitus. Ultrasound vein mapping was performed in only 37%. Temporary central venous access was necessary in 109 patients (62%) due to late presentation. Of the 160 patients who were first-time access, 137 (86%) received a native AVF and 23 (14%) had an arteriovenous graft. There was a higher rate of AVF creation in males (91% vs. 75% for females, p = 0.005). The 1-year primary patency was 90%. There were no differences in early thrombosis or 1-year patency rates with respect to gender, age, ethnicity, insurance status, presence of temporary access, or use of preoperative vein mapping. In an underserved population, NKF guidelines for native AVF for first-time access can be superseded with an excellent 1-year patency, despite late presentation.     

IgG4‐related systemic disease and lymphoplasmacytic aortitis

We describe herein a patient who developed a dissection of the ascending aorta in the setting of IgG4‐related systemic disease, linking IgG4‐related systemic disease with a newly‐recognized subset of noninfectious aortitis. At the time of aortic surgery, a transmural lymphoplasmacytic infiltrate was detected in the patient's aorta, with a principal focus of inflammation within the media. Immunohistochemical studies demonstrated that >50% of the plasma cells in the lesion stained for IgG4. By in situ hybridization, the plasma cells showed polytypic staining for kappa and lambda light chains, consistent with a polyclonal plasma cell infiltrate. Serologic evaluation revealed that the patient's IgG4 levels were elevated nearly 10‐fold. Four years before aortic surgery, the patient had undergone a mediastinal lymph node biopsy. Reexamination of the lymph node revealed features consistent with IgG4‐related systemic disease, which had not been recognized at the time of the original biopsy. Glucocorticoid therapy for the IgG4‐related systemic disease yielded a prompt response. Recognition that IgG4‐related systemic disease can involve the ascending as well as the descending abdominal aorta indicates the need for a change in the way idiopathic aortitis is regarded. This case offers new potential considerations for short‐ and long‐term management of noninfectious aortitis, because of the frequent good response of IgG4‐related systemic disease to glucocorticoid treatment without additional therapy. Treatment of the aortitis may prevent progression of the IgG4‐related systemic disease to involvement of other organs. IgG4‐related systemic disease should be considered in all patients with aortitis judged to be of unknown etiology.     

Gene expression patterns in mouse cortical penumbra after focal ischemic brain injury and reperfusion

Ischemic stress in the brain causes acute and massive cell death in the targeted core area followed by a second phase of damage in the neighboring penumbra. The purpose of this study was to examine the global gene expression patterns in the penumbra, because the ischemic lesion in this region could be rescued by restoration of blood flow and other protective therapies. Adult C57Bl/6 mice were subjected to a 90-min middle cerebral artery occlusion (MCAO). Laser capture microdissection (LCM) was used for tissue dissection at 4 and 24 hr after reperfusion. Sham-operated animals were used as controls. Gene expression in the penumbra was examined by using microarray analysis and quantitative RT-PCR. In agreement with previous reports, most genes were down-regulated at 4 hr after the onset of reperfusion in the ischemic penumbra compared with controls. In contrast, at 24 hr after reperfusion, most genes were up-regulated in the ischemic penumbra. Several genes not previously reported to be associated with ischemia were found. The gene lists generated in this study will help us to understand better the spatial and temporal distribution of molecules involved in the ischemic cascade. Published 2008 Wiley-Liss, Inc.     

The utility of radiolabeled PSMA ligands for tumor imaging

Prostate-specific membrane antigen (PSMA) is a glycosylated type-II transmembrane protein expressed in prostatic tissue and significantly overexpressed in several prostate cancer cells. Despite its name, PSMA has also been reported to be overexpressed in endothelial cells of benign and malignant non-prostate disease. So its clinical use was extended to detection, staging, and therapy of various tumor types. Recently small molecules targeting PSMA have been developed as imaging probes for diagnosis of several malignancies. Preliminary studies are emerging improved diagnostic sensitivity and specificity of PSMA imaging, leading to a change in patient management. In this review, we evaluated the first preclinical and clinical studies on PSMA ligands resulting future perspectives radiolabeled PSMA in staging and molecular characterization, based on histopathologic examinations of PSMA expression.     

Expression of BDNF-Associated lncRNAs in Parkinson’s disease

Metabolic Brain Disease - Decreased level of neurotrophic factor brain-derived neurotrophic factor (BDNF) has been supposed to participate in the pathoetiology of Parkinson’s disease (PD)....     

Hepatocellular carcinoma up-regulated long non-coding RNA: a putative marker in multiple sclerosis

Metabolic Brain Disease - Highly up-regulated in liver cancer (HULC) is a cancer-associated long non-coding RNA (lncRNA) which may regulate expression of other genes by working as a competing RNA...     

Role of FOLFIRINOX and chemoradiotherapy in locally advanced and borderline resectable pancreatic adenocarcinoma: update of the AGEO cohort

Background FOLFIRINOX has shown promising results in locally advanced (LAPA) or borderline resectable (BRPA) pancreatic adenocarcinoma. We report here a cohort of patients treated with this regimen from the AGEO group.Methods This is a retrospective multicentre study. We included all consecutive patients with non-pre-treated LAPA or BRPA treated with FOLFIRINOX.Results We included 330 patients (57.9% male, 65.4% <65 years, 96.4% PS <2). Disease was classified as BRPA in 31.1% or LAPA in 68.9%. Objective response rate with FOLFIRINOX was 29.5% and stable disease 51%. Subsequent CRT was performed in 46.4% of patients and 23.9% had curative intent surgery. Resection rates were 42.1% for BRPA and 15.5% for LAPA. Main G3/4 toxicities were fatigue (15%), neutropenia (12%) and neuropathy (G2/3 35%). After a median follow-up of 26.7 months, median OS (mOS) and PFS were 21.4 and 12.4 months, respectively. For patients treated by FOLFIRINOX alone, or FOLFIRINOX followed by CRT, or FOLFIRINOX + /− CRT + surgery, mOS was 16.8 months, 21.8 months and not reached, respectively (p < 0.0001).Conclusions FOLFIRINOX for LAPA and BRPA seems to be effective with a manageable toxicity profile. These promising results in “real-life” patients now have to be confirmed in a Phase 3 randomised trial.Subject terms: Pancreatic cancer, Pancreatic cancer