Clinical Outcome of Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease.

BACKGROUND: End-stage renal disease patients with autosomal dominant polycystic kidney disease may require native nephrectomy for various indications. However, the appropriate timing for nephrectomy in kidney transplantation and its effect on allograft survival have not been fully investigated. METHODS: We retrospectively analyzed 41 kidney transplant recipients with autosomal dominant polycystic kidney disease in whom transplantation was done simultaneously, after, or without native nephrectomy at Seoul St. Mary's hospital between January 1987 and February 2014. We divided patients into 2 groups based on when native nephrectomy was performed: simultaneously (group A, n = 13) and after or without nephrectomy (group B, n = 28), and compared perioperative outcomes, posttransplantation complications, and allograft survival rates. RESULTS: The mean operative time was significantly longer in group A than in group B (6.48 ± 1.84 vs 5.27 ± 0.84 hours; P = .048). The mean numbers of units required for intraoperative blood transfusions were also significantly higher in group A than in group B (3.66 ± 3.43 vs 0.75 ± 0.26 units; P = .018). However, there were no differences between groups in the incidence of acute rejection and other complications such as postoperative bleeding and infectious complications (P > .05, for all). The allograft survival rate also did not differ between groups (P > .05). CONCLUSIONS: Our study showed that patients undergoing simultaneous nephrectomy and kidney transplantations had clinical outcomes, in terms of complications and allograft survival, that were comparable to those in patients undergoing kidney transplantations with or without previous nephrectomy.

Effects of multipurpose, universal adhesives on resin bonding to zirconia ceramic.

This study evaluated the effects of single-bottle, multipurpose, universal adhesives on the bond strength of resin cement to zirconia ceramic. Polished zirconia ceramic (Cercon base) discs were randomly divided into four groups (n=40) according to the applied surface-conditioning agent: Single Bond 2, Single Bond Universal, All-Bond Universal, and Alloy Primer. Cured composite cylinders (Ø 0.8 mm × 1 mm) were cemented to the conditioned zirconia specimens with resin cement (RelyX ARC). The bonded specimens were subjected to a microshear bond-strength test after 24 hours of water storage and after 10,000 cycles of thermocycling. The surface-conditioning agent significantly influenced the bond strength (p<0.05). Single Bond Universal showed the highest initial bond strength (37.7 ± 5.1 MPa), followed by All-Bond Universal (31.3 ± 5.6 MPa), Alloy Primer (26.9 ± 5.1 MPa), and Single Bond 2 (8.5 ± 4.6 MPa). Artificial aging significantly reduced the bond strengths of all the test groups (p<0.05). After 10,000 cycles of thermocycling, All-Bond Universal showed the highest bond-strength value (26.9 ± 6.4 MPa). Regardless of artificial aging, Single Bond Universal and All-Bond Universal showed significantly higher bond strengths than Alloy Primer, a conventional metal primer.

A case of xanthoma disseminatum: evaluation and monitoring by 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

Xanthoma disseminatum (XD) is a rare benign histiocytic disorder with extensive mucocutaneous xanthomas that often involves other sites such as the central nervous system (CNS), respiratory tract and abdominal organs. Evaluation of the extent of disease is important because lesions in critical locations may increase morbidity and mortality. However, there are no well-established tools for the evaluation and monitoring of XD. Here, we report a case of XD in a 21-year-old male patient showing skin, mucous membrane, CNS and internal organ involvement. In this case, (18) F-fluorodeoxyglucose positron emission tomography/computed tomography was useful in detecting the extent of the disease and in estimating the therapeutic response.

PEGylation improves the hypoglycaemic efficacy of intranasally administered glucagon-like peptide-1 in type 2 diabetic db/db mice.

AIMS: PEGylation - covalent modification of therapeutic peptides with polyethylene glycol (PEG) - is viewed as an effective way of prolonging the short lifetime of glucagon-like peptide-1 (GLP-1). In this study, we investigated the hypoglycaemic efficacies of PEGylated GLP-1s administered intranasally in type 2 diabetic db/db mice. METHODS: Three types of site-specific (Lys(34)) PEGylated GLP-1 analogues (PEG molecular weight: 1, 2 or 5 kDa) were synthesized. Their metabolic stabilities were evaluated in nasal mucosa enzyme pools. Oral glucose tolerance test was conducted 30, 60 and 120 min after intranasally administering these analogues in type 2 diabetic db/db mice. RESULTS: PEGylated GLP-1 analogues were found to have significantly longer half-lives than native GLP-1 in nasal mucosa enzymes (2.4-fold to 11.0-fold, p < 0.005). Non-PEGylated GLP-1 at 100 nmol/kg was not found to have marked efficacy irrespective of nasal administration time [total hypoglycaemic degree (HD(total)) values 2.8-17.3%]. On the contrary, PEGylated GLP-1s (100 nmol/kg) showed obvious efficacies with maximum HD(total) values of >51.8 +/- 5.8% (p < 0.005 vs. GLP-1). CONCLUSION: This study highlights the pharmacological potential of intranasally administered PEGylated GLP-1s in terms of stabilizing postprandial hyperglycaemia in type 2 diabetic patients.

