Impact of preoperative calculation of nephron volume loss on future of partial nephrectomy techniques; planning a strategic roadmap for improving functional preservation and securing oncological safety.

OBJECTIVES: To assess the correlation of the resected and ischaemic volume (RAIV), which is a preoperatively calculated volume of nephron loss, with the amount of postoperative renal function (PRF) decline after minimally invasive partial nephrectomy (PN) in a multi-institutional dataset. PATIENTS AND METHODS: We identified 348 patients from March 2005 to December 2013 at six institutions. Data on all cases of laparoscopic (n = 85) and robot-assisted PN (n = 263) performed were retrospectively gathered. Univariable and multivariable linear regression analyses were used to identify the associations between various time points of PRF and the RAIV, as a continuous variable. RESULTS: The mean (sd) RAIV was 24.2 (29.2) cm3 . The mean preoperative estimated glomerular filtration rate (eGFR) and the eGFRs at postoperative day 1, 6 and 36 months after PN were 91.0 and 76.8, 80.2 and 87.7 mL/min/1.73 m2 , respectively. In multivariable linear regression analysis, the amount of decline in PRF at follow-up was significantly correlated with the RAIV (ß 0.261, 0.165, 0.260 at postoperative day 1, 6 and 36 months after PN, respectively). This study has the limitation of its retrospective nature. CONCLUSION: Preoperatively calculated RAIV significantly correlates with the amount of decline in PRF during long-term follow-up. The RAIV could lead our research to the level of prediction of the amount of PRF decline after PN and thus would be appropriate for assessing the technical advantages of emerging techniques.

An anatomical measurement of medial femoral torsion.

Medial femoral torsion (MFT) can be corrected with derotational osteotomy. Derotational osteotomies can be performed in the proximal or the distal part of the femur. Similar results have been reported for these two procedures. The aim of this study was to evaluate the pathologic location of the MFT by measuring the degree of infratrochanteric and supratrochanteric torsion (STT) of the femur using computed tomography (CT) scans. The current study was carried out in patients with the chief complaint of an in-toeing gait because of the MFT. Sixty-seven patients were enrolled in the study. Forty-one patients (72 lower extremities) were included in the intervention group; 20 patients were included in the cerebral palsy (CP) group (35 lower extremities) and 21 patients were included in the developmental MFT group [developmental femoral torsional (DF) group, 37 lower extremities]. The control group included 26 patients (33 lower extremities) with uninjured limbs with a femoral or a tibial fracture. In this study, torsional angles [MFT, STT and infratrochanteric torsion (ITT)] were measured on CT scan using picture archiving and communication system measurement tools. To measure the STT and ITT, the most prominent points of the lesser and the greater trochanter were marked on CT scans; these two points were connected and were defined as the intertrochanteric line (ITL). The angle between the ITL and the axis of the femoral neck was defined as the STT. The angle between the ITL and the axis of the condylar axis was defined as the ITT. Two authors measured the MFT, STT, and ITT angles of each femur independently. The twisting of the femur had occurred in a different location for each case. In all groups, however, STT was reduced with increasing age; this change was statistically significantly. ITT of the each group showed a random distribution. The means of the ITT in the control group and the DF group did not change significantly, and that of the CP group tended to decrease with age. MFT of the control group and the DF group reduced significantly with age (P<0.05). The value of MFT in the CP group was steady, without a significant change with age. The pathology of MFT could occur differently in the supratrochanteric, infratrochanteric region, or for both sites in each patient. To avoid another lever arm disease after surgery, the correction of MFT should be performed in the correct position. In the CP group, derotational osteotomy could be performed safely at a younger age compared with the DF group. In addition, the distal femur is the preferable osteotomy site for older CP patients.

Creating a human brain proteome atlas--13th HUPO BPP Workshop March 30-31, 2010, Ochang, Korea.

