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World Journal of Clinical Cases Jun 2024Glomerulopathy with fibrillary deposits is not uncommon in routine nephropathology practice, with amyloidosis and fibrillary glomerulonephritis being the two most...
BACKGROUND
Glomerulopathy with fibrillary deposits is not uncommon in routine nephropathology practice, with amyloidosis and fibrillary glomerulonephritis being the two most frequently encountered entities. Renal amyloid heavy and light chain (AHL) is relatively uncommon and its biopsy diagnosis is usually limited to cases that show strong equivalent staining for a single immunoglobulin (Ig) heavy chain and a single light chain, further supported by mass spectrometry (MS) and serum studies for monoclonal protein. But polyclonal light chain staining can pose a challenge.
CASE SUMMARY
Herein we present a challenging case of renal AHL with polyclonal and polytypic Ig gamma (IgG) staining pattern by immunofluorescence. The patient is a 62-year-old Caucasian male who presented to an outside institution with a serum creatinine of up to 8.1 mg/dL and nephrotic range proteinuria. Despite the finding of a polyclonal and polytypic staining pattern on immunofluorescence, ultrastructural study of the renal biopsy demonstrated the presence of fibrils with a mean diameter of 10 nm. Congo red was positive while DNAJB9 was negative. MS suggested a diagnosis of amyloid AHL type with IgG and lambda, but kappa light chains were also present supporting the immunofluorescence staining results. Serum immunofixation studies demonstrated IgG lambda monoclonal spike. The patient was started on chemotherapy. The chronic renal injury however was quite advanced and he ended up needing dialysis shortly after.
CONCLUSION
Tissue diagnosis of AHL amyloid can be tricky. Thorough confirmation using other available diagnostic techniques is recommended in such cases.
PubMed: 38898862
DOI: 10.12998/wjcc.v12.i17.3200 -
EJNMMI Physics Jun 2024This study aimed to assess the accuracy of patient-specific absorbed dose calculations for tumours and organs at risk in radiopharmaceutical therapy planning, utilizing...
PURPOSE
This study aimed to assess the accuracy of patient-specific absorbed dose calculations for tumours and organs at risk in radiopharmaceutical therapy planning, utilizing hybrid planar-SPECT/CT imaging.
METHODS
Three Monte Carlo (MC) simulated digital patient phantoms were created, with time-activity data for mIBG labelled to I-123 (LEHR and ME collimators) and I-131 (HE collimator). The study assessed the accuracy of the mean absorbed doses for I-131-mIBG therapy treatment planning. Multiple planar whole-body (WB) images were simulated (between 1 to 72 h post-injection (p.i)). The geometric-mean image of the anterior and posterior WB images was calculated, with scatter and attenuation corrections applied. Time-activity curves were created for regions of interest over the liver and two tumours (diameters: 3.0 cm and 5.0 cm) in the WB images. A corresponding SPECT study was simulated at 24 h p.i and reconstructed using the OS-EM algorithm, incorporating scatter, attenuation, collimator-detector response, septal scatter and penetration corrections. MC voxel-based absorbed dose rate calculations used two image sets, (i) the activity distribution represented by the SPECT images and (ii) the activity distribution from the SPECT images distributed uniformly within the volume of interest. Mean absorbed doses were calculated considering photon and charged particle emissions, and beta emissions only. True absorbed doses were calculated by MC voxel-based dosimetry of the known activity distributions for reference.
RESULTS
Considering photon and charged particle emissions, mean absorbed dose accuracies across all three radionuclide-collimator combinations of 3.8 ± 5.5% and 0.1 ± 0.9% (liver), 5.2 ± 10.0% and 4.3 ± 1.7% (3.0 cm tumour) and 15.0 ± 5.8% and 2.6 ± 0.6% (5.0 cm tumour) were obtained for image set (i) and (ii) respectively. Considering charged particle emissions, accuracies of 2.7 ± 4.1% and 5.7 ± 0.7% (liver), 3.2 ± 10.2% and 9.1 ± 1.7% (3.0 cm tumour) and 13.6 ± 5.7% and 7.0 ± 0.6% (5.0 cm tumour) were obtained for image set (i) and (ii) respectively.
CONCLUSION
The hybrid WB planar-SPECT/CT method proved accurate for I-131-mIBG dosimetry, suggesting its potential for personalized treatment planning.
PubMed: 38898326
DOI: 10.1186/s40658-024-00657-9 -
Neurologia Medico-chirurgica Jun 2024There is a lack of data regarding the safety and effectiveness of implanting the Pipeline Embolization Device with Shield technology (PED-Shield) compared with the...
