A case of focal segmental glomerulosclerosis syndrome secondary to high-altitude polycythemia

In recent years, focal segmental glomerulosclerosis has become the commonest cause of the nephrotic syndrome seen in adults. Secondary focal segmental glomerulosclerosis is observed when glomerular workload is increased. We report a case of focal segmental glomerulosclerosis with nephrotic syndrome secondary to high-altitude polycythemia (HAPC). Our case points out that for patients with focal segmental glomerulosclerosis, who presented with nephrotic syndrome secondary to HAPC, treatments for HAPC are crucial for the reduction of proteinuria and renal protection instead of glucocorticoid and immunosuppressive drugs.     

Post-transplant cyclophosphamide and bortezomib inhibit dendritic cell maturation and function and alter their IκB and NFκB

Impairing dendritic cell (DC) function to prevent graft versus host disease (GvHD) is an appealing concept. DC antigen presentation is NF-κB pathway-dependent and bortezomib might therefore play a role in preventing alloreactivity. We obtained DC from the blood of patients enrolled in a phase I study using post-transplant cyclophosphamide and bortezomib for prevention of GvHD. Control samples were obtained from patients receiving standard GvHD prevention regimen. Pre-treatment samples were also collected from enrolled patients. DC isolated on days + 1, + 4, and + 7 showed progressive decrease in the expression of maturation markers in comparison to control. In a DC–CD4 + mixed lymphocyte reaction (MLR) where DC isolated from the recipient blood before graft infusion were the stimulator cells, T cell proliferation measured by bromodeoxyuridine (BrdU) integration was decreased in samples obtained on days + 14 and + 21 in comparison to control group. Finally, measured by real-time PCR, the expression of IκB progressively increased while the expression of NF-κB decreased in DC on days + 1, + 4, and + 7, in comparison to pre-treatment paired controls. We conclude that our data further justify exploring the role of bortezomib in GvHD prevention and propose a novel mechanism of action of bortezomib in DC.     

Spinal cord injury increases the risk of Type 2 diabetes: a population-based cohort study

Background contextPrevious studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial.PurposeTo compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients.Study designThis is a population-based retrospective cohort study.Patient sampleData from Taiwan's National Health Insurance Research Database for the period 1997 to 2010 were analyzed. Patients aged 20 years and older newly identified with SCIs during this period were included in the SCI cohort. A non-SCI comparison cohort was randomly selected from National Health Insurance beneficiaries and matched with the SCI cohort based on age, sex, and index date.Outcome measuresBoth cohorts were followed until the first of the following occurred: the diagnosis of Type 2 diabetes (International Classification of Disease, Ninth Revision, Clinical Modification codes 250), withdrawal from the insurance system, the end of 2010, or death.MethodsA Cox proportional hazards regression analysis was used to estimate the risk of developing diabetes.ResultsTaiwan possesses an older SCI population, with a mean age of 51.6 years. The IR for diabetes in patients with and without SCIs was 22.1 per 10,000 person-years and 17.2 per 10,000 person-years, respectively. The adjusted hazard ratio (HR) for diabetes was 1.33 times higher in patients with SCIs than in those without SCIs. In patients with SCIs, men (adjusted HR=1.23, 95% confidence interval (CI)=1.04–1.44), older people (adjusted HR=4.26 in patients older than 65 years, 95% CI=3.16–5.74), patients with comorbidity (adjusted HR=1.36, 95% CI=1.14–1.62), and patients with a complete thoracic SCI (T-spine injury) (adjusted HR=2.13, 95% CI=0.95–4.79) were more likely to be diagnosed with diabetes than other patient subgroups.ConclusionsOur findings may facilitate the prioritizing of preventive health strategies and planning of long-term care for SCI patients.     

Ventricular peritoneal shunt malfunction after operative correction of scoliosis: report of three cases

Background contextTwo of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis.PurposeTo report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction.Study designThree case studies from a university hospital setting were included.Patient sampleAll three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis.Outcome measuresMalfunctioning of the ventriculoperitoneal shunts were recorded.MethodsChart reviews of three cases were analyzed.ResultsTwo children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt.ConclusionsOlder children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk.     

Correlation study of chronic nonbacterial prostatitis with the levels of COX-2 and PGE2 in prostatic secretion

Objective

The prostatitis syndrome is a multifactorial condition of largely unknown etiology. This study is to analyze the relationship between cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2) with the chronic nonbacterial prostatitis (CNBP).

Methods

A total of 172 CNBP patients and 151 healthy males were recruited as CNBP and control group, respectively. The prostatic fluid was collected and tested by pre- and post-massage test. White blood cell (WBC) number was counted, and the contents of COX-2 and PGE2 were determined by double antibody-based sandwich enzyme-linked immuno-sorbent assay. The pain and discomfort of each patient were scored according to the National Institutes of Health chronic prostatitis symptom index.

Results

Compared with the control group, CNBP group displayed significantly higher WBC count, COX-2 level, and PGE2 level. Contents of COX-2 and PGE2 in prostatic secretion of CNBP group were positively correlated with pain scores (r = 0.855 and 0.675, respectively, P < 0.01) and total symptom scores (r = 0.674 and 0.566, respectively, P < 0.01). A significantly positive correlation between COX-2 and PGE2 levels was also discovered (r = 0.493, P < 0.05). The WBC number was not obviously correlated with the accumulations of COX-2 and PGE2 or the clinic symptoms of CNBP.

