Development of Focal Segmental Glomerulosclerosis and Thrombotic Microangiopathy in a Liver Transplant Patient on Sorafenib for Hepatocellular Carcinoma: A Case Report.

Transplant patients are at risk for hemodynamic injury and glomerular diseases such as focal segmental glomerulosclerosis (FSGS) and thrombotic microangiopathy (TMA). Calcineurin inhibitors (CNI) can cause various patterns of acute kidney injury (AKI) in transplant patients and their effects must be differentiated from kidney injury due to other agents. Transplant populations are also at risk for atypical infections and malignancies. These conditions and the agents that are used to treat them can then induce their own set of glomerular diseases. We report a patient with hepatitis C who had received an orthotopic liver transplant and then developed recurrent hepatocellular carcinoma, which was treated with the oral tyrosine kinase inhibitor (TKI) sorafenib. In a manner temporally related to the initiation of the TKI, progressive AKI and high-grade rising proteinuria were noted. A biopsy disclosed FSGS and concomitant TMA. Despite the discontinuation of the TKI and high-dose steroid treatment, the patient developed end-stage renal disease and was initiated on hemodialysis. After determining the TKI as the probable culprit, as opposed to CNIs, the patient successfully received a living related renal transplant. CNIs are used to maintain renal and hepatic allografts without the development of hematuria, significant proteinuria, or significant impairment of renal function. It is noted that the pathologic phenotype observed in this case is only the second reported case of concomitant TMA and FSGS in a sorafenib-treated patient.

Effect of Acupuncture on Body Weight Reduction and Inflammatory Mediators in Egyptian Obese Patients.

AIM: Aim of this study was to examine the effectiveness of body acupuncture on body weight loss, routine laboratory tests and pro-inflammatory markers. METHODOLOGY: The study was performed on eighty obese patients. They were divided into three groups according to their body mass index. Subjects received acupuncture for three- six months in combination with a low-calorie diet. They were assessed pre and post acupuncture, by anthropometric measurement, routine laboratory tests and, tumor necrosis factor- alpha (TNF-α), interleukin- 6 (IL-6), and high sensitivity C-reactive protein (hsCRP) levels in serum. RESULTS: The pre-acupuncture results showed significant difference between the three grades of obesity and the controls regarding TNFα, IL-6 and hsCRP. We found significant reduction in anthropometric measurement of adiposity after acupuncture. In comparing the pre &post acupuncture results of TNF-α, IL-6 and hsCRP showed high significant reduction after acupuncture. There are highly significant decrease in kidney function (creatinine and uric acid) and lipid profile (cholesterol and triglycerides) and fasting blood glucose, but there was no significant difference in urea, SGPT, SGOT, HDL and LDL. CONCLUSION: Body acupuncture in combination with diet restriction was found to be effective for weight loss and also reduction of the inflammatory reactions. Acupuncture could be used as a synergistic treatment option for obesity control.

Measurement of joint effusion and haematoma formation by ultrasound in assessing the effectiveness of drains after total knee replacement: A prospective randomised study.

We prospectively randomised 78 patients into two groups, 'drains' or 'no drains' to assess the effectiveness of suction drains in reducing haematoma and effusion in the joint and its effect on wound healing after total knee replacement. Ultrasound was used to measure the formation of haematoma and effusion on the fourth post-operative day. This was a semi-quantitative assessment of volume estimation. There was no difference in the mean effusion between the groups (5.91 mm in the drain group versus 6.08 mm in the no-drain, p = 0.82). The mean amount of haematoma in the no-drain group was greater (11.07 mm versus 8.41 mm, p = 0.03). However, this was not clinically significant judged by the lack of difference in the mean reduction in the post-operative haemoglobin between the groups (drain group 3.4 g/dl; no-drain group 3.0 g/dl, p = 0.38). There were no cases of wound infection or problems with wound healing at six weeks in any patient. Our findings indicate that drains do not reduce joint effusion but do reduce haematoma formation. They have no effect on wound healing.