There is a lack of data regarding the safety and effectiveness of implanting the Pipeline Embolization Device with Shield technology (PED-Shield) compared with the previous generation of Pipeline (PED-Flex). This retrospective single-center study aimed to compare treatment outcomes between the PED-Shield and PED-Flex for treating unruptured internal carotid artery aneurysms. The PED-Flex was used in 62 procedures (67 aneurysms, 59 patients) and the PED-Shield in 53 procedures (59 aneurysms, 58 patients). The mean aneurysm diameter was significantly lower in the PED-Shield group than in the PED-Flex group (11.9 ± 7.0 mm vs. 15.2 ± 6.9 mm, p < 0.001). At the 12-month follow-up, the complete angiographic occlusion rate was 72.1% and 72.3% in the PED-Flex and PED-Shield groups, respectively (p = 0.9808). Limited to aneurysms larger than 10 mm, 70.6% and 68.0%, respectively (p = 0.8175). The incidence of more than three high signal intensity areas on diffusion-weighted imaging after treatment was significantly lower in the PED-Shield group than in the PED-Flex group (27.7% vs. 67.7%; p < 0.001). Limited to aneurysms larger than 10 mm, 41.1% and 69.6%, respectively (p < 0.0117). Symptomatic ischemic complications occurred within 30 days of four PED-Flex procedures (6.5%) and one PED-Shield procedure (2.0%) (p = 0.2315). Limited to aneurysms larger than 10 mm, 1.8% and 3.2%, respectively (p = 0.6677). The incidence of mRS score worsening at 6 months was 3.2% and 1.9% in the PED-Flex and PED-Shield groups, respectively (p = 0.6534). The PED-Shield can achieve outcomes equivalent to or better than the PED-Flex. Further large-scale studies are warranted to confirm our findings.
PubMed: 38897939
DOI: 10.2176/jns-nmc.2024-0034 -
Cardiorenal Medicine Jun 2024Determining ultrafiltration volume in patients undergoing intermittent hemodialysis (IHD) is an essential component in the assessment and management of volume status....
INTRODUCTION
Determining ultrafiltration volume in patients undergoing intermittent hemodialysis (IHD) is an essential component in the assessment and management of volume status. Venous Excess Ultrasound (VExUS) is a novel tool used to quantify the severity of venous congestion at the bedside. Given the high prevalence of pulmonary hypertension in patients with End Stage Kidney Disease (ESKD), venous Doppler could represent a useful tool to monitor decongestion in these patients.
METHODS
This is a prospective observational study conducted in ESKD patients who were admitted to the hospital requiring IHD and Ultrafiltration. Inferior vena cava maximum diameter (IVCd), portal vein Doppler (PVD) and hepatic vein Doppler (HVD) were performed in all patients before and after a single IHD session.
RESULTS
Forty-one patients were included. The prevalence of venous congestion was 88% based on IVCd and 63% based on portal vein pulsatility fraction (PVPF). Both mean IVCd and PVPF displayed a significant improvement after ultrafiltration. The percent decrease in PVPF was significantly larger than the percent decrease in IVCd. HVD alterations did not significantly improve after ultrafiltration.
CONCLUSIONS
Our study revealed a high prevalence of venous congestion in hospitalized ESKD patients undergoing hemodialysis. After a single IHD session there was a significant improvement in both IVCd and PVPF. HVD showed no significant improvement with one IHD session. PVPF changes were more sensitive than IVCd changes during volume removal. This study suggests that, due to its rapid response to volume removal, PVD, among the various components of the venous excess ultrasound grading system, could be more effective in monitoring real-time decongestion in patients undergoing IHD.
PubMed: 38897186
DOI: 10.1159/000539901 -
Veterinary Medicine and Science Jul 2024Bersama abyssinica Fresen is a plant that is used in folk medicine for the treatment of mastitis and other infectious diseases.
BACKGROUND
Bersama abyssinica Fresen is a plant that is used in folk medicine for the treatment of mastitis and other infectious diseases.
OBIECTIVE
The antibacterial activity of methanol crude extract of plant was evaluated against three common bacterial pathogens, including Gram positive (Staphylococcus aureus) and Gram negative (Escherichia coli and Pseudomonas aeruginosa).
METHODS
The antibacterial activities and minimum inhibitory concentration of B. abyssinica crude extracts were evaluated using agar-well diffusion and broth dilution methods according to the National Committee for Clinical Laboratory Standards (NCCLS).
RESULTS
A significant difference in the antibacterial activity of crude extracts was observed among different levels of concentration against tested isolates. A higher mean inhibition zone diameter was recorded in E. coli (29.2 ± 1.5 mm), followed by S. aureus (27.8 ± 1.1 mm) and P. aeruginosa (18.0 ± 0.7 mm) at a concentration of 100 mg/mL. The antibacterial activity of crude plant extract at 100 mg/mL was comparable with that of a standard antibiotic (27.6 ± 2.6) against S. aureus and E. coli isolates. The findings indicated that bacterial growth inhibition increased as the concentration of the crude extracts increased. E. coli and S. aureus isolates showed significantly higher susceptibilities to crude extracts than P. aeruginosa at all concentrations. The minimum inhibitory concentrations of extracts against S. aureus, E. coli and P. aeruginosa isolates were 0.78 mg/mL, 1.56 mg/mL and 1.56 mg/mL, respectively.
