A case of nephrocalcinosis associated with primary aldosteronism

Herein, we report a 37-year-old man presenting with nephrocalcinosis associated with primary aldosteronism. Primary hyperaldosteronism is reported to facilitate urinary calcium excretion; however, renal calculi or calcinosis in this disorder has been rarely reported. The patient had renal dysfunction and calcification in the renal medulla on both kidneys. A kidney biopsy was performed. His renal dysfunction seemed to be mainly caused by hypertension and tubulointerstitial damage. Furthermore, von Kossa-positive stones were seen in some tubules. X-ray element analysis revealed that the stones were composed of calcium phosphate.

[Case of HIV-associated nephropathy accompanied by nephrotic syndrome and acute worsening of kidney function]

A previously healthy black man presented with acute kidney injury wtih nephrotic syndrome. His serum creatinine and albumin concentrations were 8.0 mg/dL and 0.4 g/dL, respectively. Renal ultrasound demonstrated an enlarged kidney with an extremely high echogenic cortex. Human immunodeficiency virus (HIV) was serologically positive, and kidney biopsy revealed a collapsing variant of focal segmental glomerulosclerosis with interstitial nephritis. He was diagnosed as having HIV-associated nephropathy (HIVAN). Although there have been only a few cases with characteristic HIVAN features in Japan, the number of patients with HIVAN who need dialysis treatment is relatively high globally, and is expected to increase even in Japan. The rapid clinical course of HIVAN, along with its characteristic histology and the direct pathogenesis of HIV on podocytes, is noteworthy. We described this case with reference to some recent findings.

Co-culturing of follicles with interstitial cells in collagen gel reproduce follicular development accompanied with theca cell layer formation

BACKGROUND

The mechanism of theca cell layer formation in mammalian ovaries has not been elucidated; one reason is that there is no follicle culture system that can reproduce theca cell layer formation in vitro. Therefore, a three-dimensional follicle culture system that can reproduce theca cell layer formation is required.

METHODS

A collagen gel was used in the follicle culture system. To determine the optimum conditions for follicle culture that can reproduce theca cell layer formation, the effects of hormonal treatment and cell types co-cultured with follicles were examined. In addition, immunohistochemistry was used to examine the properties of the cell layers formed in the outermost part of follicles.

RESULTS

Follicles maintained a three-dimensional shape and grew in collagen gel. By adding follicle-stimulating hormone (FSH) and co-culturing with interstitial cells, the follicles grew well, and cell layers were formed in the outermost part of follicles. Immunohistochemistry confirmed that the cells forming the outermost layers of the follicles were theca cells.

CONCLUSION

In this study, follicle culture system that can reproduce theca cell layer formation in vitro was established. In our opinion, this system is suitable for the analysis of theca cell layer formation and contributes to our understanding of the mechanisms of folliculogenesis.

Impaired fracture healing in macrophage migration inhibitory factor-deficient mice

This study investigated the role of macrophage migration inhibitory factor (MIF) in fracture repair using MIF gene-deficient mice (MIF KO). Fracture healing was delayed in MIF KO, and this was mainly due to the delay in the mineralization of osteoid within the fracture callus.

INTRODUCTION

We previously reported that the expression of macrophage migration inhibitory factor (MIF) was up-regulated during the fracture healing process in rats. However, its role in the pathophysiology of this process remained unclear. The aim of the present study was to clarify the role of MIF in the fracture healing process using MIF gene-deficient mice (MIF KO).

METHODS

Bone repair in wild-type mice (WT) and MIF KO (n = 70, respectively) was investigated using a tibia fracture model. Radiographic, biomechanical, histological, bone histomorphometric, and molecular analyses were performed.

RESULTS

Post-fracture biomechanical testing showed that maximum load and stiffness were significantly lower in MIF KO than in WT on day 42. However, similar levels were observed between the two groups on day 84. Bone histomorphometric analysis revealed significantly higher osteoid volume, a lower mineral apposition rate, and smaller numbers of osteoclasts in the MIF KO callus compared to the WT callus. The messenger ribonucleic acid expressions of matrix metalloproteinase (MMP)-2, membranous type 1-MMP, cathepsin K, and tissue nonspecific alkaline phosphatase were found to be significantly suppressed in the MIF KO callus.

CONCLUSION

The results of the present study suggest that delayed fracture healing in MIF KO was mainly attributable to a delay in osteoid mineralization.

