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Tana C, Bernardinello N, Raffaelli B, Garcia-Azorin D, Waliszewska-Prosół M, Tana M, Albano G, Cipollone F, Giamberardino MA, Spagnolo P. Neuropsychiatric manifestations of sarcoidosis. Ann Med 2025; 57:2445191. [PMID: 39723989 DOI: 10.1080/07853890.2024.2445191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 11/21/2024] [Accepted: 11/29/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND There has been significant progress in understanding neurosarcoidosis (NS) as a distinct disorder, which encompasses a heterogeneous group of clinical and radiological alterations which can affect patients with systemic sarcoidosis or manifest isolated. RATIONALE AND AIM OF THE STUDY The healthcare challenges posed by NS and sarcoidosis in general extend beyond their physical symptoms and can include a variety of psychosocial factors, therefore the recognition of main neuropsychiatric symptoms can be useful to approach patients with NS. Methods: For this purpose, databases such as Pubmed, Medline and Pubmed Central (PMC) have been searched. RESULTS A correct diagnosis of NS is established by the combination of clinical picture, imaging features and the histopathological finding of non-caseating and non-necrotizing granulomas. After analyzing the current literature, there is a need for specific, case-control, cohort and clinical trials on the psychiatric manifestations of sarcoidosis, because the evaluation of psychological distress (in terms of emotional suffering e.g. anxiety or depression) is often underestimated. DISCUSSION AND CONCLUSION Exploring the neuropsychiatric manifestations of sarcoidosis is useful to raise awareness of this condition among clinicians and to establish a holistic management, which includes both physical and psychological aspects.
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Affiliation(s)
- Claudio Tana
- Center of Excellence on Headache and Geriatrics Clinic, Study of Rare Disorders, University-Hospital of Chieti, Chieti, Italy
| | - Nicol Bernardinello
- Cardiac, Thoracic and Vascular, Sciences and Public Health, University of Padova School of Medicine and Surgery, Padua, Italy
| | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - David Garcia-Azorin
- Department of Medicine, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | - Marco Tana
- Internal Medicine Unit, University-Hospital of Chieti, Chieti, Italy
| | - Giulio Albano
- Cardiac, Thoracic and Vascular, Sciences and Public Health, University of Padova School of Medicine and Surgery, Padua, Italy
| | - Francesco Cipollone
- Department of Medicine and Science of Aging, Medical Clinic, SS. Annunziata Hospital of Chieti, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Maria Adele Giamberardino
- Center of Excellence on Headache and Geriatrics Clinic, Study of Rare Disorders, University-Hospital of Chieti, Chieti, Italy
- Department of Medicine and Science of Aging and CAST, G. D'Annunzio University of Chieti, Chieti, Italy
| | - Paolo Spagnolo
- Cardiac, Thoracic and Vascular, Sciences and Public Health, University of Padova School of Medicine and Surgery, Padua, Italy
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Pilato F, Norata D, Rossi MG, Di Lazzaro V, Calandrelli R. Consciousness disturbance in patients with chronic kidney disease: Rare but potentially treatable complication. Clinical and neuroradiological review. Behav Brain Res 2025; 480:115393. [PMID: 39667649 DOI: 10.1016/j.bbr.2024.115393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 11/26/2024] [Accepted: 12/09/2024] [Indexed: 12/14/2024]
Abstract
In patients with chronic kidney disease, particularly those in end-stage kidney failure and undergoing dialysis treatment, brain complications may arise, and their potential reversibility mainly hinges on timely diagnosis and intervention. Neurological symptoms may be non-specific ranging from slight or pronounced consciousness disturbance till coma, and imaging is the main tool to guide diagnosis and may reveal the underlying pathophysiological mechanism. Kidney impairment, causing a surge in blood pressure, increases the risk of Posterior Reversible Encephalopathy Syndrome and, leads to neurochemical alterations that result in uremic encephalopathy. In end-stage kidney failure patients, Posterior Reversible Encephalopathy Syndrome predominantly occurs in atypical locations, often involving the bilateral basal ganglia, and exhibit larger volumes compared to patients without kidney dysfunction. Uremic encephalopathy may involve the basal ganglia, white matter, and cortical or subcortical regions; in the latter case, imaging features resemble the typical location of Posterior Reversible Encephalopathy Syndrome. Dialysis Disequilibrium Syndrome, Osmotic Demyelination Syndrome, and Wernicke's encephalopathy are uncommon complications associated with dialysis. Each syndrome manifests distinct imaging patterns: Dialysis Disequilibrium Syndrome shows bilateral, patchy, diffuse white matter alterations; Osmotic Demyelination Syndrome causes central pontine and less often extrapontine lesions (involving bilateral basal ganglia, thalamus, and cerebral peduncles); Wernicke's encephalopathy determines symmetrical abnormalities in the thalamus, mammillary bodies, periaqueductal gray matter, midbrain tectal plate but the nature of brain edema associated with these complications remains controversial. Besides, in rare cases, overlapping imaging features may occur, and only the accurate patient's clinical history reconstruction along with laboratory examination results can lead to a better evaluation of MRI findings and underlying causes allowing prompt therapy.