CONCLUSIONS
All tested pathogenic bacterial species were susceptible to plant leaf extract and broad-spectrum activity against Gram-positive and Gram-negative bacteria. The study recommends further fractionation of the B. abyssinica plant that contributes to its antibacterial activity and understands the mode of action of this plant against bacteria and other microbes.
Topics: Plant Extracts; Anti-Bacterial Agents; Microbial Sensitivity Tests; Gram-Negative Bacteria; Gram-Positive Bacteria; Escherichia coli; Staphylococcus aureus; Pseudomonas aeruginosa
PubMed: 38896065
DOI: 10.1002/vms3.1498 -
Ecology and Evolution Jun 2024Colonial nesting waterbirds in agricultural landscapes have historically received limited research attention, especially in South Asia. For example, the Asian openbill...
Colonial nesting waterbirds in agricultural landscapes have historically received limited research attention, especially in South Asia. For example, the Asian openbill () is a colonial species that extensively utilizes agricultural landscapes, yet there is a notable lack of substantial studies despite increasing urbanization across these landscapes. We investigated the factors affecting the breeding ecology of Asian openbills in eastern Nepal. We used a grid-based approach to locate stork colonies and monitored them throughout the breeding season from May to November for three consecutive years (2020-2022). Altogether, we observed a total of 67 active colonies, comprising 4020 active nests, which successfully fledged a total of 7566 chicks. Additionally, most of the colonies were located within areas of human settlements (40%), followed by community forests (33%) and agricultural land (27%). The Asian openbills primarily preferred large trees, such as (72%), for nesting. The mean height of nesting trees was approximately 4 m taller, the diameter at breast height was twice as large, and the canopy cover area was three times greater than that of non-nesting trees. The canopy cover area of trees positively influenced the colony size, while colony size positively influenced the fledgling's success. Our study underscores the significance of large trees in providing sufficient space for accommodating a substantial number of openbill nests and fledglings. These findings have significant implications for conservation efforts to protect large trees along with wetlands and agricultural lands, as crucial measures to ensure the sustainable breeding of this nationally vulnerable species.
PubMed: 38895574
DOI: 10.1002/ece3.11504 -
Journal of Inflammation Research 2024To evaluate the predictive capacity of the nutritional-inflammatory index and clinicopathological characteristics in patients with locally advanced rectal cancer (LARC)...
PURPOSE
To evaluate the predictive capacity of the nutritional-inflammatory index and clinicopathological characteristics in patients with locally advanced rectal cancer (LARC) receiving total neoadjuvant therapy (TNT).
METHODS
Data from 127 patients with LARC receiving TNT from January 2017 to January 2021 were retrospectively analyzed. Clinicopathological characteristics with different TNT-induced responses were compared. The Chi-square test and the Mann-Whitney test were used to analyze the association between pre-TNT factors and TNT-induced responses. Multivariable logistic regression analysis was used to construct a predictive model.
RESULTS
In the cohort of 127 patients with LARC who underwent total neoadjuvant therapy (TNT), the mean age was 54.1 ± 11.4 years; 88 (69.3%) were male. Seventy patients (55.1%) exhibited a favorable response to TNT, while 57 patients (44.9%) demonstrated a poor response. Tumor characteristics, including diameter, distance from the anal verge, pre-TNT lymphocyte, pre-TNT hemoglobin, CA199, PLR, and HALP, exhibit correlations with TNT-induced tumor regression. Multivariate logistic regression analysis identified large tumor diameters (> 5.0 cm; = 0.005, HR 2.958; 95% CI 1.382-6.335) and low HALP (≤ 40; = 0.002, HR 0.261; 95% CI 0.111-0.612) as predictors of TNT-induced poor responses. Additionally, low levels of HALP were associated with an increased risk of recurrence in patients with LARC with TNT, but this was not statistically significant ( = 0.087, HR 2.008, 95% CI 0.906-4.447).
CONCLUSION
A large tumor diameter and low HALP predict poor tumor regression induced by the CAPOX-based TNT regimen in patients with LARC.
PubMed: 38895140
DOI: 10.2147/JIR.S462985 -
Journal of Pain Research 2024Pain leads to activation of the autonomic nervous system and thus, among other things, to pupillary reflex dilation (PRD). Previous studies have already confirmed a...
