Effects of cyclosporine on bone mineral density in patients with glucocorticoid-dependent nephrotic syndrome in remission

Purpose

Cyclosporine (CsA) is often prescribed to patients with glucocorticoid (GC)-dependent nephrotic syndrome. Although it is well known that long-term administration of GC causes osteoporosis, the effects of CsA on bone metabolism are not fully established. Therefore, we examined the effects of CsA on bone metabolism in patients with GC-dependent nephrotic syndrome in remission.

Methods

We followed 23 patients treated with prednisolone alone (GC alone group) and 17 patients treated with CsA in combination with prednisolone (GC + CsA group). Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry, and biochemical markers of bone metabolism were simultaneously measured in serum and urine samples.

Results

BMD decreased significantly in the GC group from 752 to 623 mg/cm² but non-significantly in the GC + CsA group from 751 to 684 mg/cm². Although the cumulative dose of GC increased in both groups, there were no significant differences in biochemical markers at either the start or the end of the study. Vertebrate bone fracture and other side effects associated with CsA treatment did not occur in our study.

Conclusions

Our results indicate that CsA does not accelerate GC-induced osteoporosis in patients with nephrotic syndrome. We conclude that CsA is appropriate for the treatment of GC-dependent nephrotic syndrome, because it does not adversely affect bone metabolism and has favorable glomerular effects.     

CD14 expression and Kupffer cell dysfunction in non-alcoholic steatohepatitis: superparamagnetic iron oxide-magnetic resonance image and pathologic correlation

Background and Aim: Kupffer cell (KC) function and CD14 expression contributes to pathogenesis of non‐alcoholic steatohepatitis (NASH). However, these relationships remain unclear. We investigated the relationship of KC function with superparamagnetic iron oxide‐enhanced magnetic resonance imaging (SPIO‐MRI), histopathological severity of NASH, and number of CD14‐positive KCs in NASH. Methods: This retrospective study included 32 patients (24 with NASH and eight with simple steatosis) who had previously undergone SPIO‐MRI with T2‐weighted gradient‐recalled echo sequence. All subjects were diagnosed pathologically and were evaluated for necroinflammation grade, fibrosis stage, and number of CD14‐positive KCs. Patients with NASH and simple steatosis were compared by using the Mann–Whitney test to determine differences in percent reduction of liver‐to‐muscle signal intensity ratio (reduction‐%LMR), as a surrogate parameter of KC function, and number of CD14‐positive KCs. Kruskal–Wallis test and Pearson's correlation coefficient were used to analyze relation among reduction‐%LMR, histopathological severity and number of CD14‐positive KCs. Results: There were statistically significant differences in reduction‐%LMR and number of CD14‐positive KCs between NASH and simple steatosis patients (Mann–Whitney test, P < 0.001 for all comparisons). Reduction‐%LMR decreased with an increase in necroinflammation grade or fibrosis stage. The number of CD14‐positive KCs increased with an increase in necroinflammation grade and fibrosis stage (Kruskal–Wallis test, both, P < 0.001). A high correlation was seen between number of CD14‐positive KCs and reduction‐%LMR (Pearson r = 0.81; P < 0.001). Conclusions: KC phagocytic function evaluated with SPIO‐MRI correlated with histopathological severity and number of CD14‐positive KCs. These results support the concept that KC phagocytic dysfunction contributes to the pathogenesis of NASH.     

Reduced difference of α<Subscript>2</Subscript>-plasmin inhibitor levels between plasma and serum in patients with severe factor XIII deficiency,including autoimmune hemorrhaphilia due to anti-factor XIII antibodies

Coagulation factor XIII/13 (FXIII/13) stabilizes fibrin molecules by creating crosslinks with other fibrin molecules as well as with α₂-plasmin inhibitor (α₂-PI). “Hemorrhagic acquired FXIII/13 deficiency” was formerly considered rare, but has been increasing recently in Japan. During the 10 months of our nationwide campaign, we diagnosed five new patients with “acquired hemorrhaphilia due to anti-FXIII/13 autoantibodies,” after examining 20 newly suspected cases of “hemorrhagic acquired FXIII/13 deficiency.” When FXIII/13 activity was reduced to less than 50% of normal, it was proportional to the difference in α₂-PI levels between plasma and serum (plasma–serum α₂-PI), likely due to its cross-linking to fibrin by activated FXIII/13. Accordingly, decreased amounts of the plasma–serum α₂-PI ex vivo may reflect reduced FXIII/13 activity in vivo. The plasma–serum α₂-PI may thus also be a useful diagnostic marker for severe FXIII/13 deficiency.     