The HUPO Brain Proteome Project (HUPO BPP) held its 13th workshop in Ochang from March 30th to 31st, 2010 prior to the Korean HUPO 10th Annual International Proteomics Conference. The principal aim of this project is to obtain a better understanding of neurodiseases and aging with the ultimate objective of discovering prognostic and diagnostic biomarkers, in addition to the development of novel diagnostic techniques and new medications. The attendees came together to discuss progress in the clinical neuroproteomics of human and to define the needs and guidelines required for more advanced proteomics approaches.

Creating a human brain proteome atlas--14th HUPO BPP workshop September 20-21, 2010, Sydney, Australia.

The HUPO Brain Proteome Project (HUPO BPP) held its 14th workshop during the HUPO 9th Annual World Congress in Sydney, Australia. The principal aim of this project is to discover prognostic and diagnostic biomarkers associated with neurodegenerative diseases and brain aging, with the ultimate objective of obtaining a better understanding of these conditions and creating roads for the development of novel diagnostic techniques and effective treatments. The attendees came together to discuss progress in the human clinical neuroproteomics and to define the needs and guidelines required for more advanced proteomics approaches.

Epilepsy with dual pathology: surgical treatment of cortical dysplasia accompanied by hippocampal sclerosis.

PURPOSE: The presence of two or more epileptogenic pathologies in patients with epilepsy is often observed, and the coexistence of focal cortical dysplasia (FCD) with hippocampal sclerosis (HS) is one of the most frequent clinical presentations. Although surgical resection has been an important treatment for patients with refractory epilepsy associated with FCD, there are few studies on the surgical treatment of FCD accompanied by HS, and treatment by resection of both neocortical dysplastic tissue and hippocampus is still controversial. METHODS: We retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with the pathologic diagnosis of FCD and the radiologic evidence of HS. We evaluated the prognostic roles of clinical factors, various diagnostic modalities, surgical procedures, and the severity of pathology. RESULTS: A total of 40 patients were included, and only 35.0% of patients became seizure free. Complete resection of the epileptogenic area (p = 0.02), and the presence of dysmorphic neurons or balloon cells on histopathology (p = 0.01) were associated with favorable surgical outcomes. Patients who underwent hippocampal resection were more likely to have a favorable surgical outcome (p = 0.02). CONCLUSIONS: We show that patients with complete resection of epileptogenic area, the presence of dysmorphic neurons or balloon cells on histopathology, or resection of hippocampus have a higher chance of a favorable surgical outcome. We believe that this observation is useful in planning of surgical procedures and predicting the prognoses of individual patients with FCD patients accompanied by HS.

Experiences with acute kidney injury complicating non-fulminant hepatitis A.

AIM: To describe the clinical features and to identify factors related to development of acute kidney injury in acute hepatitis A patients. METHODS: The study and control groups consisted of 21 and 425 patients who did or did not develop acute kidney injury, respectively, after acute hepatitis A from January 1997 to May 2007. RESULTS: There were 13 men and eight women; their mean age at diagnosis was 28.8 +/- 8.2 years in the study group. Peak values for renal and liver function impairment consisted of a median serum creatinine of 4.6 mg/dL (range, 1.5-15.3 mg/dL) on day 6 (range, days 1-20) and a median total bilirubin of 10.7 mg/dL (range, 2.6-57.5 mg/dL) on day 8 (range, day 1-19). Serum creatinine concentrations returned to baseline level by a median of 16 days and total bilirubin levels returned to normal by a median of 62 days. Six of 21 (29%) patient underwent haemodialysis. Renal biopsies performed in two patients showed acute tubular necrosis and interstitial nephritis, respectively. Logistic regression analysis showed that a lower haematocrit, the presence of coagulopathy and high C-reactive protein concentration on admission, and higher peak bilirubin value during the illness were associated with development of acute kidney injury. CONCLUSION: Acute hepatitis A should be considered in the differential diagnosis of patients with acute kidney injury, even without fulminant hepatic failure. A lower haematocrit, the presence of coagulopathy and high C-reactive protein level at presentation, and higher peak bilirubin level during the illness were associated with development of acute kidney injury in acute hepatitis A patients.