Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling.

Purpose: The purpose of this study was to assess the surgical outcomes of patients with primary aldosteronism when surgery was based only on CT finding of unilateral adenoma without adrenal vein sampling (AVS). Methods: This is a retrospective review of the records of patients who had undergone retroperitoneal laparoscopic adrenalectomy for primary aldosteronism based on CT scan finding of unilateral adenoma and had a follow-up of at least 6-12 months from January 2012 to December 2020 in a single center; decision for adrenalectomy was based on CT scan, and AVS was not used. The clinical and biochemical outcomes were accessed using the standardized primary aldosteronism surgical outcome (PASO) criteria. Patient's demographics and preoperative factors were analyzed to assess for independent predictor of surgical success. Results: According to the PASO criteria, 172 patients finally enrolled in the training dataset, and 20 patients enrolled in the validation dataset. In the training dataset, complete clinical success was achieved in 71 patients (41.3%), partial success in 87 (50.6%), and absent success in 14 (8.1%). Biochemical outcomes showed that 151 patients (87.8%) were completely cured, 14 patients (8.1%) got a partial biochemical success, and an absent biochemical success was found in seven patients (4.1%). Multivariate logistic regression analysis showed that age, body mass index (BMI), tumor size, mean arterial pressure (MAP), and serum potassium were the most independent factors for incomplete biochemical success. Based on the results of statistical analysis, our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. Conclusions: Laparoscopic adrenalectomy for patients with primary aldosteronism base on CT scan finding of a unilateral adenoma without AVS had a high rate of complete biochemical cure at 12 months. Risk factors for incomplete biochemical success include age, BMI, tumor size, MAP, and serum potassium. Our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. The nomogram accurately and reliably predicted the incomplete biochemical success.

Granulation tissue-type hemangioma of ureter: a highly misdiagnosed disease (a rare case report and literature review).

BACKGROUND: Ureteral granulation tissue hemangiomas are rare benign vascular lesions, and they may be clinically asymptomatic or present with massive or recurrent hematuria. Sometimes hemangiomas are difficult to distinguish from malignant ureteral tumors, and most ureteral hemangiomas are confirmed by postoperative pathological examination. This article aims to present a case of granulation tissue-type hemangioma of the ureter and briefly review the current literature on this condition. CASE PRESENTATION: A 30-year-old male patient presented with complaints of painless macroscopic hematuria for 2 months. Computerized tomography of the urinary system showed that the upper 1/3 of the right ureter was occupied, and then the possibility of tumor lesions was considered. The urine cytology showed occasional nuclear abnormalities and many light-stained crystals in urine. Because of suspicious radiological and cytological findings, the patient underwent the right ureteroscopy and the laparoscopic right ureteral mass resection. The postoperative pathological report showed that it was a mesenchymal tumor. The morphological and immunohistochemical staining was consistent with that of hemangioma, tending to granulation tissue hemangioma. After surgery, the patient was in a good state and recovered well at the last follow-up. CONCLUSIONS: Ureteral granulation tissue hemangiomas are an easily misdiagnosed disease. Intermittent painless hematuria is an important characteristic of this disease. Therefore, we suggest that unnecessary radical surgery can be avoided when clinicians consider the possibility of benign ureteral tumors during the evaluation.

PSMA conjugated combinatorial liposomal formulation encapsulating genistein and plumbagin to induce apoptosis in prostate cancer cells.

Although the biomedical sciences have achieved tremendous success in developing novel approaches to managing prostate cancer, this disease remains one of the major health concerns among men worldwide. Liposomal formulations of single drugs have shown promising results in cancer treatment; however, the use of multi drugs has shown a better therapeutic index than individual drugs. The identification of cancer-specific receptors has added value to design targeted drug delivering nanocarriers. We have developed genistein and plumbagin co-encapsulating liposomes (∼120 nm) with PSMA specific antibodies to target prostate cancer cells selectively in this work. These liposomes showed >90 % decrease in PSMA expressing prostate cancer cell proliferation without any appreciable toxicity to healthy cells and human red blood cells. Release of plumbagin and genistein was found to decrease the expression of PI3/AKT3 signaling proteins and Glut-1 receptors (inhibited glucose uptake and metabolism), respectively. The decrease in migration potential of cells and induced apoptosis established the observed anti-proliferative effect in prostate cancer cell lines. The discussed strategy of developing novel, non-toxic, and PSMA specific antibody conjugated liposomes carrying genistein and plumbagin drugs may also be used for encapsulating other drugs and inhibit the growth of different types of cancers.

A novel GPCR target in correlation with androgen deprivation therapy for prostate cancer drug discovery.

Most prostate carcinomas require androgen stimulation to grow, and for nearly 70 years, androgen ablation therapy has been one of the central therapeutic strategies against advanced prostate cancer. Although most tumours initially respond to this therapy, some will be acquired resistant and progress to metastatic castration-resistant (mCRPC) disease which clinically tends to progress more rapidly than earlier disease manifestations. The underlying molecular biology of mCRPC is highly complex, and numerous mechanisms have been proposed that promote and retain androgen independence. In various clinical and preclinical data explored, the nature of intracellular signalling pathways mediating mitogenic acquired resistant effects of GPCRs in prostate cancer is poorly defined. G-protein-coupled receptor kinase 2 (GRK2) contributes to the modulation of basic cellular functions-such as cell proliferation, survival or motility-and is involved in metabolic homeostasis, inflammation or angiogenic processes. Moreover, altered GRK2 levels are starting to be reported in different tumoural contexts and shown to promote breast tumourigenesis or to trigger the tumoural angiogenic switch. Thus, we are exploring recent findings that present unexpected opportunities to interfere with major tumourigenic signals by manipulating GPCR-mediated pathways.