Feasibility of fibrin glue versus endoclips to close the transgastric peritoneal access site in NOTES in a survival porcine study

INTRODUCTION

Safe peritoneal access and gastric closure are the most important concerns in clinical applications of NOTES. Our past study demonstrated usefulness of the submucosal tunnel technique for safe peritoneal access and closure with endoclips. However, such closure is sometimes difficult and time-consuming. This study investigated the feasibility of fibrin glue for submucosal tunnel closure in a NOTES porcine model.

METHODS

In 10 female pigs each weighing 40 kg, transgastric peritoneoscopy was performed through a 60 mm-long submucosal tunnel created using the endoscopic submucosal dissection technique. After transgastric peritoneoscopy for 30 min, the submucosal tunnel was closed with endoclips in five pigs and fibrin glue in five pigs. After a 7 d follow-up period, the pigs were euthanized for post-mortem examination. Outcome measures included (a) technical feasibility of closure with endoclips versus fibrin glue, (b) clinical monitoring for 7 d, (c) follow-up necropsy at 7 d, and (d) histopathologic examination of the peritoneal access site.

RESULTS

Transgastric peritoneoscopy with submucosal tunnel technique was successful in all pigs. Mean time required to close the mucosal incision site with fibrin glue was 1.6 ± 0.5 versus 19 ± 18.7 min with endoclips. All pigs survived well without complications. Necropsy revealed no peritonitis. There were no differences in transgastric peritoneal access sites between endoclips and fibrin glue. Histopathologic examination of the submucosal tunnel demonstrated wound healing with transmural fibrosis. No adverse effects from fibrin glue were noted.

CONCLUSION

Compared with endoclips, the application of fibrin glue is easy and simple in the closure of transgastric peritoneal access in NOTES.

Transfection of human HGF plasmid DNA improves limb salvage in Buerger's disease patients with critical limb ischemia

AIM

Hepatocyte growth factor is a potent angiogenic agent. This study investigated the efficacy and safety of intramuscular injection of naked plasmid DNA encoding the human hepatocyte growth factor gene in Japanese patients with Buerger's disease and critical limb ischemia.

METHODS

An open-label clinical study was performed at eight hospitals in Japan from May 2004 to April 2008. Ten patients were enrolled. They had Buerger's disease with ischemic ulcers, were not candidates for revascularization, and were unresponsive to conventional drug therapy. Treatment consisted of 8 injections (total dose: 4 mg) of hepatocyte growth factor plasmid, which were administered into the calf muscles and/or distal thigh muscles of the ischemic limbs under ultrasound guidance. Administration was done twice at an interval of 4 weeks. If there was no improvement after 2 doses, a 3rd dose could be administered. The response to treatment was evaluated from the reduction of ischemic ulcer size.

RESULTS

The size of ischemic ulcers showed a decrease in 6/9 (66.7%) patients and the ulcers healed completely in 5/9 (55.6%) patients after gene therapy. Major amputation was not required. There were no deaths and no major safety concerns.

CONCLUSION

Hepatocyte growth factor gene therapy is safe and effective for critical limb ischemia in patients with Buerger's disease.

Methoxy-substituted isoTQEN family for enhanced fluorescence response toward zinc ion

Previously, we have reported that 1- and 3-isoTQENs (N,N,N',N'-tetrakis(1- or 3-isoquinolylmethyl)ethylenediamines) exhibit a specific fluorescence enhancement toward zinc ion. In this study, three methoxy-substituted derivatives of 1-isoTQEN were synthesized and their fluorescent response toward zinc ion was studied. The substitution pattern of the methoxy group significantly changes the solubility of compounds in aqueous DMF, λ(max) in the absorption spectra, excitation/emission wavelengths and fluorescence intensity of zinc complexes. In the presence of zinc ion, 7-MeO-1-isoTQEN exhibits higher fluorescence intensity and longer excitation/emission wavelengths (λ(ex) = 342 nm, λ(em) = 526 nm) than 6-MeO-1-isoTQEN (λ(ex) = 303 nm, λ(em) = 469 nm) and 5,6,7-triMeO-1-isoTQEN (λ(ex) = 340 nm, λ(em) = 504 nm). The fluorescence intensity of a zinc complex of 7-MeO-1-isoTQEN (ϕ = 0.122) is four times higher than the parent 1-isoTQEN (ϕ = 0.034) under the same conditions. The crystal structure of 7-MeO-1-isoTQEN-Zn complex reveals that all six nitrogen atoms participate to the metal coordination with ideal octahedral geometry, affording significantly high metal binding affinity comparable with TPEN (N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine). 7-MeO-1-isoTQEN detects zinc ion concentration change in cells by fluorescence microscopic analysis.