Plant crude extracts could be the solution: extracts showing in vivo antitumorigenic activity.

Screening active compounds from plants lead to discover new medicinal drugs which have efficient protection and treatment roles against various diseases including cancer. In our study, extracts from different plants represent seeds of: Gossypium barbadense, Ricinus communis, Sesamum indicum, Nigella sativa, Vinca rosea and Melia azedarah; fruits of: Xanthium occidental; flowers of: Atriplex nummularia; barks of: Cinnamomum zeylanicum; latex of: Ficus carica and rhizomes of: Curcuma longa and Zingiber officinale were tested in vivo using three subsequent bioassays: the BST (Brine Shrimp Toxicity bioassay), AWD (Agar well diffusion antimicrobial bioassay) and AtPDT (Agrobacterium tumefaciens Potato Disc Tumor bioassay). AWD technique omitted any extracts have antimicrobial activities while BST omitted any extract did not has physiological activity and determined the various LC(50) of each plant extract. For the first time, using a range of concentrations in the AtPDT modified protocol allowed the detection of tumor promotion caused by extract represented by A. nummularia. Using cluster analysis leads to classifying the different plant extracts activities to six groups regarding to their toxicity, antitumor activities and both of them. The extracts from edible plants represent 50% of the first and the second group which have the highest antitumor activities represented in F. caraica (group 1) and C. longa (group 2) as well as the non-edible plant extracts of Gossypium barbadense and Ricinus communis. A comparison study between the edible and herbaceous plants different extracts for their antitumor activities was performed. We recommended using the modified protocols used in this study for investigating more plants and using crude plant extracts which have antitumor activities in cancer treatment. Edible plants, which show in vivo antitumor activities, are recommended as save sources for antitumor compounds.

Results of instrumented posterolateral fusion in failed back surgery.

The success rate following revision surgery for failed back surgery is inherently low. However, a general consensus for a satisfactory surgical intervention after failed disc surgery has not yet been reached. We present a cohort study of 25 adult cases treated by instrumented posterolateral fusion with or without nerve root exploration/decompression for recurrence or persistence of symptoms after previous disc surgery. The average age at surgery was 47 years (range 39-56 years). Complications were seen in four patients in the form of intraoperative dural tears. A satisfactory clinical outcome was seen in 80% of the patients, and the overall fusion rate was 93%.

Transient osteoporosis of the knee following trauma.

Transient osteoporosis is an uncommon, self-limiting, reversible condition. We report a case involving the knee following trauma. The aetiology is unknown, but the association between transient osteoporosis and trauma has not been documented previously. The clinical presentation represents a degree of overlap among various clinical syndromes, including reflex sympathetic dystrophy and avascular necrosis. The diagnosis was confirmed by bone scan and MRI. The patient, a 47-year-old man, was treated with non-steroidal anti-inflammatory medication, protected weight-bearing and physiotherapy. He made a full clinical recovery and bone quality returned to virtual normality.

Combined anterior interbody fusion and posterior pedicle screw fixation in patients with degenerative lumbar disc disease.

We reviewed 47 consecutive patients with degenerative lumbar disc disease. All patients were treated by anterior interbody fusion using an autogenous iliac bone graft in combination with posterior pedicle fixation but without a posterior fusion. There were 32 men and 15 women with a mean age of 44 (range 23-56) years. One third (n=15) of the patients had previous surgery. We saw complications in six patients including two with vascular injury. The mean follow-up was 2.2 years. Seventy-two per cent of the cases had a satisfactory clinical outcome, and the overall fusion rate was 97%.

Lumbosacral fusion using the Boucher technique in combination with a posterolateral bone graft.

