Risk of bleeding-related complications after kidney biopsy in patients with systemic lupus erythematosus

Clinical Rheumatology - Kidney biopsy is essential for the diagnosis and classification of lupus nephritis. Percutaneous biopsy has a risk of bleeding-related complications; however, data on the...     

Incidence and Risk of Venous Thromboembolism in Bisphosphonates and Selective Estrogen Receptor Modulators Treatment in Korea

BackgroundSelective estrogen receptor modulators (SERMs) were associated with an increased risk of venous thromboembolism (VTE) due to the estrogen effect. In this study, we investigated the effect of SERMs on VTE compared to bisphosphonates (BPs) using the Korean National Health Insurance claims database.MethodsThis was a retrospective cohort study. Women over 50 years old who were first prescribed BPs or SERMs for osteoporosis treatment in 2012 were included. The difference in VTE incidence between the SERMs and BP groups was compared. Both groups were followed up for VTE or PE occurrence, death, or until December 2016. The study population was analyzed by 3:1 matching according to age using a multivariate Cox model.ResultsThe hazard ratio (HR) for VTE was 0.72 (95% confidence interval [CI], 0.40–1.28) in the SERMs group compared to BP group. Older age (60–69 vs. 50–59 years: HR, 3.77; 95% CI, 2.07–6.86 and 70–79 vs. 50–59 years: HR, 5.88; 95% CI, 3.14–11.02), major osteoporotic fracture (HR, 1.77; 95% CI, 1.16- 2.70), atrial fibrillation (HR, 3.31; 95% CI, 1.35–8.11), and estrogen replacement (HR, 3.40; 95% CI, 2.01–5.73) all increased VTE risk. In subgroup analysis of the SERMs group, past hospitalization (HR, 2.24; 95% CI, 1.02–4.92), estrogen replacement (HR, 5.75; 95% CI, 2.29–14.39), and glucocorticoid replacement (HR, 2.71; 95% CI, 1.05–7.0) increased VTE risk.ConclusionSERMs did not increase the risk of VTE compared to BPs in Koreans with osteoporosis. However, old age and estrogen replacement both increased VTE risk.     

Chronic administration of udenafil, a selective phosphodiesterase type 5 inhibitor, promotes erectile function recovery in an animal model of bilateral cavernous nerve crush injury

IntroductionPreservation of the cavernous nerves (CNs) during radical prostatectomy is crucial for the patient's erectile function. Despite advances in operative technique, the majority of men report compromised erectile function postprostatectomy or complete loss of potency due to CN trauma even with nerve-sparing modifications.AimThis study was designed to investigate whether repeated dosing of udenafil, a phosphodiesterase type 5 inhibitor, helps to improve erectile function after CN injury.MethodsUsing the CN crush injury model, 8-week-old male Sprague Dawley rats were divided into the following groups; sham-operated group, bilateral CN crush injury exposed to either no udenafil (vehicle) or udenafil (5, 20 mg/kg) daily for two different durations (4 and 8 weeks, p.o.).Main Outcome MeasuresAt both time points, CN electrical stimulation was used to assess erectile function by measuring the intracavernous pressure. The expressions of hypoxia-inducible factor 1-alpha (HIF-1α), transforming growth factor-beta (TGF-β1), nerve growth factor (NGF), endothelin B receptor (ET_B), endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and sonic hedgehog homolog (SHH) in penile tissue were examined. Immunohistochemical antibody staining was performed for NGF, eNOS, nNOS, CD31, and alpha-smooth muscle actin (α-SMA). Additionally, terminal deoxynucleotidyl transferase-mediated nick-end labeling assay was performed to quantify apoptosis and the tissue slides were stained for Masson's trichrome to assess the smooth muscle/collagen ratio.ResultsUdenafil improved erectile function in a dose- and time-dependent manner with the maximum erectile function recovery achieved by 20 mg/kg udenafil at an 8-week time point. CN injury increased the expression of HIF-1α, TGF-β1, NGF, and ET_B, however, decreased the expression of eNOS, nNOS, and SHH. Udenafil significantly suppressed these alterations. The results from the histological analyses show that udenafil markedly reduces apoptosis induced by CN injury and augments the smooth muscle/collagen ratio.ConclusionsCN injury induces significantly impaired erectile function and altered gene/protein expression. Chronic administration of udenafil preserves erectile function and has a beneficial role against the pathophysiological consequences of CN injury. Lee C-H, Kim H-S, Goo M-J, Kang K-K, Ahn B-O, Kim SH, and Yang D-Y. Chronic administration of udenafil, a selective phosphodiesterase type 5 inhibitor, promotes erectile function recovery in an animal model of bilateral cavernous nerve crush injury.     