A survey on diarrhea and convenience of intake associated with a single-dose extended release formulation of azithromycin

The development of a single-dose extended release formulation of azithromycin (AZ-SR) improves the adherence. However, gastrointestinal side effects such as diarrhea are frequent adverse drug reactions. The aim of the present study was to investigate the incidence of patient-reported in a diarrhea and the convenience of intake of AZ-SR in an Asian population. To assess the incidence of diarrhea and convenience of intake, patient-reported in a questionnaire about the incidence, onset, duration and severity of diarrhea, shape of stool, and patients' impression on taste. The drug was prepared and used in common with the hospital pharmacy and the community pharmacy. AZ-SR was prescribed in 96 outpatients, among whom 81 patients received the medicine and the questionnaire at the hospital pharmacy or one of five neighboring community pharmacies. The recovery of the questionnaire was 40.7%. Diarrhea occurred in 18 of 33 patients (54.5%), which was more frequent than in earlier reports, although the symptom was mild (grade 1-2) and occurred in most cases within 2 days. Approximately one third of patients reported inconvenience in taking the formulation in respect of the ease (36.4%), amount (42.4%), and unpleasant bitter taste (36.4%). We report here the importance of collaboration between hospital pharmacists and community pharmacists in providing accurate drug information, including the incidence of diarrhea, to patients receiving AZ-SR.

Remote access laparoscopic (REAL) surgery: a novel approach for single-port surgery without a visible scar

INTRODUCTION

Single-port laparoscopic surgery usually uses the transumbilical approach. However, the transumbilical incision may be associated with a high frequency of wound-related complications, including trocar site hernia and infection. Therefore, we developed remote access laparoscopic (REAL) surgery, a new access technique for single-port surgery within the pubic hairline. This study reports on a technique developed at our institution and describes our preliminary results.

MATERIALS AND SURGICAL TECHNIQUE

Ten patients with cholecystolithiasis underwent REAL surgery. A single 2.5-cm transverse incision was made medially within the pubic hairline area, and a SILS Port was inserted. A 5-mm flexible endoscope and an articulating grasper or a long laparoscopic grasper were used. Dissection of the gallbladder was achieved with laparoscopic ultrasonic shears just as in the conventional laparoscopic cholecystectomy. All procedures were successfully performed without conversion to conventional laparoscopic technique. There were no postoperative complications, and outpatient evaluation showed a clean scar within the pubic hair area in all patients.

DISCUSSION

Our early experience shows that REAL surgery is feasible and safe. This novel access technique can preserve the native umbilicus and provides an invisible scar that is concealed within the pubic hair.

The roles of THY1 and integrin beta3 in cell adhesion during theca cell layer formation and the effect of follicle-stimulating hormone on THY1 and integrin beta3 localization in mouse ovarian follicles

The mechanism of theca cell layer formation in mammalian ovaries has not been elucidated. In the present study, we examined the roles of THY1 and integrin beta3 in theca cell layer formation during mouse folliculogenesis. The localization pattern of THY1 and integrin beta3 in adult mouse ovary was investigated immunohistochemically. The strongest THY1 signal was observed in theca cell layers from secondary to preantral follicles, at which time theca cells have begun to participate in follicle formation. Integrin beta3 also localized to the theca cell layer of secondary to preantral follicles and showed a localization pattern similar to that of THY1. Moreover, the role of THY1 in theca cell layer formation was examined using a follicle culture system. When anti-THY1 antibody was added to this culture, no theca cell layers were formed, and the granulosa cells were distanced from each other. Because a THY1 signal was not observed in ovaries at stages earlier than prepuberty, THY1 localization also appeared to be affected by mouse development. This possibility was examined by determining the effect of administering follicle-stimulating hormone, luteinizing hormone, and 17beta-estradiol to 7-day-old mice on THY1 localization in the ovary 3 days later. Only follicle-stimulating hormone induced a THY1 signal in 10-day-old mouse ovaries. No THY1 signal was observed in untreated 10-day-old ovaries. In conclusion, THY1 might play a role in cell adhesion via binding to integrin beta3 in mouse ovaries. The present results suggest that THY1 localization may be affected by follicle-stimulating hormone in mouse ovaries.

Effects of chronic kidney disease and post-angiographic acute kidney injury on long-term prognosis after coronary artery angiography

BACKGROUND

Both chronic kidney disease (CKD) and post-angiographic acute kidney injury (AKI) are regarded as risks factors for long-term mortality after coronary angiography. On the other hand, acute haemodynamic disturbances requiring haemodynamic support have a strong impact on both the incidence of AKI and on prognosis after coronary angiography. The aim of this study was to determine the impact of CKD and AKI on long-term prognosis after coronary angiography among hospital survivors and to determine relationships with haemodynamic variables.