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Affiliation(s)
- Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo Roma, 200, 00128, Italy.
| | - Davide Norata
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo Roma, 200, 00128, Italy
| | - Maria Grazia Rossi
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo Roma, 200, 00128, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo Roma, 200, 00128, Italy
| | - Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, Rome 00168, Italy
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Carter J, Shanmugalingam T, Lafond S, Sudbury B, Hedley B, Saleh M, Sener A, Grimmer J, Tole S. Successful Use of TPO-Receptor Agonist Eltrombopag to Correct Thrombocytopenia for Unrelated-Donor Renal Transplant in an Adolescent with MYH-9-Related Disease. Pediatr Blood Cancer 2025; 72:e31534. [PMID: 39757540 DOI: 10.1002/pbc.31534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 12/25/2024] [Accepted: 12/26/2024] [Indexed: 01/07/2025]
Affiliation(s)
- Jillian Carter
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Thunnisa Shanmugalingam
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Sarah Lafond
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Brendan Sudbury
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Ben Hedley
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Maha Saleh
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, London Health Sciences Centre, London, Ontario, Canada
| | - Joanne Grimmer
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
| | - Soumitra Tole
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Hematology/Oncology, London Health Sciences Centre, London, Ontario, Canada
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4
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K S PK, Jyothi MN, Prashant A. Mitochondrial DNA variants in the pathogenesis and metabolic alterations of diabetes mellitus. Mol Genet Metab Rep 2025; 42:101183. [PMID: 39835172 PMCID: PMC11743804 DOI: 10.1016/j.ymgmr.2024.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 12/15/2024] [Accepted: 12/17/2024] [Indexed: 01/22/2025] Open
Abstract
Mitochondrial DNA (mtDNA) variants considerably affect diabetes mellitus by disturbing mitochondrial function, energy metabolism, oxidative stress response, and even insulin secretion. The m.3243 A > G variants is associated with maternally inherited diabetes and deafness (MIDD), where early onset diabetes and hearing loss are prominent features. Other types of mtDNA variants involve genes ND4 and tRNA Ala genes that increase susceptibility to type 2 diabetes. Understanding these variants will provide a basis for developing targeted therapy to improve mitochondrial function and metabolic health. This article reviews the impact of mtDNA variants in diabetes, specifically with regards to the m.3243 A > G variant effects on mitochondrial function and insulin secretion and other mtDNA variants that contribute to diabetes susceptibility, particularly ND4 and tRNA Ala gene variants. Data from extant literature were synthesised to obtain an understanding of how mtDNA variants affect diabetes pathogenesis. The main defect for MIDD is the m.3243 A > G variant, which comprises enhanced susceptibility to metabolic syndrome and type 2 diabetes, followed by mitochondrial dysfunction, insulin resistance, and beta-cell dysfunction. Other mtDNA variants have also been reported to enhance diabetes susceptibility through mitochondrial dysfunction and insulin resistance. Increased production of reactive oxygen species (ROS) resulting from mitochondrial malfunction adds to metabolic and tissue damage. This happens in tissues crucial to glucose homeostasis, and it represents an important contribution of mitochondrial dysfunction to metabolic disturbances in diabetes. These mechanisms would underlie the rationale for developing targeted therapies to preserve mitochondrial function and, hence improve the metabolic health of diabetic patients.