Discontinuation of adalimumab treatment in rheumatoid arthritis patients after achieving low disease activity

Objective

We implemented a retrospective study to explore discontinuation of therapy with adalimumab (ADA) without exacerbation in rheumatoid arthritis (RA) patients who had achieved low disease activity (LDA) with the biological agent.

Methods

We enrolled 46 RA patients who had completed open extension of a double-blind, placebo-controlled trial of ADA monotherapy in Japan and who had LDA (DAS28-CRP <2.7) at the last administration of ADA in the extension trials; this date was defined as week 0 in the present study. Treatment of RA was at the discretion of the attending physician after week 0. The primary endpoint of this study was the percentage of patients who maintained discontinuation of biological agents and LDA for 52?weeks.

Results

Twenty-four of the enrolled patients continued ADA while the rest discontinued ADA after the administration of the drug at week 0. Fourteen of the 22 patients did not restart biological agents, and 4 (18.2%) of these maintained LDA through week 52. All 4 of these patients had received ADA monotherapy before week 0.

Conclusion

Some RA patients who have achieved LDA with ADA monotherapy can discontinue the biologic without incurring increased disease activity. A prospective randomized study is required to confirm the results of our study.     

Screening and characterisation of CdTe/CdS quantum dot-binding peptides for material surface functionalisation

Quantum dots (QDs) are promising nanomaterials due to their unique photophysical properties. For them to be useful in biological applications, the particle surface generally needs to be conjugated to biological molecules, such as antibodies. In this study, we screened CdTe/CdS QD-binding peptides from a phage display library as linkers for simple and bio-friendly QD modification. Among five QD-binding peptide candidates, a series of truncated peptides designed from two high-affinity peptides were subjected to an array-based binding assay with QDs to assess their functional core sequences and characteristics. Linking these isolated, shortened peptides (PWSLNR and SGVYK) with an antibody-binding peptide (NKFRGKYK) created dual-functional peptides that are capable of QD surface functionalisation by antibodies. Consequently, the dual-functional peptides could mediate anti-CD9 antibody functionalisation onto CdTe/CdS QD surface; CD9 protein imaging of cancer cells was also demonstrated. Our proposed peptides offer an effective vehicle for QD surface functionalisation in biological applications.

We explored peptide binders to quantum dots (QDs) and proposed a simple and bio-friendly QD functionalisation using dual-functional peptides.     

Electrochromic Os-based metallo-supramolecular polymers: electronic state tracking by in situ XAFS,IR, and impedance spectroscopies

In this study, the electronic states of Os-based metallo-supramolecular polymers (poly(OsL)²⁺) during electrochromism were tracked by in situ X-ray absorption fine structure (XAFS), infrared (IR), and impedance spectroscopies. The XAFS spectra suggested electronic charge migration in the polymer, and the in situ spectra revealed reversible changes caused by electrochemical redox reactions. The IR spectra of the polymers showed an IVCT band, and we also confirmed the reversible changes by applying a voltage to the redox cell. During the impedance measurements, we found a drastic decrease in the charge transfer resistance (R_CT) of the polymer films near the electrochemical redox potential.

In this study, the electronic states of Os-based metallo-supramolecular polymers (poly(OsL)²⁺) during electrochromism were tracked by in situ X-ray absorption fine structure (XAFS), infrared (IR), and impedance spectroscopies.     

Endoscopic Resection of Tuberculum Sellae Meningiomas

Objective To evaluate the results of endoscopic transnasal resection of tuberculum sellae meningiomas (TSMs) as compared with transcranial approaches.Design We retrospectively analyzed five patients who underwent endoscopic endonasal resection of TSM and performed a comprehensive review of articles published between 2000 and 2012 describing the operative treatment of TSMs.Results Gross total resection (GTR) was achieved in four patients (80%). Transient diabetes insipidus occurred in three patients (60%). Preoperative visual field deficit resolved in all patients. Cerebrospinal fluid (CSF) leak occurred in one patient. Analysis of published studies included 1,026 transcranial and 144 transnasal cases. GTR was achieved in 85% of transcranial and 72% of transnasal cases. Visual field deficit improved in 65% of transcranial and 82% of transnasal cases. Rate of diabetes insipidus and CSF leak was higher in the transnasal series. Rate of GTR and visual improvement was higher in endoscopic endonasal as compared with microsurgical transnasal series.Conclusion The literature supports transsphenoidal surgery for the resection of TSMs with significant optic nerve compromise and limited lateral extension. This approach may have an equivalent if not superior outcome over transcranial surgery in visual outcome. CSF leaks are still a challenge but may improve with the use of vascularized nasoseptal flaps.     

Effect of Transcatheter Arterial Microembolization on Phantom Limb Pain Persisting for 17 Years

CardioVascular and Interventional Radiology - Phantom limb pain is a frequent consequence of the amputation; currently available treatments are far from satisfactory. The present report describes a...