A therapeutic confirmatory study to assess the safety and efficacy of Zydena (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus

IntroductionPatients with diabetes mellitus (DM) are reported to experience more severe erectile dysfunction (ED) symptoms and respond less to ED treatments compared with patients with ED of other etiologies.AimThis study was undertaken to evaluate the safety and efficacy of udenafil for the treatment of ED in a larger number of patients with DM.MethodsA placebo‐controlled, randomized, double‐blind, double‐dummy, parallel‐group design multicenter study, fixed‐dose trial was conducted. The trial involved seven study sites in Korea, with 174 ED patients with DM. The subjects, treated with placebo, 100 mg, or 200 mg of udenafil for 12 weeks, were asked to complete the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and the Global Assessment Question (GAQ) during the study period.Main Outcome MeasuresThe primary efficacy parameter was the change in the erectile function domain (EFD) score of IIEF from baseline. Secondary parameters were IIEF questions 3 (Q3) and Q4, SEP Q2 and Q3, rate of achieving normal erectile function (EFD ≥ 26), and the response to GAQ.ResultsCompared with the placebo, patients receiving both doses of udenafil showed statistically significant improvements in the IIEF‐EFD score, respectively. However, statistically significant difference was not observed between the udenafil 100 mg and the udenafil 200 mg groups. Similar results were observed in the comparison of Q3 and Q4 of IIEF, SEP diary, and GAQ. The percentages of subjects experiencing at least one adverse event related to the study drugs were 3.6%, 15.8%, and 22.4% for the placebo, udenafil 100 mg, and udenafil 200 mg groups, respectively. However, these events were all mild in severity. Major adverse events were flushing, headache, nausea, and conjunctival hyperemia.ConclusionUdenafil was significantly effective for the treatment of ED, demonstrating statistically significant improvement in erectile function in patients with DM. The incidence of adverse events was relatively low and well tolerated in patients with DM. Moon DG, Yang DY, Lee CH, Ahn TY, Min KS, Park K, Park CK, and Kim JJ. A therapeutic confirmatory study to assess the safety and efficacy of Zydena^® (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med 2011;8:2048–2061.     

Apocrine poroma with sebaceous differentiation

Poromas have been classified as eccrine neoplasms, but several recent reports of poroid tumors with sebaceous, follicular, and apocrine differentiation have challenged this concept. We report a case of apocrine poroma with sebaceous differentiation. A 69-year-old man presented with an asymptomatic elevated erythematous plaque. Histopathology revealed cellular nests composed of cuboidal poroid cells and sebocytes. The nests varied in size and were entirely intraepidermally arranged in a growth pattern similar to that of hidroacanthoma simplex. Given the common embryologic origin of folliculosebaceous and apocrine units, we believe that this lesion represents an apocrine poroma with sebaceous differentiation.     

THE DISTRIBUTION OF MELANOCYTIC NAEVI IN MELANOMA PATIENTS AND CONTROL SUBJECTS

A study of 121 melanoma patients and 139 control subjects was conducted among whites to examine and compare the distribution of non-dysplastic and dysplastic naevi and other pigmented lesions in each group. Melanoma patients had a mean of 97 melanocytic naevi which were greater than 2 mm in diameter and controls had a mean of 36 such naevi, while the medians were 58 and 22 respectively (p less than 0.0001). 55% of melanoma patients and 17% of controls had at least one clinically determined dysplastic naevus, and 26% of melanoma patients and 6% of controls had at least 5 dysplastic naevi. Men were found to have more naevi on the trunk than women in both melanoma cases (p = 0.01), and controls (p = 0.005). Dysplastic naevi were most often found on the trunk and were present at this location in 51% of cases and 17% of controls. Melanoma patients and control subjects with dysplastic naevi, when compared to those without these lesions, had larger number of non-dysplastic naevi. Lentigines were more common among melanoma patients that among control subjects (p = 0.02). There were no differences in the number of non-dysplastic naevi among cases with light and dark hair and eyes, or among controls with these characteristics. There also was little variation in the number of naevi according to number of blistering sunburns.     

Trends in the prevalence of atopic dermatitis in school children: longitudinal study in Osaka Prefecture, Japan, from 1985 to 1997

BACKGROUND: The authors have carried out questionnaire surveys of health symptoms in school children (aged 7-12 years) in Osaka Prefecture, Japan. In this study, the geographical distribution of and trends in the prevalence of atopic dermatitis were evaluated. OBJECTIVES: To assess the relationship between the prevalence of atopic dermatitis in children and the environmental factors, and to estimate future changes of the prevalence of atopic dermatitis. METHODS: A total of seven population surveys were carried out at 2-year intervals between 1985 and 1997 in a total of about 4 million primary school children (460 000-740 000 per survey). RESULTS: The lifetime prevalence of atopic dermatitis increased from 15.0% in 1985 to 24.1% in 1993 but levelled off thereafter. According to the school year, the prevalence was higher in lower-year pupils. However, the prevalence stopped rising earlier in lower-year pupils and began to decrease in 1997 in first- to third-year pupils. The prevalence according to areas was significantly correlated negatively with air pollution and positively with the income index. According to the income classes, the prevalence increased until 1993 but levelled off thereafter in all classes, which reduced the differences among the classes. CONCLUSIONS: The increase of the prevalence of atopic dermatitis in school children stopped in 1993 in Osaka Prefecture, Japan. It is conceivable that the prevalence had reached the saturation level.