Predictive factors for postoperative renal function after off-clamp,non-renorrhaphy partial nephrectomy

BackgroundThere is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy. Therefore, this retrospective study aimed to identify predictive factors of perioperative decline in renal function after off-clamp, non-renorrhaphy open partial nephrectomy.MethodsClinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy was performed using a soft coagulation system. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery.ResultsThe median operation time was 122 minutes, and the median volume of estimated blood loss was 155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Estimated blood loss was an independent predictor of perioperative decline in eGFR 5 days after surgery [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96, 0.98; P<0.001]. Preoperative eGFR and estimated blood loss were independent predictors of perioperative decline in eGFR 1 month after surgery (OR: 0.86; 95% CI: 0.77, 0.95; P=0.007 and OR: 0.98; 95% CI: 0.97, 0.99; P<0.001, respectively). Age, preoperative eGFR, and estimated blood loss were independent predictors of perioperative decline in eGFR 3 months after surgery (OR: 0.64; 95% CI: 0.54, 0.81; P<0.001, OR: 0.72; 95% CI: 0.61, 0.85; P<0.001; and OR: 0.98; 95% CI: 0.97, 0.99; P=0.004, respectively).ConclusionsEstimated blood loss during surgery was a predictor of perioperative decline in eGFR within 3 months after off-clamp, non-renorrhaphy open partial nephrectomy. Age was a predictor of perioperative decline in eGFR 3 months after surgery.     

以CD54为评价指标的THP-1细胞光致敏体外评价方法的确定和验证

目的 确定并验证以细胞表面标志物CD54作为评价指标的光致敏体外评价方法。方法 将THP-1细胞与多种光致敏剂、光刺激剂、皮肤致敏剂、皮肤刺激剂和阴性受试物分别孵育,在光照射或避光处理后,用流式细胞仪测定细胞表面标志物CD54和CD86的表达水平并统计分析,进一步确定具体的评价指标,并对该方法的准确性、特异性、灵敏度、重复性进行验证。结果 19种光致敏剂中有15种引起照射组THP-1细胞表达CD54的平均荧光强度（MFI）较非照射组显著增加（P<0.05、0.01） ,且照射组细胞表达CD54的相对荧光强度（RFI）值均在1.5以上。光刺激剂经光照射后也可引起细胞表达CD54的MFI显著增加（P<0.01） ,但经过预照射处理后,CD54的表达水平较直接照射组显著下降（P<0.01）。未经光照射条件下,皮肤致敏剂即可引起THP-1细胞表达CD54和CD86的MFI比对照组显著增加（P<0.01） ,光照后CD54的表达反而略有下降。在光照和避光条件下,皮肤刺激剂、阴性受试物（乳酸）均未引起细胞表达CD54或CD86的显著性变化。以CD54为评价指标的THP-1细胞光致敏评价方法检测光致敏剂的准确性、特异性和灵敏度分别是85.2%、100%和78.9%,具有良好的重复性。结论 确定了THP-1细胞光致敏评价方法的细胞表面标志物评价指标为CD54,判定标准为：（1）光照后THP-1细胞表达CD54的MFI较照射前显著性增加;（2）光照后THP-1细胞表达CD54的RFI≥1.5;（3）当上述条件均满足时,对受试物进行预照射处理,结果仍然满足前2条标准。     

Selective effect of cinnarizine on the vestibular nucleus neurons

Summary Effects of cinnarizine were studied on the lateral vestibular nucleus (LVN) and spinal trigeminal nucleus (STN) of cats anesthetized with -chloralose. Cinnarizine did not produce any obvious alterations of the field potential and spike generation of type B interneurons in STN elicited by trigeminal nerve stimulation as well as the field potential in LVN by vestibular nerve stimulation. Spike generation of monosynaptic LVN neurons elicited by the suprathreshold stimulus to the vestibular nerve was unaffected by cinnarizine up to 4 mg/kg. When the subthreshold stimulus was applied to the vestibular nerve, however, the spike number of LVN monosynaptic neurons was significantly increased after cinnarizine treatment. The enhancement of spike firing by cinnarizine upon both supra- and subthreshold stimuli to the vestibular nerve was found to be more pronounced in LVN polysynaptic neurons than monosynaptic ones. Since the effect of cinnarizine on LVN neurons was not dose-dependent, it is suggested that the enhanced responsiveness of the neurons by the drug might be due to an increase of blood flow, but not to a direct excitation of the neurons themselves.     