This study evaluates the clinical and radiological results of using the facet screw fixation technique described by Boucher in combination with a posterolateral fusion rather than a posterior fusion for symptomatic degenerative disease of the lumbosacral junction. It is a retrospective review of 38 consecutive patients with an average follow-up of 28 months. Radiologically, all patients had a solid fusion. Clinically, 23 patients (60%) had excellent results, 11 patients (29%) good results, 3 patients (8%) fair results and 1 patient (3%) had a poor result. There were no neurological complications. The findings support the view that the Boucher technique of facet joint fixation in combination with a posterolateral fusion is a safe and effective method of dealing with chronic symptoms relating to degenerative changes at the lumbosacral junction. The authors stress the importance of patient selection and attention to operative technique if the clinical results are to correlate with the results of fusion.

Isothermal and non-isothermal characterization of catalytic nylon membranes chemically grafted: dependence on the grafting percentage.

The behaviour of five different hydrophobic beta-galactosidase derivatives, obtained by grafting different amount of butylmethacrylate (BMA) on planar nylon membranes, has been studied under isothermal and non-isothermal conditions.Under isothermal conditions the effect of the grafting percentage on the enzyme activity has been studied as a function of pH, temperature and substrate concentration. Independently from the parameters under observation, the yield of the catalytic process reaches the maximum value at a grafting percentage value equal to 21%. The apparent K(m) values result linearly increasing with the increase of the grafting percentage, while the apparent V(max) exhibits a maximum value.Under non-isothermal conditions, a decrease of the apparent K(m) values and increase of the apparent V(max) has been found in respect to the same values obtained under isothermal conditions.The percentage activity increases induced by the presence of a temperature gradient have been found to decrease with the increase of the percentage of graft BMA.A parameter correlating the percentage increase of enzyme activity under non-isothermal conditions with the hydrophobicity of the catalytic membrane has also been identified. This parameter is the ratio between thermoosmotic and hydraulic permeability.Results have been discussed in terms of reduction of diffusion limitations for substrate and products movement towards or away from the catalytic site by the process of thermodialysis.The usefulness of using non-isothermal bioreactors in industrial biotechnological processes has been confirmed.

Immediate effect of balloon valvuloplasty on hemostatic changes in mitral stenosis.

This study was conducted to assess right and left atrial hemostatic function in patients with mitral stenosis (MS) and to investigate the immediate effect of balloon mitral valvuloplasty (BMV) on hemostatic function. BMV was performed in 28 patients with MS (age 29 +/- 8 years) who had sinus rhythm and no left atrial (LA) thrombus. Right and left atrial biochemical markers of platelet activity (platelet factor 4 [PF4] and B thromboglobulin [BTG]), coagulation (thrombin-antithrombin III complex [TAT]), and fibrinolytic activity (D-dimer) were measured before and 30 minutes after BMV. Right atrial levels of these markers were also measured in 20 control subjects. Compared with control subjects, patients with MS had higher right atrial levels of PF4 (30 +/- 15 vs 5 +/- 2 IU/ml), BTG (231 +/- 53 vs 30 +/- 8 IU/ml), TAT (7 +/- 4 vs 2 +/- 0.3 microg/L), and D-dimer (380 +/- 145 vs 160 +/- 35 ng/ml, p < 0.0001 in all). TAT levels were higher in the left atrium than in the right atrium of patients before BMV (8 +/- 4 vs 7 +/- 4 microg/L, p < 0.0001). BMV was successful (final mitral valve area > or = 1.5 cm2 and > or = 50% increase of the initial valve area) in all patients. There was a significant reduction of LA levels of PF4 (35 +/- 8 to 26 +/- 9 IU/ml, p < 0.0001), BTG (225 +/- 41 to 196 +/- 28 IU/ml, p < 0.001), and TAT (10 +/- 5 to 7 +/- 1 microg/L, p < 0.05) in the 16 patients with LA pressure < 10 mm Hg after BMV, whereas these markers were not reduced in the 12 patients with left atrial pressure > or = 10 mm Hg after BMV. These data indicate that platelet function, coagulation status, and fibrinolytic activity are increased regionally in the left atrium and in the systemic circulation in patients with MS and sinus rhythm in the absence of LA thrombus. Successful BMV induces a significant reduction of prethrombotic status in patients with low LA pressure after the procedure. Patients with high LA pressure after BMV maintain a high prethrombotic state and may be considered at an increased risk of thromboembolism after the procedure.

