Pentoxifylline protects against loss of function and renal interstitial fibrosis in chronic experimental partial ureteral obstruction

Tubulointerstitial fibrosis (TIF) is a hallmark of chronic kidney disease resulting from diverse etiologies and predicts severity and progression of the kidney disease. To investigate the pathogenesis of TIF, complete unilateral ureteral obstruction (UUO) is the most widely used animal model. However, UUO precludes evaluation of renal function. In the present study, we created a rat model of chronic partial ureteral obstruction (PUO), which allowed assessment of renal function at different intervals after obstruction. We examined the effects of pentoxifylline (PTF), a phosphodiesterase inhibitor used clinically to treat peripheral artery disease, on renal function and TIF. Studies were performed in sham-PUO rats and rats with 14-day PUO or 30-day PUO receiving vehicle in drinking water or PTF (400?mg/liter in drinking water). At day-14 PUO, glomerular filtration rate (GFR) was markedly and similarly depressed in rats receiving vehicle or PTF as compared with sham-operated rats. However, at day-30 PUO, GFR in rats receiving PTF was significantly higher than that in rats receiving vehicle, approaching the level seen in the sham-operated rats. At day-30 PUO, histologic studies also revealed a marked reduction of TIF in rats treated with PTF as compared with the rats receiving vehicle in drinking water. Western blot analysis demonstrated that at day-30 the expression of α-smooth muscle actin (an indicator of renal fibrosis) in the medulla was significantly reduced in PUO rats treated with PTF. In conclusion, PTF treatment ameliorated renal fibrosis and helped preserve renal function in a rodent model of PUO.     

Is catheter rupture rare after totally implantable access port implantation via the right internal jugular vein? Report of a case

Catheter rupture after totally implantable access port (TIAP) implantation via the right internal jugular vein is thought to be very rare. We report a case of catheter rupture found 682 days after TIAP surgery in a 52-year-old woman with recurrent right breast cancer. It is possible that chronic stress at the flexure of the catheter induced by neck movements caused the catheter to rupture. Therefore, when inserting a TIAP via the right internal jugular vein, the site of venous puncture should be decided on carefully. Although a fracture of this type is rarely reported in the literature, the incidence of catheter injury of a TIAP inserted via the internal jugular vein at our institute is 1.8 %. This highlights the need to educate and caution medical staff and patients about preventing catheter fracture being caused by external factors.     

Influence of different implant materials on the primary stability of orthodontic mini-implants

This study evaluates the influence of different implant materials on the primary stability of orthodontic mini-implants by measuring the resonance frequency. Twenty-five orthodontic mini-implants with a diameter of 2 mm were used. The first group contained stainless steel mini-implants with two different lengths (10 and 12 mm). The second group included titanium alloy mini-implants with two different lengths (10 and 12 mm) and stainless steel mini-implants 10 mm in length. The mini-implants were inserted into artificial bones with a 2-mm-thick cortical layer and 40 or 20 lb/ft³ trabecular bone density at insertion depths of 2, 4, and 6 mm. The resonance frequency of the mini-implants in the artificial bone was detected with the Implomates^® device. Data were analyzed by two-way analysis of variance followed by the Tukey honestly significant difference test (α = 0.05). Greater insertion depth resulted in higher resonance frequency, whereas longer mini-implants showed lower resonance frequency values. However, resonance frequency was not influenced by the implant materials titanium alloy or stainless steel. Therefore, the primary stability of a mini-implant is influenced by insertion depth and not by implant material. Insertion depth is extremely important for primary implant stability and is critical for treatment success.     

Outcome predictors of cirrhotic patients with spontaneous bacterial empyema

Background: Spontaneous bacterial empyema (SBE) is a complication of cirrhotic patients in which a pre‐existing pleural effusion becomes infected. This retrospective study was designed to investigate the bacteriology and outcome predictors of SBE in cirrhotic patients. Methods: Medical records of cirrhotic patients treated in a tertiary care university hospital from December 2004 to December 2008 were retrospectively reviewed. Results: Of 3390 cirrhotic patients seen during the study period, 81 cases of SBE were diagnosed. The incidence of SBE was 2.4% (81/3390) in cirrhotic patients and 16% (81/508) in patients with cirrhosis with hydrothorax. There were 46 monomicrobial infections found in 46 SBE patients. Aerobic Gram‐negative organisms were the predominant pathogens (n=29, 63%), and Escherichia coli (n=9, 20%) was the most frequently isolated sole pathogen. The mortality rate of SBE was 38% (31/81). Univariate analysis showed that Child–Pugh score, model for end‐stage liver disease (MELD)–Na score, concomitant bacteraemia, concomitant spontaneous bacterial peritonitis, initial intensive care unit (ICU) admission and initial antibiotic treatment failure were predictors of poor outcomes. Multivariate regression analysis demonstrated that the independent factors related to a poor outcome were initial ICU admission [odds ratio (OR): 4.318; 95% confidence interval 1CI) 1.09–17.03; P=0.037], MELD–Na score (OR: 1.267; 95% CI 1.08–1.49; P=0.004) and initial antibiotic treatment failure (OR: 13.10; 95% CI 2.60–66.03). Conclusion: Spontaneous bacterial empyema in cirrhotic patients is a high mortality complication. The independent factors related to poor outcome are high MELD–Na score, initial ICU admission and initial antibiotic treatment failure. High MELD–Na score may be a useful mortality predictor of SBE in cirrhotic patients.