Conclusion

Increase in PGE2 concentration caused by activated COX-2 pathway may contribute to the pain or discomfort symptom of the CNBP patients. Our results indicate that selective COX-2 inhibitors have application prospect in CNBP treatment.     

DNA Methylation Profiling Identifies EYA4 Gene as a Prognostic Molecular Marker in Hepatocellular Carcinoma

Background

DNA hypermethylation plays important roles in carcinogenesis by silencing key genes. This study aims to identify pivotal genes in hepatocellular carcinoma (HCC) by DNA methylation microarray and to assess their prognostic values.

Materials and Methods

DNA methylation microarray was performed in 45 pairs of HCC and adjacent nontumorous tissues and six normal liver tissues to identify hypermethylated genes in HCC. Potential prognosis-related genes were selected among hypermethylated genes by analyzing influences of methylation levels on disease-free survival (DFS) and overall survival (OS) in 45 patients. Their prognostic values were validated in 154 patients with HCC (including the initial 45 patients) to determine the independent prognostic gene.

Results

Altogether, 54 CpG islands in 44 genes were hypermethylated in HCC compared with liver tissues. Among them, methylation levels of ERG and HOXA11 were inversely associated with DFS (both P < 0.050), and methylation levels of EYA4 were inversely related to DFS and OS (both P < 0.050). EYA4 expression was inversely related to tumor size (P < 0.050). Lower EYA4 expression and larger tumor size were independent predictors of both shorter DFS and OS, and higher Barcelona Clinic Liver Cancer (BCLC) staging was an independent predictor of shorter OS (all P < 0.050).

Conclusions

EYA4 functions as a prognostic molecular marker in HCC. Its aberrant hypermethylation and subsequent down-regulation may promote tumor progression.     

经腹腹腔镜治疗妇科术后膀胱阴道瘘的初步体会

目的总结经腹途径腹腔镜在膀胱阴道瘘修补中的可行性及疗效。方法2012年12月至2017年12月暨南大学附属第一医院因子宫全切除(n=6,均为开放手术)或宫颈癌根治术后(n=1)致膀胱阴道瘘患者共7例,年龄42~57岁,所有瘘口均位于输尿管嵴以上,瘘口直径0.5~3.5 cm,尿瘘病史3个月~5年余,其中2例既往有1~2次经膀胱修补失败病史。采用经腹腹腔镜下膀胱阴道瘘修补术,直视下放置操作通道,其中5例瘘口较大或复发性膀胱阴道瘘采用大网膜填充膀胱与阴道之间的间隙。术后留置尿管2~3周。结果7例患者手术均顺利完成,手术时间150~280 min,出血量50~150 ml,无输血,术后拔除尿管后尿瘘消失。随访6~54个月未出现尿瘘。结论经腹腹腔镜修补高位膀胱阴道瘘微创、有效,尤其是复发性病例,但尚需更多临床资料论证。     

DVPV系统三维影像及虚拟现实导航在泌尿外科复杂手术的应用

目的探讨DVPV数字化手术辅助影像导航技术在泌尿外科复杂手术中的应用价值。方法应用DVPV系统的三维可视化数字重建、虚拟现实应用、全息医疗专业影像平台,在普通CT或MRI数据的基础上进行三维图像重建,术前制定最优的手术方案,术中通过虚拟现实眼镜观看病灶影像并为手术操作进行导航。记录手术操作时间、疗效与围手术期并发症。结果 7例手术均顺利完成。3例肾血管平滑肌瘤(2例为较大体积,1例为肾门肿瘤)被完整切除,患侧肾脏均被保留。无损伤肾门血管和肾盂,平均出血量30 ml,平均手术时间105 min。在肾结石病例中,术中影像导航下避开肾脏重要血管,切开肾皮质的薄弱处取净鹿角型结石,手术时间120 min,出血量约50 ml。大体积中叶前列腺癌用腹腔镜技术完成根治术,出血量约75 ml。前列腺巨大囊性肿物行经直肠穿刺抽液+肿物活检术。肾上腺肿瘤用腹腔镜切除。全部患者平均住院日4.5 d,术中术后无并发症,恢复良好。结论 DVPV数字化手术影像导航系统有助于术前疾病评估,明确病变位置,术中虚拟现实影像导航,可提高医师操作的精准性,降低手术出血量、操作难度与风险,缩短手术时间,让患者获益。     

供肾活组织检查在组织病理学评估中的应用及展望

供肾质量是影响肾移植疗效的重要因素之一,供肾移植前活组织检查(活检)为器官分配及术后免疫抑制方案选择提供组织病理学依据,不同组织学病变情况产生不同的移植效果。本文综述了冰冻切片病理和石蜡切片病理在供肾活检中的应用,阐述了它们在组织病理学评估中的优缺点及显微成像技术应用于供肾评估潜力的展望。旨在寻求一种精准的供肾组织病理学评估手段,在最大化提高器官利用率的同时,将移植肾功能不全发生率降到最低。