Variant angina induced by carbon monoxide poisoning: A CARE compliant case report.

RATIONALE: Carbon monoxide (CO) poisoning can cause severe damage to the nervous system, and can also cause serious damage to organs, such as the heart, kidneys, and lungs. CO damage to myocardial cells has been previously reported. This can lead to serious complications, such as myocardial infarction. PATIENT CONCERNS: A 47-year-old female patient complained of sudden chest pain for 30 minutes. Before admission, the patient had non-radiating burning chest pain after inhalation of soot. DIAGNOSIS: An electrocardiogram showed that myocardial ischemia was progressively aggravated, manifested by progressive ST-segment elevation, and accompanied by T wave inversion and other changes. No obvious coronary stenosis was observed in a coronary angiographic examination. Therefore, the patient was considered to have developed variant angina resulting from CO poisoning-induced coronary artery spasm. INTERVENTIONS: The patient was treated with drugs for improving blood circulation and preventing thrombosis, and underwent hyperbaric oxygen therapy. OUTCOMES: Clinical symptoms relieved after the treatment. LESSONS: Findings from this case suggest that CO can cause coronary artery spasm and it is one of the predisposing factors of variant angina. For these patients, hyperbaric oxygen therapy can improve blood circulation and prevent formation of thrombus and encephalopathy.

[Effects of dexmedetomidine on sedation and ß-endorphin in traumatic brain injury: a comparative study with propofol].

OBJECTIVE: To compare the efficacy of dextraldexmede (DEX) and propofol on sedation and ß-endorphin (ß-EP) in patients with moderate and severe traumatic brain injury (TBI). METHODS: Ninety patients with moderate and severe TBI with Glasgow coma score (GCS) 6-13 were randomly divided into three groups according to the order of admission of odd and even numbers. In group A (DEX/+morphine), DEX load 0.5-1.0 µg/kg was injected within 30 minutes, and maintaining at 0.2-0.6 µg×kg⁻¹ × h⁻¹ for 24 hours; and in group B (propofol/+ morphine), propofol load 0.5-2.0 mg/kg was injected within 10 minutes, and maintaining at 1-3 mg×kg⁻¹×h⁻¹ for 72 hours. Patients with poor efficacy were added with morphine intravenously. In group C, intramuscular injection of pethidine and other temporary medication was injected. The comprehensive assessment was conducted according to the Riker sedation and agitation score, combined with the physiological body reaction positive indicator elimination. The vital signs was monitored, and blood white blood cell (WBC) count, blood sugar, cortisol and ß-EP before and after administration were determined. RESULTS: (1) The sedation efficiency rate of the group A, B, C were 84.38% (27/32), 80.64% (25/31), 77.78% (21/27), respectively. The booster dose of morphine in group A was less than that in group B (24 h dosage: 16.23 ± 3.45 mg vs. 21.34 ± 5.55 mg). (2) Blood pressure and heart rate were significantly affected in the group A. The mean arterial pressure (MAP) in 0.5 hour of reaching loading dose in group A was significantly lower than that in group B and C (75.50 ± 9.35 mm Hg vs. 87.90 ± 8.05 mm Hg, 85.70 ± 7.10 mm Hg, both P<0.05). (3) WBC and cortisol levels showed downwards trends after treatment in group A and group B; WBC fell more in the group A compared with group B, cortisol level fell more in group B compared with group A, and the WBC and cortisol level began to decline after 24 hours in group C. (4) There were no significant differences in blood sugar and ß-EP levels before and after treatment in group B, but ß-EP had an increasing tendency in group A and group C, and the amplification in group C was more obvious than that in group A. CONCLUSIONS: The sedation efficacy of DEX was superior to propofol in moderate and severe TBI, and was able to control excessive stress response after TBI better, and with more effect on blood pressure. Plasma ß-EP was elevated during the early phase of brain injury by DEX, which was considered as its positive role in the regulation of early stress.

[Dynamic changes of platelet number in early multiple injury and it is effect on prognosis].

OBJECTIVE: To study the dynamic changes of platelet number in early multiple injured patients and its clinical significance. METHODS: Ninety patients with multiple injury less than 48 hours were selected. Blood analysis was dynamicly investigated at 1, 24, 72, 120 and 168 hours after in Hospital, and acute physiology and chronic health evaluation III (APACHE III) and injury seriousness scale (ISS) scores were recorded. RESULTS: The platelet number declined after injury, reached the lowest point at 72 hours after in hospital, then restored to the normal level at 120 hours. In the platelet decrease group, the trauma was more critically[ISS (29.60+/-9.80) scores vs. (22.30+/-12.00) scores, (P<0.05)] and the incidence of multiple organs dysfunction syndrome (MODS) was higher than normal group (83.9% vs. 62.7%, P<0.05). In the death group, the number of platelet was declined[ (30.1+/-10.3) hours vs. (51.3+/-14.8) hours, (P<0.05) and the lasting tine was longer[ (63.7+/-11.0) hours vs. (54.2+/-13.4) hours, (P<0.05). CONCLUSION: The platelet number declines after multiple injury. The decrease and continuously lower level of platelet suggest poor prognosis.