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Affiliation(s)
- Praveen Kumar K S
- Department of Medical Genetics, JSS Medical College and Hospital, JSS-AHER, Mysuru 570015, India
- SIG-TRRG, JSS Medical College and Hospitals, JSS-AHER, Mysuru - 570015, India
| | - M N Jyothi
- Department of Medical Genetics, JSS Medical College and Hospital, JSS-AHER, Mysuru 570015, India
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS-AHER, Mysuru 570015, India
- SIG-TRRG, JSS Medical College and Hospitals, JSS-AHER, Mysuru - 570015, India
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Vakharia M. Noninsulin Diabetes Medications in Hospitalized Children and Adolescents. Crit Care Nurs Clin North Am 2025; 37:19-33. [PMID: 39890348 DOI: 10.1016/j.cnc.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
The prevalence of pediatric diabetes continues to rise in the United States and worldwide. There are various forms of pediatric diabetes including type 1, type 2, and maturity onset diabetes of youth. The treatment depends on each unique type of diabetes and must be taken into consideration for patients based on presentation and clinical setting. There is limited literature supporting the use of noninsulin medications to manage pediatric diabetes in an inpatient setting. This article focuses on noninsulin medication management of children and adolescents presenting with hyperglycemia in acute care settings, both critically and noncritically ill.
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Affiliation(s)
- Mili Vakharia
- Division of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, 1020 MS: BCM320, 6621 Fannin Street, Houston, TX, USA.
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6
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Renshof KJPH, Sandberg Y, Weerkamp F, Bain BJ. Fulminant intravascular hemolysis resulting from Clostridium perfringens infection. Am J Hematol 2025; 100:481-482. [PMID: 39436153 DOI: 10.1002/ajh.27511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 10/13/2024] [Indexed: 10/23/2024]
Affiliation(s)
- Kyo J P H Renshof
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Yorick Sandberg
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Floor Weerkamp
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, The Netherlands
| | - Barbara J Bain
- Centre for Haematology, St Mary's Hospital Campus of Imperial College Faculty of Medicine, St Mary's Hospital, London, UK
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刘 爱, 赵 慧, 武 蓓, 郑 姝, 左 力, 王 梅. [Bacterial biofilm formation of peritoneal dialysis catheter in patients with peritonitis-associated catheter removal]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2025; 57:161-165. [PMID: 39856522 PMCID: PMC11759799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Indexed: 01/27/2025]
Abstract
OBJECTIVE Peritoneal dialysis(PD)-associated peritonitis is a common and major complication of PD and the most common cause of technical failure of PD. The presence of bacterial biofilm may be an important factor leading to refractory or recurrence of peritonitis. To investigate the formation and characteristics of bacterial biofilms on PD catheters after peritonitis-associated catheter removal. METHODS The patients with maintenance PD who were regularly followed up in the Peking University People' s Hospital from June 2007 to January 2022 were retrospectively analyzed. The patients who withdrew from PD because of peritonitis and removed the PD catheter in our hospital and underwent the scanning electron microscope examination of the catheter were selected. The general information of the patients, the electron microscope results of the PD catheter and the bacterial culture results of the PD fluid were summarized. RESULTS (1) A total of 18 patients were included, 11 were female (accounting for 61.1%). The average age of the patients was (59.1±11.5) years, and the average duration of dialysis was (80.1±47.4) months. Primary kidney diseases were predominantly chronic glomerulonephritis (55.6%), followed by diabetic nephropathy (27.8%), and others (16.6%). The reasons for catheters removal in 18 patients were refractory peritonitis in 11 cases, recurrent peritonitis in 5 cases, and fungal peritonitis in 2 cases. (2) 16 of the 18 patients (88.9%) had catheter bacterial biofilm, and the bacterial biofilm forms were all cocci. Some were arranged in grape-like shapes, and their diameters ranged from about 500 nm to 1 000 nm. The bacterial culture results of peritoneal dialysis fluid showed that the three most common pathogens were Escherichia coli, methicillin-sensitive Staphylococcus aureus (MSSA), and Staphylococcus epidermidis. (3) Among the 18 patients enrolled, 13 patients (72.2%) had peritonitis in the past. The causative bacteria of peritonitis in 9 patients were cocci, including coagulase-negative Staphylococci (Staphylococcus suis, Staphylococcus surface, Staphylococcus xylosus, Staphylococcus warneri), Staphylococcus aureus, Streptococcus (Streptococcus salivarius and Aerococus viridans). CONCLUSION Bacterial biofilm formation on the inner surface of PD catheter is common in peritonitis-associated catheter removal patients. Not all PD catheters removed due to peritonitis have bacterial biofilms. Bacterial biofilms and peritonitis pathogens may not be consistent.