Prognostic value of electroneurography in Bell's palsy and Ramsay-Hunt's syndrome.

OBJECTIVES: This study evaluated the accuracy of electroneurography to predict the prognosis of Bell's palsy and Ramsay-Hunt's syndrome. DESIGN: A retrospective, institutional review board-approved study. SETTING: A secondary referral and a university-based centre. PARTICIPANTS: The patients had been treated for a sudden onset unilateral facial paralysis over the past 10 years (1994-2004). This retrospective study included only those patients who had been followed up for at least 3 months or if they had reached a complete recovery before then. MAIN OUTCOMES MEASURES: House-Backmann grade versus electroneurography value. RESULTS: The recovery rates to House-Brackmann grade II or better were 95% in those with Bell's palsy and 84% in those with herpes zoster oticus. The electroneurography value of the recovery and non-recovery groups from those with either Bell's palsy or herpes zoster oticus was similar. The logistic regression model between the electroneurography values and the probability of recovery showed no correlation in those with Bell's palsy or with herpes zoster oticus. This study did not identify the proper electroneurography value that had enough appropriate sensitivity and specificity to predict the prognosis of paralysis accurately in Bell's palsy or in herpes zoster oticus patients. CONCLUSION: Electroneurography performed between day 7 and 10 for Bell's palsy or day 10 and 14 for herpes zoster oticus does not provide accurate information on the prognosis or recovery rate of the facial paralysis.

Bioactive polymers for biohybrid artificial pancreas.

To address the solution for some of the obstacles, such as low insulin secretion, limited lifespan and aggregation of transplanted islets, encountered in developing a biohybrid artificial pancreas (BAP), polymeric materials including a reversible polymeric extracellular matrix (ECM), crystallized glucagon-like peptide-1, and oxygen carrying polymers, were prepared and their potential utilities in designing a compact and rechargeable BAP were investigated. For a synthetic, reversible ECM, high molecular weight N-isopropylacrylamide copolymer with a small amount of acrylic acid (2 mole%) was synthesized by conventional radical polymerization in benzene, and its aqueous solution above a critical polymer concentration displayed a sol-gel transition temperature near physiological temperature (33-35 degrees C) without noticeable hysteresis. The physicochemical properties of the gel with islet compatibility proved that the synthetic ECM is an appropriate matrix which can make a BAP rechargeable. Glucagon-like peptide-1 (GLP-1, 7-37) is known to have a strong stimulatory effect on insulin secretion, particularly at high glucose concentrations. When zinc-crystallized GLP-1 was entrapped along with islets in a hollow fiber macrocapsule device, insulin secretion was enhanced at a high glucose concentration (300 mg/dl) with a >85% increase in insulin secretion after an induction period. The cross-linked hemoglobin with difunctional PEO (Hb-C) was prepared to increase the high molecular weight of Hb. This prevents diffusional loss when enclosed in an immunoprotecting membrane. The Hb-C, entrapped in microcapsules, enhanced insulin secretion and improved the viability of microencapsulated islets by promoting oxygen supply to islets. The introduction of the synthetic ECM, crystallized GLP-1, and Hb-C into a BAP may provide a basis for designing a compact and rechargeable BAP (macrocapsule).

Synthesis of sulfonylurea conjugated copolymer via PEO spacer and its in vitro short-term bioactivity in insulin secretion from islets of Langerhans.

In order to reduce the number of immunoprotected islets required in xeno- or allogenic transplants for reversing diabetes, analogues of glyburide (a sulfonylurea), an extremely hydrophobic insulin secretagogue, were synthesized and used in an attempt to produce water soluble sulfonylurea (SU) grafted polymers. After synthesizing various polymers containing glyburide analogues, a poly(N-vinyl-2-pyrrolidone-co-sulfonylurea succinyl PEO (Mw = 3000) acrylate) was found to be soluble in a cell culture medium at pH 7.4. However, solubility was only obtained by decreasing solution pH from 11 to 7.4. When the copolymer was added to the islet cell culture media at a concentration of 5 microg ml(-1) (based on the theoretical SU content of the copolymer), insulin secretion was enhanced by about 30% at low glucose concentrations of 50 and 100 mg dl(-1) compared to the control. This is equivalent to 40-60% bioactivity of glyburide. The polymer's effect on insulin secretion at a higher glucose concentration of 200 mg dl(-1) was not significant. Considering the previous results where a similar but insoluble polymer without a PEO spacer was used and the polymer showed SU bioactivity only at a glucose concentration of 50 mg dl(-1), the observations from this study indicates that the solubility of SU-grafted polymers may affect the binding of SU groups to SU receptors on the pancreatic beta-cells, resulting in improved pharmacodynamic effect of SU.

