Does intraoperative radioguided surgery influence the complication rates and completeness of completion thyroidectomy?

BACKGROUND: To investigate whether radioguided surgery (RGS) has any beneficial effects on the complication rates and the completeness of completion thyroidectomy (CT) in a center experienced in endocrine surgery. METHODS: Thirty-three patients scheduled for CT for thyroid carcinoma were randomly selected for 2 types of intervention. CT was performed by RGS following administration of 5 mCi technetium-99m in 15 patients (group 1) and with conventional surgical exploration without RGS in 18 patients (group 2). The duration of the CT, thyroid function tests, iodine-131 uptake at 24 hours at the third postoperative week, and complication rates were compared between groups 1 and 2. RESULTS: In groups 1 and 2, the duration of CT (63.3 +/- 7.5 vs 65 +/- 10.8 minutes, P = .7), postoperative serum thyrotropin-stimulating hormone (TSH) levels (43.9 +/- 17.5 mIU/L vs 36.8 +/- 8.6 mIU/L, P = .2), postoperative (131)I uptake at 24 hours (6.86 +/- 1.7 vs 7.0 +/- 1.3, P = .8), and complication rates (13.3% vs 5.6%, P = .6) showed no significant differences. CONCLUSION: RGS during CT offers no benefit over conventional surgical exploration with respect to operation time, complication rates, or completeness of surgery in a center experienced in endocrine surgery. However, it might be helpful for general surgeons who are less familiar with re-operative thyroid surgery.     

白内障超声乳化术后前房膜形成的危险因素

目的:探讨白内障超声乳化术后前房膜形成的危险因素。方法:对1356例行白内障超声乳化 单片式PMMA人工晶体植入术患者进行前瞻性研究。假性囊膜剥脱综合症,核硬度,瞳孔大小,超声时间,实际超声时间,系统性疾病,术中并发症(囊膜撕裂,悬韧带断裂,后囊破裂伴玻璃体丢失),IOL植入位置和术后并发症(眼内压变化,粘连形成)作为膜形成的危险因素分析。结果:观察到111例患者(8.1%)术后出现伴有膜形成的纤维素性前葡萄膜炎。膜形成平均时间是术后第2d(术后第1～7d),膜存在持续时间平均为5.2d(1～48d)。在膜形成病例中, 4级核病例占45%,而在无膜形成病例中仅为13.5%,差异具有显著统计学意义(P<0.05)。在膜形成组,平均超声时间为2.4min,平均实际超声时间为32.8s,而无膜形成组分别为1.8min和22.1s。这两项参数在膜形成组均明显较长(P<0.05)。在膜形成组中,出现后囊破裂伴玻璃体丢失和IOL睫状沟植入者占33%,而无膜形成组为11%(P<0.05)。其他危险因素在膜形成组和无膜形成组中的比较无统计学意义。在术后第1d和第7d,平均最佳矫正视力(Snellen视力表)在膜形成组分别为0.2和0.4,无膜形成组为0.4和0.6(P<0.05)。但术后3mo,平均最佳矫正视力在膜形成组和无膜形成组中结果相似(分别为0.8和0.9)。结论:晶状体核硬度较高,较长超声时间和实际超声时间,术中后囊破裂是术后前房纤维膜形成的明显相关性危险因素。     

Clinical and pathologic features of primary membranous nephropathy in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group

BackgroundWe aimed to evaluate the features of primary membranous nephropathy (MNP) in Turkish people.MethodsThis is a retrospective analysis of patients with biopsy-proven primary MNP. We obtained the data collected between 2009 and 2019 in the primary glomerulonephritis registry of the Turkish Society of Nephrology Glomerular Diseases Study Group (TSN-GOLD). Patients with a secondary cause for MNP were excluded. Clinical, demographic, laboratory, and histopathological findings were analyzed.ResultsA total of 995 patients with primary MNP were included in the analyses. Males constituted the majority (58.8%). The mean age was 48.4 ± 13.9 years. The most common presentation was the presence of nephrotic syndrome (81.7%) and sub nephrotic proteinuria (10.3%). Microscopic hematuria was detected in one-third of patients. The median estimated glomerular filtration rate (eGFR) was 100.6 mL/min/1.73 m² (IQR, 75.4–116.3), and median proteinuria was 6000 mg/d (IQR, 3656–9457). Serum C3 and C4 complement levels were decreased in 3.7 and 1.7% of patients, respectively. Twenty-four (2.4%) patients had glomerular crescents in their kidney biopsy samples. Basal membrane thickening was detected in 93.8% of cases under light microscopy. Mesangial proliferation and interstitial inflammation were evident in 32.8 and 55.9% of the patients, respectively. The most commonly detected depositions were IgG (93%), C3 complement (68.8%), and kappa and lambda immunoglobulin light chains (70%). Although renal functions were normal at presentation, vascular, interstitial, and glomerular findings were more prominent on biopsy in hypertensive patients. No significant effect of BMI on biopsy findings was observed.ConclusionsDespite some atypical findings, the main features of primary MNP in Turkey were similar to the published literature. This is the largest MNP study to date conducted in Turkish people.     