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Affiliation(s)
- 爱春 刘
- 北京大学人民医院肾内科,北京 100044Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
| | - 慧萍 赵
- 北京大学人民医院肾内科,北京 100044Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
| | - 蓓 武
- 北京大学人民医院肾内科,北京 100044Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
| | - 姝颖 郑
- 北京大学人民医院电子显微镜实验室,北京 100044Department of Laboratory of Electron Microscope, Peking University People's Hospital, Beijing 100044, China
| | - 力 左
- 北京大学人民医院肾内科,北京 100044Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
| | - 梅 王
- 北京大学人民医院肾内科,北京 100044Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
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Akiyama M, Matsubara K, Terashima H, Abe Y, Ohno K, Kamei K. Case of maternal uniparental isodisomy with autosomal recessive Alport syndrome combined with congenital myasthenia and Oguchi disease. CEN Case Rep 2025:10.1007/s13730-025-00972-9. [PMID: 39913008 DOI: 10.1007/s13730-025-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 01/20/2025] [Indexed: 02/07/2025] Open
Abstract
Uniparental isodisomy (UPiD) is a genetic condition in which an individual inherits two identical copies of a chromosome, or part of a chromosome, from one parent. UPiD can result in the development of autosomal recessive disorders if the chromosome inherited from one parent has a pathogenic variant. Herein, we present a 20 year-old female patient who had no significant family history including kidney, muscular, or ocular diseases. She had muscle weakness since infancy and was suspected with congenital myasthenia. She was diagnosed with Oguchi disease, a congenital condition characterized by night blindness, by an ophthalmologist. At 3 years of age, hematuria was noted, and gross hematuria was occasionally observed thereafter. Exome analysis revealed homozygous variants in the COL4A4, CHRND, and SAG genes on chromosome 2, which are the causative genes of Alport syndrome, congenital myasthenic syndrome, and Oguchi disease, respectively. Array comparative genomic hybridization analysis and microsatellite analysis revealed maternal UPiD. At approximately 18 years of age, she presented with proteinuria with mild kidney impairment, and kidney biopsy was performed at 20 years of age. Type IV collagen α5 chain staining showed a weak but positive image in the glomerular basement membrane. However, thinning and irregular thickening of the glomerular basement membrane and reticular changes in the dense layer were observed, which were consistent with Alport syndrome. Angiotensin II receptor blocker (candesartan) was administered, and her urinary protein levels decreased. She had a homozygous missense variant, positive α5 chain staining, and a mild phenotype.
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Affiliation(s)
- Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Keiko Matsubara
- Division of Diversity Research, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Terashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Kinji Ohno
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Aichi, Japan
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
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Purwar R, Kanugonda J, Shukla M, Pandey M. An unusual case of post-menopausal bleeding. World J Surg Oncol 2025; 23:37. [PMID: 39905489 DOI: 10.1186/s12957-025-03684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 01/21/2025] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Metastasis from Renal cell carcinoma at presentation is seen in nearly one fifth of the patients and commonly occur to lung, bone and liver. Synchronous vaginal and cervical metastasis is extremely rare. Several pathways have been proposed of which blood reflux from left renal vein to ovarian vein is most plausible. The prognosis is usually very poor as they are often associated with disseminated metastasis. CASE PRESENTATION A 55-year-old women presented with post-menopausal vaginal bleeding, on examination a smooth mass occupying the vagina and obscuring the view of cervix with normal mucosa was found. Biopsy and Immunohistochemistry showed it to be renal cell carcinoma. Further investigations lead to identification of left renal mass with pulmonary, vaginal and cervical metastasis. Patient was started on Pazopanib 800 mg PO per day, and was lost to follow-up. CONCLUSION Vaginal metastasis presenting as post-menopausal bleeding is one of the rarest presentation of renal cell carcinoma with only 3 cases reported in literature before this. Metastatic tumors to the vagina are more common than primary tumors and are mostly from cervix, endometrium and ovary. A high index of suspicion and through examination and investigation is the key to correct diagnosis and management.