Evaluation of coronary flow reserve in hypertensive patients by dipyridamole transesophageal doppler echocardiography.

This study evaluates the coronary flow reserve (CFR) in hypertensive patients with and without left ventricular (LV) hypertrophy. CFR was assessed by transesophageal Doppler echocardiography in 15 normal subjects (group I), 21 hypertensive patients without LV hypertrophy (group II), and 27 hypertensive patients with LV hypertrophy (group III). All hypertensive patients were complaining of typical anginal pain and had normal coronary angiograms. The sample volume was placed at the bifurcation of the left main and left anterior descending coronary arteries. Coronary blood flow velocities were evaluated at rest, 2 minutes after dipyridamole infusion, and 2 minutes after intravenous aminophylline. The ratios of dipyridamole to rest peak diastolic and systolic velocities were considered as indexes of CFR. Peak diastolic velocity ratio was significantly lower in group III than in groups I and II (1.6 +/- 0.2, 2.7 +/- 0.4, and 2.1 +/- 0.2, respectively; p <0.05), and it was significantly lower in group II than I (p <0.05). The peak systolic velocity ratio was significantly lower in group III than in groups I and II (1.7 +/- 0.3, 2.8 +/- 0.3, and 2.1 +/- 0.2, respectively; p <0.05), and it was significantly lower in group II than I (p <0.05). The peak diastolic velocity ratio was inversely related to systolic blood pressure, diastolic blood pressure, and LV mass index (r = -0.48, -0. 51, and -0.37 respectively) in hypertensive patients. It is concluded that CFR is significantly impaired in hypertensive patients, especially those with LV hypertrophy, compared with healthy subjects. The degree of impairment of CFR is related to LV mass index.

Five-year follow-up after percutaneous balloon mitral valvuloplasty in children and adolescents.

Balloon mitral valvuloplasty (BMV) is an effective intervention in patients with symptomatic mitral stenosis. However, the late results of BMV in children and adolescents have not been well studied. The aim of this study was to assess the late functional and morphologic results after BMV in children and adolescents. BMV was performed in 46 children and adolescents (mean age 15.5 +/- 3.2 years, range 7 to 19; 19 males) with rheumatic mitral stenosis. Serial clinical and echocardiographic evaluation was conducted to assess the long-term results of the procedure during a follow-up period of 66 +/- 6 months. The mitral valve score was 6 +/- 2/16. BMV was successful in 45 patients (98%). There was a significant increase of the mean mitral valve area index (MVAI) (0.65 +/- 0.14 vs 1.54 +/- 0.23 cm2/m2, p <0.001) and a significant reduction of the mean transmitral pressure gradient (16.1 +/- 2.9 vs 5.1 +/- 3.1 mm Hg, p <0.001) from pre- to post-BMV, respectively. There was no significant change of MVAI or the pressure gradient during the follow-up compared with immediately after BMV (1.51 +/- 0.31 cm2/m2 and 4.9 +/- 2.5 mm Hg, respectively). No deaths or mitral valve replacement occurred during the follow-up period. Restenosis (loss of >50% of the achieved increase in MVAI) occurred in 3 patients (6.5%). All other patients showed persistent improvement in their New York Heart Association class (< or = II). Thus, the event-free survival with good functional results was encountered in 42 patients (91%) at the end of the follow-up period. The left atrial diameter decreased from 4.6 +/- 0.9 before BMV to 3.7 +/- 0.6 cm at follow-up (p <0.05). It is concluded that BMV has excellent intermediate-term results in children and adolescents with a relatively low mitral valve score.

Marine algae that display anti-tumorigenic activity against Agrobacterium tumefaciens.