METHODS

We studied 2439 patients who underwent coronary angiography or percutaneous coronary intervention. Relationships between both CKD and AKI and mortality or cardiovascular diseases were measured using unadjusted and adjusted Cox models for case-mix and laboratory variables.

RESULTS

Multivariable Cox regression analysis identified CKD as an independent predictor of long-term mortality [adjusted hazard ratio (AHR) 1.51; 95% confidence interval (95% CI) 1.07-2.13] and composite end points (AHR 1.72; 95% CI 1.40-2.11). Lower estimated glomerular filtration ratio levels below 50 mL/min/1.73 m(2) were significantly associated with mortality after adjustments. A similar association was found even in haemodynamically stable patients. AKI was also a predictor of long-term composite end points (AHR 1.64; 95% CI 1.09-2.46); however, its impact was attenuated in haemodynamically stable patients.

CONCLUSIONS

Among hospital survivors, CKD is an independent predictor for both long-term mortality and composite end points, regardless of haemodynamic conditions. AKI is also a predictor of long-term prognosis; however, its impact may be attenuated in haemodynamically stable hospital survivors.

Impact of age and overt proteinuria on outcomes of stage 3 to 5 chronic kidney disease in a referred cohort

BACKGROUND AND OBJECTIVES

Population-based studies have reported outcomes and risk factors for patients with chronic kidney disease (CKD), defined primarily by decreased estimated GFR (eGFR). They are characterized by old age, low proteinuria level, and stage 3 CKD. However, many patients referred to nephrologists are younger and have overt proteinuria and advanced CKD. This study evaluated the association between outcomes and those factors among referred CKD patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We retrospectively reviewed 461 referred patients with stage 3 to 5 CKD from January 2003 to December 2007. Key outcomes were death and ESRD. Patients were followed from the time of first serum creatinine measurement to December 2009.

RESULTS

The median age of subjects was 67.0 years, and median follow-up was 3.2 years. Overt proteinuria was present in 57.0% of subjects. For stage 3, 4, and 5 CKD, cumulative mortality and probability of ESRD at 3 years was 9.5 and 6.5%, 11.2 and 27.8%, and 16.5 and 79.1%, respectively. Using proportional-hazards regression models, age was a determinant for death, whereas overt proteinuria was strongly associated with ESRD. Among stage 3 CKD patients older than 65 years without overt proteinuria, the incidence of death before renal replacement therapy (RRT) was 2.8/100 patient-years and none had ESRD. In patients with advanced CKD and overt proteinuria, the incidence of ESRD was substantially higher than that of death before RRT.

CONCLUSIONS

Stratification by age, proteinuria level, and CKD stage could predict the competing outcomes of death before RRT and ESRD among CKD patients.

Endothelial progenitors encapsulated in bioartificial niches are insulated from systemic cytotoxicity and are angiogenesis competent

Intrinsic stem cells (SC) participate in tissue remodeling and regeneration in various diseases and following toxic insults. Failure of tissue regeneration is in part attributed to lack of SC protection from toxic stress of noxious stimuli, thus prompting intense research efforts to develop strategies for SC protection and functional preservation for in vivo delivery. One strategy is creation of artificial SC niches in an attempt to mimic the requirements of endogenous SC niches by generating scaffolds with properties of extracellular matrix. Here, we investigated the use of hyaluronic acid (HA) hydrogels as an artificial SC niche and examined regenerative capabilities of encapsulated embryonic endothelial progenitor cells (eEPC) in three different in vivo models. Hydrogel-encapsulated eEPC demonstrated improved resistance to toxic insult (adriamycin) in vitro, thus prompting in vivo studies. Implantation of HA hydrogels containing eEPC to mice with adriamycin nephropathy or renal ischemia resulted in eEPC mobilization to injured kidneys (and to a lesser extent to the spleen) and improvement of renal function, which was equal or superior to adoptively transferred EPC by intravenous infusion. In mice with hindlimb ischemia, EPC encapsulated in HA hydrogels dramatically accelerated the recovery of collateral circulation with the efficacy superior to intravenous infusion of EPC. In conclusion, HA hydrogels protect eEPC against adriamycin cytotoxicity and implantation of eEPC encapsulated in HA hydrogels supports renal regeneration in ischemic and cytotoxic (adriamycin) nephropathy and neovascularization of ischemic hindlimb, thus establishing their functional competence and superior capabilities to deliver stem cells stored in and released from this bioartificial niche.