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Affiliation(s)
- Roli Purwar
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Jyothi Kanugonda
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Singh W, Kushwaha P, Kushwaha SP. Exploring Menatetrenone: Origin, Chemistry, Therapies and Delivery. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2025:1-13. [PMID: 39898865 DOI: 10.1080/27697061.2025.2460539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 01/09/2025] [Accepted: 01/26/2025] [Indexed: 02/04/2025]
Abstract
Menatetrenone (MK-4), a potent form of vitamin K2, has gained significant attention for its diverse therapeutic potential, particularly in bone health, cardiovascular protection, and metabolic disorders. This manuscript explores the origins and chemical structure of menatetrenone, highlighting its synthesis from dietary sources and its enzymatic conversion in the body. The review examines the extensive therapeutic applications of MK-4, focusing on its role in treating osteoporosis, diabetes, and cardiovascular diseases, along with emerging evidence of its anticancer and neuroprotective effects. Furthermore, the manuscript discusses innovative delivery systems, such as nanostructured lipid carriers and other advanced formulations, designed to enhance the bioavailability and therapeutic efficacy of menatetrenone. By addressing the challenges associated with its pharmacokinetics and exploring novel drug delivery strategies, this review provides a comprehensive overview of menatetrenone's therapeutic promise and outlines future directions for its clinical use.
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Affiliation(s)
- Widhilika Singh
- Department of Pharmacy, Integral University, Lucknow, Uttar Pradesh, India
| | - Poonam Kushwaha
- Department of Pharmacy, Integral University, Lucknow, Uttar Pradesh, India
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Bai H, Wang J, Nie X, Li H, Ma L, Han X, Peng L. Associations of acute kidney injury with oral anticoagulants: a disproportionality analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Expert Opin Drug Saf 2025:1-10. [PMID: 39885708 DOI: 10.1080/14740338.2025.2461203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/02/2025] [Indexed: 02/01/2025]
Abstract
OBJECTIVE The FDA Adverse Event Reporting System (FAERS) was used to evaluate the associations between oral anticoagulants (OACs) and acute kidney injury (AKI). METHODS Disproportionality analysis was applied to data in the FAERS database from January 2004 to December 2023 to detect adverse events (AEs) for various OACs. The adjusted reporting odds ratios (RORs) calculated using multiple logistic regression were used to explore the risk factors for OACs-associated AKI. RESULTS The crude RORs for the associations of AKI with warfarin, rivaroxaban, dabigatran, apixaban, and edoxaban were 1.35, 2.14, 2.98, 1.33, and 3.56, respectively. The risk of OACs-associated AKI was affected by age and sex, being higher in those aged 65 years and males. The adjusted RORs for rivaroxaban, dabigatran, apixaban, and edoxaban were 1.26, 1.67, 0.65, and 2.06, respectively.Nearly 50% of AKI cases occurred within the first 2 months, and each OAC was of the early-failure type. Hospitalization and mortality rates for AKI patients after OACs were 45.53% and 22.98%, respectively. CONCLUSIONS The study revealed a strong association between AKI and OACs, emphasizing the need for regular renal function monitoring , especially in elderly male patients. Further in-depth research is needed to confirm these exploratory findings.
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Affiliation(s)
- Hehe Bai
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Jinping Wang
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Xiaojing Nie
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Huan Li
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Li Ma
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Xiaonian Han
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Lirong Peng
- Department of Pharmacy, Xi'an Central Hospital, Xi'an, Shaanxi, China
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Tsuyuki T, Kitamura M, Takatani M, Tsuji K, Torigoe K, Tsuji S, Fujita N, Yamaguchi Y, Mukae H, Nishino T. Simultaneous Presentation of Minimal Change Disease and Tubulointerstitial Nephritis Associated with Primary Sjögren's Syndrome and Hashimoto's Thyroiditis: A Case Report. Intern Med 2025:4747-24. [PMID: 39894500 DOI: 10.2169/internalmedicine.4747-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Abstract
A 78-year-old woman experienced systemic edema and was diagnosed with nephrotic syndrome and Hashimoto's thyroiditis (HT). A renal biopsy revealed minimal change disease (MCD) and tubulointerstitial nephritis, which resulted in the diagnosis of primary Sjögren's syndrome (PSS). PSS and HT can be complicated with MCD; however, there are no published case reports of MCD presenting with both conditions simultaneously. We aimed to inform nephrologists and rheumatologists about this rare condition through a literature review of renal outcomes in patients with MCD associated with PSS and HT.
