Clinicopathological features of antineutrophil cytoplasmic antibodies associated vasculitis with glomerular IgA deposits

Objective To investigate the clinical manifestations, renal pathology and prognosis of antineutrophil cytoplasmic antibody-associated small-vessel vasculitis (AAV) accompanied with renal glomerular IgA deposition. Methods A retrospective analysis was performed at the First Affiliated Hospital of Zhejiang University College of Medicine. Patients diagnosed with AAV associated renal injury by renal biopsy from February 2004 to February 2017 were enrolled. Patients with antiglomerular basement membrane antibody-mediated nephritis, systemic lupus erythematosus nephritis, Henoch Schonlein purpura nephritis, hepatitis B virus associated nephritis and other known etiology were excluded. According to immunofluorescence examination, the patients were divided into IgA deposition group and pauci-immune complex deposition group. The differences in clinical manifestation, pathological features and prognosis were compared between groups. Results A total of 150 AAV cases were included, among which 25 cases were with IgA deposition and 125 cases with pauci-immune complex deposition. The level of serum albumin in IgA deposition group was higher than that in pauci-immune complex deposition group [(35.0±6.2) g/L vs (32.6±5.3) g/L, P=0.049], but the titer of MPO-ANCA was lower [24.8(10.4, 71.8) U/ml vs 63.0(21.9, 100.0) U/ml, P=0.044] in IgA deposition group. There was no significant difference between two groups in other laboratory indexes and renal pathological findings. The median follow-up time was 15.2 months in IgA deposition group and 8.9 months in pauci immune complex deposition group. During the follow-up there were 8 patients (32.0%) in IgA deposition group and 29 patients (23.2%) in pauci immune complex deposition group on maintaining dialysis; 2 patients (8.0%) in IgA deposition group and 7 patients (5.6%) in pauci immune complex deposition group died. There was no significant difference between two groups in patients' outcomes. Conclusions AAV patients with glomerular IgA deposition and AAV patients with typical glomerular immunoglobulin complex deposition are similar as regards clinical appearance and prognosis.     

Food intake,survival, and immunity of Nibea albiflora to Cryptocaryon irritans infection

Parasitology Research - Cultured Nibea albiflora rarely die from cryptocaryoniasis. To explore the resistance of N. albiflora against the invasion of Cryptocaryon irritans, in this study,...     

Ratio of the tibial tuberosity–trochlear groove distance to the tibial maximal mediolateral axis: A more reliable and standardized way to measure the tibial tuberosity–trochlear groove distance

Background

Tibial tuberosity–trochlear groove distance(TT-TG) is a measurement to assist in the diagnosis and treatment of patellar instability, however it still has some limitations. Our study was to modify the accepted measurement method and seek a more reliable and standardized method.

Rapid Pore Cranial Drilling With External Ventricular Drainage for Treatment of Intraventricular Hemorrhage: A 36-Year Case Series

This study aimed to describe the technique details of rapid pore cranial drilling with external ventricular drainage and document its clinical outcomes by highlighting the advantages over the traditional and modified cranial drilling technique. Intraventricular hemorrhage is one of the most severe subtypes of hemorrhagic stroke with high mortality. The amount of blood in the ventricles is associated with severity of outcomes, and fast removal of the blood clot is the key to a good prognosis. Between 1977 and 2013, 3773 patients admitted for intraventricular hemorrhage underwent rapid pore cranial drilling drainage. The therapeutic effects and clinical outcomes were retrospectively analyzed. Of these patients, 1049 (27.8%) experienced complete remission, 1788 (47.4%) had improved condition, and 936 (24.8%) died. A total of 3229 (85.6%) patients gained immediate remission. One typical case was illustrated to demonstrate the efficacy of the rapid pore drilling technique. Rapid pore cranial drilling drainage in patients with intraventricular hemorrhage is fast, effective, and provides immediate relief in patients with severe conditions. It could be a better alternative to the conventional drilling approach for treatment of intraventricular hemorrhage. A randomized controlled trial for direct comparison between the rapid pore cranial drilling drainage and conventional drilling technique is in urgent need.Key words: Intraventricular hemorrhage, External ventricular drainage, Rapid pore cranial drillingIntraventricular hemorrhage (IVH) denotes a bleeding within the ventricular system of the brain. It usually results from traumatic brain injuries or hemorrhagic stroke, and the prognosis can be very poor.^1,2 Volume of IVH has been reported to be a predictor of outcome in patients with spontaneous intracerebral hemorrhage (ICH) and extension to the ventricles.^3,4 Epidemiologic data has demonstrated a strong association between the amount of blood in the ventricles and severity of outcomes including mortality, coma, and functional impairment.⁴ This finding provides substantial support for the therapeutic idea of intraventricular hematoma removal, which has been validated in animal studies. The removal of blood clot from ventricles prevents hydrocephalus and inhibits inflammation mediated progressive tissue damage.^5,6 External ventricular drainage (EVD), also known as ventriculostomy, has then been developed to remove the blood or obstructed cerebrospinal fluid (CSF) from the ventricles of the brain, which thus relieves the elevated intracranial pressure (ICP) and hydrocephalus.⁷ Efforts have been made to improve the drilling and drainage techniques. For example, the method of percutaneous needle trephination has been introduced and performed in case of emergency as a simple, low-risk, effective way to reduce ICP.^8,9 Similarly, Zhang et al first introduced a medical device named rapid pore drilling apparatus in 1975, and shortly after reported the first success using the rapid pore drilling technique to perform EVD via the frontal horn of the lateral ventricle, which saved the life of a patient with IVH and severe tonsillar hernia.^10,11 It was a fast procedure, completed within 10 minutes, and could be performed at the bedside under sterile condition. Since then, this technique has been adopted in many hospitals in Shandong Province, China. In this study, we collected and analyzed clinical data on 3773 patients who were admitted for IVH at 14 hospitals from 1977 to 2013 and received rapid pore cranial drilling with EVD. The clinical experiences, including operating procedures, duration, technical performances, and the therapeutic effect of rapid pore drilling with EVD were recorded. To our best knowledge, the present study was the biggest one that involved the largest cohort so far and summarized the clinical practice of the rapid pore cranial drilling technique over 30 years. The results indicate that the rapid pore cranial drilling technique is minimally invasive, fast, safe, and effective for treating patients with severe IVH.     