Vestibulo-ocular reflex in eccentric rotation in squirrel monkeys.

In addition to angular acceleration, eccentric rotation (ECR) imparts linear acceleration to the head positioned eccentric to the axis of rotation. Using ECR in squirrel monkeys, the effects of otolith organ stimulation by linear acceleration on vestibulo-ocular reflex (VOR) gain were investigated. With the animal's head facing away from the rotation axis, ECR significantly enhanced VOR gain over that seen in centric rotation (CR) at 1.0 Hz, but not at 0.5 Hz. However, no enhancement of VOR gain at 1.0 Hz was observed in eccentriclateral rotation when the animal faced tangentially. After bilateral ablation of the otolith organs (sacculectomy and utricular neurectomy), the ECR did not increase VOR gain, even at 1.0 Hz. In animals in which the lateral and posterior semicircular canals were plugged bilaterally, horizontal sinusoidal eye movements were induced by ECR at 1.0 Hz; no clear compensatory eye movement occurred during CR at 1.0 Hz. These findings demonstrate that during ECR, tangential acceleration along the interaural axis stimulates the utricular maculae, inducing horizontal eye movements in addition to those induced by the semicircular canal, thus resulting in an enhancement of VOR gain. Our results also suggest synergistic interactions of the otolith organs and semicircular canals. We conclude that ECR is a useful clinical test of the function of the otolith organs.

Effects of otolith stimulation in eccentric rotation on the vestibulo-ocular reflex in squirrel monkeys.

When a subject is rotated around an axis located behind his head (eccentric rotation, ECR), he experiences a combination of angular acceleration and two kinds of linear accelerations, tangential and centrifugal. The effects of stimulation of the otolith organs by linear acceleration in ECR on gain of the vestibulo-ocular reflex (VOR) were examined in squirrel monkeys. The VOR gain in ECR with the animal's head facing away from the rotation axis was significantly higher than that in centric rotation (CR) at 1.0 Hz, but not at 0.5 Hz. However, the VOR gain did not increase in eccentric-lateral rotation when the animal faced tangentially, even at 1.0 Hz. After bilateral ablation of the otolith organs (sacculectomy and utricular neurectomy), the VOR gain in ECR did not increase, even at 1.0 Hz. These findings demonstrate that tangential acceleration along the interaural axis in ECR stimulates the utricular maculae, resulting in enhancement of the VOR gain. The results also suggest that ECR is a useful clinical test for the function of the otolith organs.

Recovery of the otolith-ocular reflex after unilateral deafferentation of the otolith organs in squirrel monkeys.

The enhancement of the vestibulo-ocular reflex (VOR) gain in the eccentric rotation is mediated by the otolith organs. Functional recovery of the otolith-ocular reflex after deafferentation of the otolith organs was examined in squirrel monkeys, using the enhancement of the eccentric VOR gain as an indicator of the reflex. After unilateral deafferentation of the otolith organs, the enhancement of the eccentric VOR gain decreased and then recovered completely within eight weeks. However, the eccentric VOR gain was not enhanced after contralateral side lesions. These findings demonstrate that functional recovery of the otolith-ocular reflex is achieved after unilateral deafferentation of the otolith organs, and that afferents from the remaining otolith organs are necessary for the functional compensation.

Sodium concentration in saliva along the time course of experimental Coriolis sickness.

Procedures designed to evaluate the severity of motion sickness have included subjective reporting of changes in salivation. In order to increase objectivity, we studied the sodium concentration of saliva, which is directly related to the flow rate. Healthy adults with normal vestibular function underwent a modified Coriolis Sickness Susceptibility Index (CSSI) test, utilizing a staircase profile. Saliva was collected without interrupting the stimulus by means of cotton placed beneath the subject's tongue for one minute. Samples were obtained 5 min prior to stimulation, 30 and 45 min following stimulus onset, and/or upon reaching the "nausea II" endpoint. Saliva for analysis by atomic absorption spectrophotometry was obtained by centrifugation of the cotton. A significant difference in sodium concentration was found between the baseline and 30-min sample (p less than 0.01). Although the amount of salivation was rather variable, the pattern of changes in sodium concentration was similar in all experimental cases.