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Affiliation(s)
- Tomohisa Tsuyuki
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Department of Nephrology, Nagasaki Genbaku Hospital, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Miho Takatani
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kiyokazu Tsuji
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kenta Torigoe
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Sosuke Tsuji
- Department of Rheumatology, Nagasaki Genbaku Hospital, Japan
| | - Naruhiro Fujita
- Department of Endocrinology, Nagasaki Genbaku Hospital, Japan
| | | | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Tasaki A, Fukuda A, Kudo A, Nishikawa E, Koumatsu N, Wada M, Okita J, Maruo M, Uchida H, Nakata T, Itani K, Shibata H. A First Case Report of Autoimmune Acquired Factor V Deficiency After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA Vaccination at the Time of Initiating Haemodialysis. Nephrology (Carlton) 2025; 30:e70003. [PMID: 39887486 PMCID: PMC11790345 DOI: 10.1111/nep.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 02/01/2025]
Abstract
A 73-year-old Japanese man with chronic kidney disease had no history of abnormal clotting or bleeding. Six days after receiving his third dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (BNT162b2; Pfizer/BioNTech), blood tests showed a marked prolongation of the prothrombin time-international normalised ratio and activated partial thromboplastin time, as well as a decrease in factor V (FV) activity. Three months later, he required dialysis owing to worsening heart and renal failure. After supplementation with FV, a flexible double-lumen catheter was inserted, and haemodialysis was initiated without the use of anticoagulants. The patient was found to be positive for FV inhibitors and was diagnosed with autoimmune acquired factor V deficiency (AiFVD). AiFVD is a rare autoimmune disease in which factor V inhibitors decrease FV activity. The patient did not undergo immunosuppressive therapy because he did not have severe bleeding symptoms, and he is currently able to continue dialysis without causing fatal bleeding. FV inhibitors can be induced by bovine thrombin, surgery, and infection, but have also been detected after SARS-CoV-2 infection. The development of various acquired coagulation factor inhibitors has been reported after SARS-CoV-2 infection or vaccination, but there have been no reports of AiFVD due to SARS-CoV-2 vaccination. To the best of our knowledge, this is the first report of AiFVD probably associated with SARS-CoV-2 vaccination. Although AiFVD is rare, physicians should be aware of its possibility after SARS-CoV-2 vaccination.
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Affiliation(s)
- Ayako Tasaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Akihiro Fukuda
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Akiko Kudo
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Emiko Nishikawa
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Nobuchika Koumatsu
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Megumi Wada
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Jun Okita
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Misaki Maruo
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Hiroki Uchida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Takeshi Nakata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
| | - Kazuhito Itani
- Division of Haematology, Faculty of MedicineOita UniversityOitaJapan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of MedicineOita UniversityOitaJapan
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Mochida H, Kyoda M, Ushio Y, Morito T, Kamiyama T, Oyagi H, Hirasawa A, Hasegawa N, Kakuta Y, Kang D, Honda K, Taneda S, Hatano M. A case of crystalglobulin-induced nephropathy wherein M protein was identified by mass spectrometry and immunoglobulin G subclass staining. CEN Case Rep 2025; 14:53-60. [PMID: 38918330 PMCID: PMC11785854 DOI: 10.1007/s13730-024-00906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
Crystalglobulin-induced nephropathy is a rare disease that causes the deposition of crystallized monoclonal immunoglobulins into the glomerular capillary and arteriole spaces. Here, we report the case of a patient who presented with skin ulcers, urinary protein, and renal dysfunction. The patient underwent renal and skin biopsies, and the biopsy tissue samples were subjected to mass spectrometry. The patient was diagnosed with crystalglobulin-induced nephropathy. A literature review suggested that pathological examinations using electron microscopy, mass spectrometry, and immunofluorescent staining of paraffin-embedded biopsy samples treated with pronase may be useful for the diagnosis of this condition.
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Affiliation(s)
- Hibiki Mochida
- Department of Nephrology, Yokohama Rosai Hospital, 3211, Kozukue-cho, Kohoku-ku, Yokohama-shi, Kanagawa Prefecture, Japan.