Neural Crest‐Specific TSC1 Deletion in Mice Leads to Sclerotic Craniofacial Bone Lesion

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by mutations in either TSC1 or TSC2. TSC has high frequency of osseous manifestations such as sclerotic lesions in the craniofacial region. However, an animal model that replicates TSC craniofacial bone lesions has not yet been described. The roles of Tsc1 and the sequelae of Tsc1 dysfunction in bone are unknown. In this study, we generated a mouse model of TSC with a deletion of Tsc1 in neural crest‐derived (NCD) cells that recapitulated the sclerotic craniofacial bone lesions in TSC. Analysis of this mouse model demonstrated that TSC1 deletion led to enhanced mTORC1 signaling in NCD bones and the increase in bone formation is responsible for the aberrantly increased bone mass. Lineage mapping revealed that TSC1 deficient NCD cells overpopulated the NCD bones. Mechanistically, hyperproliferation of osteoprogenitors at an early postnatal stage accounts for the increased osteoblast pool. Intriguingly, early postnatal treatment with rapamycin, an mTORC1 inhibitor, can completely rescue the aberrant bone mass, but late treatment cannot. Our data suggest that enhanced mTOR signaling in NCD cells can increase bone mass through enlargement of the osteoprogenitor pool, which likely explains the sclerotic bone lesion observed in TSC patients. © 2015 American Society for Bone and Mineral Research.     

不同镇痛方式对全膝关节置换术后镇痛效果及炎性反应的影响

目的探讨神经刺激仪引导下连续股神经阻滞(continuous femoral nerve block,CFNB)镇痛或静脉镇痛对全膝关节置换术(total knee arthroplasty,TKA)后患者镇痛效果及炎性反应的影响。方法择期行单侧全膝关节置换术患者60例,ASAⅠ或Ⅱ级,年龄51~71岁,体重50~77kg,随机均分两组:PCIA组和患者自控股神经镇痛组(PCNA组)。PCIA组:术后持续输注芬太尼镇痛;PCNA组:在神经刺激仪引导下行股神经置管,术后连续股神经阻滞镇痛。分别于术前、术毕、术后6、12、24和48h时采集股静脉血,检测IL-6及IL-10浓度。观察并记录术后2、12、24、36、48h静止时和术后24、48、72h运动时VAS评分。记录尿潴留、低氧血症(SpO290%)、恶心、呕吐、嗜睡不良反应发生情况及追加哌替啶例数。结果与术前比较,术后各时点PCIA组IL-6、IL-10浓度明显升高(P0.05),PCNA组术后6、12hIL-6和术后6、12、24hIL-10浓度明显升高(P0.05)。与PCNA组比较,术后各时点PCIA组IL-6浓度明显升高(P0.05),而术后6h时PCIA组IL-10浓度明显降低(P0.05)。与PCNA组比较,PCIA组术后2、12、24、36、48h静止时VAS评分和术后24、48、72h运动时VAS明显升高(P0.05)。与PCNA组比较,PCIA组术后恶心、嗜睡、追加哌替啶例数明显增加(P0.05)。两组无一例患者发生低氧血症。结论神经刺激仪引导下连续股神经阻滞镇痛效果良好,不良反应少,可以减轻TKA术后患者机体炎性反应。     

An indirect comparison meta-analysis of noninvasive intravesical instillation and intravesical injection of botulinum toxin-A in bladder disorders

International Urology and Nephrology - Botulinum toxin type A (BTX-A) intravesical instillation and BTX-A intravesical injection are both effective treatments or overactive bladder (OAB) and...