Adherent perinephric fat at minimally invasive partial nephrectomy is associated with adverse peri-operative outcomes and malignant renal histology.

OBJECTIVES: To predict adherent perinephric fat (APF) at minimally invasive partial nephrectomy (MIPN) using the Mayo adhesive probability (MAP) score and to determine the impact of MAP score and APF on MIPN outcomes. PATIENTS AND METHODS: A total of 245 patients undergoing MIPN were included in the study. The presence of APF was determined through keywords in operating notes, and radiographic data were obtained from preoperative cross-sectional imaging. Posterior fat thickness was measured between the renal capsule and the posterior abdominal wall at the level of the renal vein. Perinephric stranding was graded on a 0-3 severity scale. RESULTS: The study included 123 men and 122 women, with a median age of 55 years, body mass index of 31.7, tumour size of 2.7 cm and nephrometry score of 6. The median posterior fat thickness was 1.79 cm and MAP score 2.63. In all, 26 patients (10.6%) had evidence of APF at the time of renal surgery. Factors predictive of APF included increasing age (P = 0.001), male gender (P = 0.045), perinephric stranding (P = 0.002), posterior fat thickness (P < 0.001) and MAP score (P < 0.001). APF was associated with adverse pathological and peri-operative outcomes including malignant renal histology (P = 0.04), longer operating time (P = 0.005) and greater estimated blood loss (EBL; P = 0.025). CONCLUSIONS: Specific clinical and radiographic factors predict APF at MIPN. The presence of APF is associated with adverse peri-operative outcomes including longer operating time and greater EBL. APF was also associated with renal malignancy on final pathology, but further studies are necessary to elucidate the precise underlying mechanism.

Relationship between plethysmographic waveform changes and hemodynamic variables in anesthetized, mechanically ventilated patients undergoing continuous cardiac output monitoring.

OBJECTIVE: To assess the relation between photoplethysmographically-derived parameters and invasively-determined hemodynamic variables. DESIGN: After induction of anesthesia and placement of a Swan-Ganz CCOmbo catheter, a Nonin OEM III probe was placed on each patient's earlobe. Photoplethysmographic signals were recorded in conjunction with cardiac output. Photoplethysmographic metrics (amplitude of absorbance waveform, maximal slope of absorbance waveform, area under the curve, and width) were calculated offline and compared with invasively determined hemodynamic variables. Subject-specific associations between each dependent and independent variable pair were summarized on a per-subject basis by the nonparametric Spearman rank correlation coefficient. The bias-corrected accelerated bootstrap resampling procedure of Efron and Tibshirani was used to obtain a 95% confidence interval for the median subject-specific correlation coefficient, and Wilcoxon sign-rank tests were conducted to test the null hypothesis that the median of the subject-specific correlation coefficients were equal to 0. SETTING: University hospital. PARTICIPANTS: Eighteen patients undergoing coronary artery bypass graft surgery. INTERVENTIONS: Placement of a Swan-Ganz CCOmbo catheter and a Nonin OEM III pulse oximetry probe. MEASUREMENTS AND MAIN RESULTS: There was a positive, statistically significant correlation between stroke volume and width (median correlation coefficient, 0.29; confidence interval, 0.01-0.46; p = 0.034). The concordance between changes in stroke volume and changes in width was 53%. No other correlations achieved statistical significance. CONCLUSIONS: This study was unable to reproduce the results of prior studies. Only stroke volume and photoplethysmographic width were correlated in this study; however, the correlation and concordance (based on analysis of a 4-quadrant plot) were too weak to be clinically useful. Future studies in patients undergoing low-to-moderate risk surgery may result in improved correlations and clinical utility.

Structural and functional analyses of Kaposi sarcoma-associated herpesvirus ORF57 nuclear localization signals in living cells.

Kaposi sarcoma-associated herpesvirus (KSHV) ORF57 is a multifunctional, nuclear protein involved in post-transcriptional regulation of a subset of viral genes during lytic replication. Three nuclear localization signals (NLSs), NLS1 (amino acids (aa 101-107), NLS2 (aa 121-130), and NLS3 (aa 143-152), were identified in the N terminus of the ORF57 protein, and each of the three represents a short stretch of basic amino acid residues. Disruption of all three NLSs prevented localization of ORF57 in the nucleus. Insertion of individual NLSs into a heterologous cytoplasmic protein converted it into a nuclear protein, confirming that each NLS functions independently and is sufficient to promote protein nuclear localization. Although it exhibits a function similar to that of Epstein-Barr virus EB2 in promoting KSHV ORF59 expression, KSHV ORF57 differs from the herpes simplex virus ICP27 protein, and its function could be disrupted by point mutations of single or two NLSs in random combination, despite the proper localization of the mutant protein in the nucleus. The dysfunctional ORF57 containing NLS mutations also had low affinity with ORF59 RNA and the RNA export factor REF. However, the REF binding of ORF57 in vivo appeared to have no effect on ORF57-mediated enhancement of ORF59 expression. Thus, the three NLSs identified in ORF57 provide at least two functions, nuclear localization of ORF57 and up-regulation of ORF59 expression.