Hippocampal Subfield Volumes Predict Disengagement from Maintenance Treatment in First Episode Schizophrenia

ObjectivesDisengagement from treatment is common in first episode schizophrenia (FES) and is associated with poor outcomes. Our aim was to determine whether hippocampal subfield volumes predict disengagement during maintenance treatment of FES.MethodsFES patients were recruited from sites in Boston, New York, Shanghai, and Changsha. After stabilization on antipsychotic medication, participants were randomized to add-on citalopram or placebo and followed for 12 months. Demographic, clinical and cognitive factors at baseline were compared between completers and disengagers in addition to volumes of hippocampal subfields.ResultsBaseline data were available for 95 randomized participants. Disengagers (n = 38, 40%) differed from completers (n = 57, 60%) by race (more likely Black; less likely Asian) and in more alcohol use, parkinsonism, negative symptoms and more impairment in visual learning and working memory. Bilateral dentate gyrus (DG), CA1, CA2/3 and whole hippocampal volumes were significantly smaller in disengagers compared to completers. When all the eight volumes were entered into the model simultaneously, only left DG volume significantly predicted disengagement status and remained significant after adjusting for age, sex, race, intracranial volume, antipsychotic dose, duration of untreated psychosis, citalopram status, alcohol status, and smoking status (P < .01). Left DG volume predicted disengagement with 57% sensitivity and 83% specificity.ConclusionsSmaller left DG was significantly associated with disengagement status over 12 months of maintenance treatment in patients with FES participating in a randomized clinical trial. If replicated, these findings may provide a biomarker to identify patients at risk for disengagement and a potential target for interventions.     

Megakaryocytes,erythropoietic and granulopoietic cells express CAL2 antibody in myeloproliferative neoplasms carrying CALR gene mutations

Testing for the CALR mutation is included in the updated WHO criteria for essential thrombocythaemia (ET) and primary myelofibrosis (PMF). We report on the application of the CAL2 monoclonal antibody, raised against the mutated CALR gene to myeloid cases. The immunostain was used on 116 acute myeloid leukaemias (AML) and 66 myeloproliferative neoplasms (MPN) or myelodysplastic syndromes/myeloproliferative neoplasms (MDS/MPN). None of AML cases was stained by the CAL2 antibody, while 20/66 MPNs and MDS/MPNs appeared positive. Fourteen of the latter cases were studied by molecular techniques, and all showed aberrations of the CALR gene. In addition, CAL2 positivity was found in some small‐sized elements besides megakaryocytes. By double staining, these elements corresponded to small megakaryocytes as well as both erythroid and myeloid precursors. This finding suggests possible occurrence of CALR gene abnormalities in a stem cell.     

Interaction between caspofungin or voriconazole and cefoperazone–sulbactam or piperacillin–tazobactam by in vitro and in vivo methods

Immunosuppressive patients are at risk of fungal and bacterial infections. Therefore, these patients receive prophylactic, preemptive, empirical or target antifungal and concomitant antibiotic therapy. To this end, caspofungin (CAS) or voriconazole (VRC) antifungals and cefoperazone–sulbactam (CPZ/SAM) or piperacillin–tazobactam (PIP/TAZ) antibiotics may be used. Here, we aimed to investigate the interaction between these antifungals and antibiotics by in vitro and in vivo methods. The interaction was tested by chequerboard analysis and fractional inhibitory concentration index (FICI). It was also tested in a neutropenic mice‐invasive candidiasis model and evaluated by fungal burden in kidney tissue of infected animals from the first day to the fifth day of treatment with 24 h intervals. A synergism was detected between CAS and CPZ/SAM (FICI = 0.1) and PIP/TAZ (FICI = 0.3). Fungal burden in tissues of drug‐treated mice was reduced compared with controls in a time‐dependent manner. In comparison with CAS‐alone treated group, there were 1.32 log₁₀ reductions of fungal burden in CAS + CPZ/SAM (p = 0.002) and in CAS + PIP/TAZ group (p = 0.14). The same interactions were not found with VRC and antibiotics. CPZ/SAM had stronger synergistic interaction with CAS than PIP/TAZ. The mechanism of synergism is not well understood. This is most likely due to an increase in the anticandidal effect of CAS plus antibiotics.