Inhibition of human Na(v)1.5 sodium channels by strychnine and its analogs

Strychnine and brucine from the seeds of the plant Strychnos nux vomica have been shown to have interesting pharmacological effects on several neurotransmitter receptors. In this study, we have characterized the pharmacological properties of strychnine and its analogs on human Na_v1.5 channels to assess their potential therapeutic advantage in certain arrhythmias. Among the eight alkaloids, only strychnine and icajine exhibited inhibition potency on the Na_v1.5 channel with the half-maximum inhibition (IC₅₀) values of 83.1 μM and 104.6 μM, respectively. Structure–function analysis indicated that the increased bulky methoxy groups on the phenyl ring or the negatively charged oxygen atom may account for this lack of inhibition on the Na_v1.5 channel. Strychnine and icajine may bind to the channel by cation–π interactions. The substitution with a large side chain on the phenyl ring or the increased molecular volume may alter the optimized position for the compound close to the binding sites of the channel. Strychnine and icajine bind to the Na_v1.5 channel with a new mechanism that is different from TTX and local anesthetics. They bind to the outer vestibule of the channel pore with fast association and dissociation rates at resting state. Strychnine and icajine had little effect on steady-state fast inactivation but markedly shifted the slow inactivation of Na_v1.5 currents toward more hyperpolarized potentials. The property of icajine influencing slow-inactivated state of Na_v1.5 channel would be potential therapeutic advantages in certain arrhythmias.     

异丙酚对小鼠海马锥体神经元膜特性和突触后电流的影响

目的观察异丙酚对小鼠鼠海马锥体神经元膜特性和突触后电流的影响。方法用冰冻切片的方法将C57小鼠海马半脑切成300 μm厚度。运用全细胞膜片钳技术记录海马锥体神经元在异丙酚作用前后动作电位反应、I-V曲线及突触后电流反应后变化情况。结果异丙酚明显减少不同刺激强度下胞体动作电位产生的个数,加入异丙酚后使锥体细胞动作电位发放个数由5±3个降至2±1个（P<0.01）,而对动作电位幅度无显著影响。异丙酚可改变海马锥体神经元对兴奋性电压刺激的I-V曲线平台期反应,使最大电流幅度由1647.63±124.02 pA增加至2955.08±119.10 pA（P<0.01）。异丙酚可降低锥体神经元突触后电流,加入异丙酚前为146.5±25.89 pA,加入异丙酚后为72.8±18.71 pA（P<0.01）,20 min洗脱异丙酚后电流幅度恢复至132.1±30.2 pA（P<0.01）。结论异丙酚可降低海马锥体神经元动作电位发放数,改变I-V曲线兴奋性平台期反应和可逆地降低神经元突触后电流反应。     

Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer

BackgroundFrom 2004 to 2014, 821 colorectal cancer primary resections were conducted at our institution. Of these, 102 patients (12.4%) were older adults over 80 years old. underwent either the conventional laparotomy group (72 patients) or the hand-assisted laparoscopic surgery (HALS) group (30 patients).MethodsData were extracted for 102 patients over 80 years old who underwent primary resection for colorectal cancer and were divided into two groups: conventional laparotomy (CL) (n=72) and hand-assisted laparoscopy (n=30). Pre-operative characteristics and outcomes were compared.ResultsBaseline characteristics were similar between groups, except for age: CL group median 83.5 years old (range, 80–92 years old) and hand-assisted laparoscopy (HALS) group median 81.5 years old (range, 80–88 years old) (P=0.027). Pre-operative cardiac and lung function risk, performance status, and pathological classification stage (pStage) were almost similar between groups (P=0.668, P=0.176, P>0.999, P=0.217). No significant differences were found for operation time. The HALS group resulted in less blood loss (median 204 mL in the CL group and median 68 mL in the HALS group, P=0.003), shorter postoperative hospital stay (median was 18 days in the CL group and median was 12 days in the HALS group, P<0.001), and fewer postoperative wound infections (18 cases in the CL group and 2 cases in the HALS group, P=0.034). Five-year relapse-free survival (5Y-RFS) was 48.1% in the CL group and 73.3% in the HALS group (P=0.028). Five-year overall survival (5Y-OS) was 48.2% in the CL group and 73.3% in the HALS group (P=0.027).ConclusionsApproximately 70% of surgical treatment for patients over 80 years old with colorectal carcinoma were performed by CL. However, HALS had significant advantages including less blood loss, fewer wound infections, and shorter hospital stays. Therefore, HALS could proactively be considered to older adult patients with colorectal cancer.     

A case of refractory polyarteritis nodosa successfully treated with rituximab

A 59-year-old man who presented with continuous fever, livedo reticularis, and left leg ischemia with multiple tibial artery stenosis and renal artery aneurysm, as demonstrated by arteriography, was diagnosed with polyarteritis nodosa (PAN) 6 years ago. Although he frequently relapsed in spite of intensive immunosuppressive therapies, the disease activity of PAN was controlled with repeated rituximab (RTX) therapies and steroid doses were tapered safely. Peripheral CD19⁺ B-cells disappeared soon after the 1st administration of RTX. Although CD19⁺ B-cells remained absent, 3.1% of CD3⁺CD20⁺ T-cells were observed in the peripheral blood prior to the 2nd administration of RTX. Recent studies have suggested the pathogenic role of CD3⁺CD20⁺ T-cells in autoimmune diseases in the context of RTX therapy; therefore, their roles in the pathogenesis of PAN also need to be considered.