Thirty-five extracts representing different seasonal growths of 17 marine algal species collected from the Alexandria coast were tested for anti-tumorigenic activity against Agrobacterium tumefaciens galls on potato discs. Eleven extracts (nine species) displayed > 20% inhibition of tumor initiation, with three of these (Codium tomentosum, winter; Jania rubens, summer; Padina pavonia, winter) displaying relatively high activity. Bacterial viability tests showed that the inhibitory effects were directly due to anti-tumorigenesis rather than an indirect result of anti-bacterial activity.

Behavioristic study of 14C-lindane in the aquatic ecosystem model.

The present study was carried out by treating 100 gm soil with 1 UCi of 14C-Lindane. The untreated and treated soil were layered on the bottom of separate all glass aquarium tanks. These tanks were prepared as aquatic ecosystem model. The experiments were proceeded at pH 7.0, 8.2 and 5.5 and at 35 degrees C and 15 degrees C in complete darkness and light for 60 days. The obtained data revealed that, the higher temperature the higher loss of 14C from treated soil. Also the acidity of the media reduced the efficiency of 14C-recovery from the soil at 25 degrees C and 15 degrees C. In addition the obtained data illustrated that, the distribution and bioaccumulation ratio (BR) of radioactive material by fish was many times higher than that of algae and snail. Furthermore, BR of fish and snail proved to be pH depended. While BR of algae was generally higher in the light than in the dark. Finally it can be observed that, the total recovery of 14C-Lindane in the light was higher than in the dark at all conditions of the experiment. From the obtained data it can be concluded that, the amount of radioactive material recovered from soil or trapped as 14CO2 was to some extent pH dependent.

Electron probe X-ray microanalysis of bacterial DNA.

X-ray microanalysis provides a potentially useful technique for the detection, quantitation and statistical analysis of cation levels in microsamples of freshly-isolated bacterial DNA. The dilution of the sample deposited on the electron microscope grid is important both for the visualisation of discrete macromolecules and also for the microanalytical detection of a full range of divalent cations. Approximately 50 detectable cations (30 monovalent, 20 divalent) were present per 100 phosphorus atoms, which is equivalent to one detectable cation per 2 nucleotides. Significant correlations in the occurrence of K, Ca, Ni and Zn with continuum and also with phosphorus suggests that these cations are distributed homogeneously in the sample, while Mn, Fe and Cu showed no such correlations. The occurrence of K in the different spectral analyses did not show any significant correlation with any divalent cations, whereas significant correlations did occur between divalent cations. This suggest that fundamental differences occur between monovalent and divalent cations in their association with the DNA molecule.

Effects of two organophosphorus insecticides on some biochemical constituents in the nervous system and liver of rabbits.

Male Baladi rabbits were acutely and sub-chronically intoxicated with cyanofenphos and profenophos. The levels of cholesterol, triglycerides, B-lipoproteins and total proteins were determined in the serum, brain, spinal cord and sciatic nerve of rabbits. Moreover, the activities of alkaline phosphatase, acid phosphatase and glutamic-pyruvic transaminase were determined in the liver of the animals. The whole studies revealed that the biochemical constituents were highly affected by the tested insecticides. Also, the liver function suffered from adverse effects of the tested insecticides.

The use of metalloproteins as standards for X-ray microanalysis of biological material.

Thin films of metalloprotein, deposited directly onto carbon-formvar-coated electron microscope grids, provide a potentially useful, but little developed, type of standard for biological transmission X-ray microanalysis. The possibility of using various metalloproteins was investigated in terms of their suitability as standards, and compared with an evaporated film of gelatin-salt mixture. The metalloproteins that were selected comprised conalbumin (containing detectable S, Fe), hemocyanin (S, K, Ca, Fe and Cu), insulin (S, Zn), phosvitin (P, Ca, Fe, and Zn) and alpha-lactalbumin (S, Ca). In each case, the metalloprotein preparation was homogeneous at the microlevel (unlike evaporated gelatin-salt mixtures), and was stable in the electron beam up to a current of 120 nA, over a lifetime of 200 s.