BACKGROUND
Pain leads to activation of the autonomic nervous system and thus, among other things, to pupillary reflex dilation (PRD). Previous studies have already confirmed a correlation between the perception of pain and the pupillary reaction, measured using pupillometry. However, the previous study populations were under the influence of medication for analgesia in perioperative setting or suffered from pain. This study examines the relationship between pupillary reaction and pain perception in healthy controls and addresses the question of whether endogenous pain inhibition, clinically tested by conditioned pain modulation (CPM), can be quantified using pupillometry.
METHODS
Forty-two healthy volunteers (21 females, 21 males, mean age 27.9 ± 5.8 years, range 20-39 years) were included in this study. The PRD, as a measure of the pupillary reaction (variance from the base diameter in percent), was investigated during baseline, heat application and during CPM testing and results compared to the reported pain intensity on the numerical rating scale (NRS).
RESULTS
The volunteers showed higher variances under painful conditions compared to the measurement at rest corresponding to higher sympathetic activity during pain. Volunteers with a higher variance, ie a stronger pupillary reaction, gave higher pain ratings than subjects with a lower pupil variance. However, there was no correlation between the NRS and PRD. PRD and pain ratings during CPM were significantly lower compared to heat pain application alone. However, there was no correlation between the calculated CPM effect and the PRD.
CONCLUSION
Pupillometry is capable of objectively reflecting the pain response, eg pain relief through CPM testing. However, the CPM effect calculated from the subjective pain ratings and the objective PRD measurements is not associated suggesting that both measure different aspects of pain perception. It must be discussed whether the CPM effect can be the correct measure for the functionality of the pain system.
PubMed: 38894860
DOI: 10.2147/JPR.S461906 -
Journal of Clinical Medicine Jun 2024Most recent clinical practice guidelines addressing the management of infantile hemangiomas (IHs) recommend oral propranolol, a non-selective beta-adrenergic...
Most recent clinical practice guidelines addressing the management of infantile hemangiomas (IHs) recommend oral propranolol, a non-selective beta-adrenergic antagonist, as first-line treatment. However, few reports have provided continuous follow-up data regarding cardiac evaluations. Sixty-four patients diagnosed with IHs and treated with oral propranolol before 2 years of age at the Department of Pediatrics, Kangbuk Samsung Hospital (Seoul, Republic of Korea), with regular examinations between 2017 and 2021, were included. Cardiac evaluations, including electrocardiography, Holter monitoring, chest X-ray, and echocardiography, were performed. Sixty-four patients with IHs successfully underwent continuous follow-up cardiac evaluations. The median age at diagnosis was 2 weeks (1 day to 34.3 weeks). The median age at treatment initiation was 13.6 weeks (2.4-87.9 weeks), the mean longitudinal diameter of hemangioma at diagnosis was 2.8 ± 2.1 cm (0.3-12.0 cm), and the mean percentage of size decrease after 1 year of oral propranolol treatment was 71.8%. None of the 64 patients experienced severe adverse side effects during propranolol treatment. There was no statistically significant differences in echocardiographic function and electrocardiographic data after treatment. Propranolol treatment ≥6 months was effective and safe without significant cardiac toxicity in the treatment of patients with infantile hemangiomas.
PubMed: 38893043
DOI: 10.3390/jcm13113332 -
Journal of Clinical Medicine May 2024A growing body of evidence highlights the effects of air pollution on chronic and acute cardiovascular diseases, such as associations between PM and several...
A growing body of evidence highlights the effects of air pollution on chronic and acute cardiovascular diseases, such as associations between PM and several cardiovascular events. However, evidence of the impact of fine air pollutants on the development and progression of peripheral arterial aneurysms is not available. Data were obtained from the multicenter PAA outcome registry POPART and the German Environment Agency. Means of the mean daily concentration of PM, PM, NO and O concentrations were calculated for 2, 10, and 3650 days prior to surgery for each patient. Additionally, weighted ten-year averages were analyzed. Correlation was assessed by calculating Pearson correlation coefficients, and regression analyses were conducted as multiple linear or multiple logistic regression, depending on the dependent variable. For 1193 patients from the POPART registry, paired air pollution data were available. Most patients were male (95.6%) and received open surgical repair (89.9%). On a regional level, the arithmetic means of the daily means of PM between 2000 and 2022 were neither associated with average diameters nor runoff vessels. Negative correlations for mean PAA diameter and mean NO, as well as a positive correlation with mean O, were found; however, they were not statistically significant. On patient level, no evidence for an association of mean PM exposure over ten years prior to inclusion in the registry and PAA diameter or the number of runoff vessels was found. Weighted PM NO and O exposure over ten years also did not result in significant associations with aneurysm diameter or runoff vessels. Short-term air pollutant concentrations were not associated with symptomatic PAAs or with perioperative complications. We found no indication that long-term air pollutant concentrations are associated with PAA size or severity, neither on a regional nor individual level. Additionally, short-term air pollution showed no association with clinical presentation or treatment outcomes.
PubMed: 38892961
DOI: 10.3390/jcm13113250