| | - Mizuki Kyoda
- Department of Nephrology, Yokohama Rosai Hospital, 3211, Kozukue-cho, Kohoku-ku, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Yusuke Ushio
- Department of Nephrology, Yokohama Rosai Hospital, 3211, Kozukue-cho, Kohoku-ku, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Taku Morito
- Department of Nephrology, Yokohama Rosai Hospital, 3211, Kozukue-cho, Kohoku-ku, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Takahiro Kamiyama
- Department of Nephrology, Yokohama Rosai Hospital, 3211, Kozukue-cho, Kohoku-ku, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Hideaki Oyagi
- Department of Hematology, Yokohama Rosai Hospital, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Akira Hirasawa
- Department of Hematology, Yokohama Rosai Hospital, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Naoki Hasegawa
- Department of Diagnostic Pathology, Yokohama Rosai Hospital, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Yukio Kakuta
- Department of Diagnostic Pathology, Yokohama Rosai Hospital, Yokohama-shi, Kanagawa Prefecture, Japan
| | - Dedong Kang
- Department of Anatomy Microscopic Anatomy, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Kazuho Honda
- Department of Anatomy Microscopic Anatomy, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Sekiko Taneda
- Department of Diagnostic Pathology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Michiyasu Hatano
- Department of Nephrology, Yokohama Rosai Hospital, 3211, Kozukue-cho, Kohoku-ku, Yokohama-shi, Kanagawa Prefecture, Japan
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15
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Sugi M, Lombardi A, Krishnan I, Sandrasegaran K. Imaging appearances of perinephric myxoid pseudotumor of fat (PMPF). Clin Radiol 2025; 81:106775. [PMID: 39799834 DOI: 10.1016/j.crad.2024.106775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 12/05/2024] [Accepted: 12/10/2024] [Indexed: 01/15/2025]
Abstract
AIM This study aimed to identify the imaging feature of perinephric myxoid pseudotumor of fat (PMPF) in a large cohort. MATERIALS AND METHODS Institutional radiology and pathology databases were queried for PMPF for the period from January 2010 to December 2023. Of the 22 identified individuals, two were excluded due to nonavailability of computed tomography (CT) or magnetic resonance (MR) images and five due to lack of pathological confirmation. The study cohort comprised of 15 individuals (males = 10), with median age of 59 years (range: 26-87 years). Three abdominal radiologists in consensus reviewed all relevant CT, magnetic resonance imaging (MRI) and positron emission tomography (PET) images. RESULTS Seventeen tumuors were analysed since two individuals had bilateral tumuors. The tumuors were at the renal hilum (n=7) or perinephric space (n=10). Two imaging patterns were seen: hazy ill-defined predominantly fatty mass (n=9) or a soft tissue mass (n=8) with variable fat content (0-90%). At presentation, the tumuors ranged in size from 1.5 to 16.5 cm (median: 6.2 cm). The perihilar tumuors encased central renal vessels without occlusion or thrombus. Ureteric encasement and mild hydronephrosis were seen in 11 and 4 tumuors, respectively. Most (9 of 13) of the affected native kidneys and all transplant kidneys (n=5) showed parenchymal poor contrast enhancement. Tumuors with greater than 12-month follow-up (n=11) showed a median growth of 15%. CONCLUSION PMPF may be considered in the diagnosis of tumuors with soft tissue and fat components situated at the renal hilum or perinephric space. The delayed contrast enhancement, relative lack of mass effect for size, and poor function of affected kidney are diagnostic features.
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Affiliation(s)
- M Sugi
- Mayo Clinic Arizona, Department of Radiology, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
| | - A Lombardi
- Mayo Clinic Arizona, Department of Radiology, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
| | - I Krishnan
- Mayo Clinic Arizona, Department of Radiology, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
| | - K Sandrasegaran
- Mayo Clinic Arizona, Department of Radiology, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
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Kita Y, Shirai S, Koyama T, Makinouchi R, Machida S, Matsui K, Koike J, Imai N. Fanconi syndrome with karyomegalic interstitial nephritis after ifosfamide treatment for osteosarcoma: a case report. CEN Case Rep 2025; 14:65-70. [PMID: 38955949 PMCID: PMC11785847 DOI: 10.1007/s13730-024-00907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
Patients with ifosfamide-induced renal damage present with Fanconi syndrome. Karyomegalic nephropathy/interstitial nephritis (KNIN) is a rare form of chronic tubulo-interstitial nephritis that was initially considered a type of familial nephropathy. However, several reports of drug-induced KNIN, i.e., KNIN-like nephropathy, have been reported in recent years. We present the case of an 18-year-old man who presented with Fanconi syndrome and progressive renal dysfunction after receiving chemotherapy including ifosfamide and cisplatin for right femoral osteosarcoma. Renal biopsy revealed numerous atrophied tubular epithelial cells with large, polymorphic nuclei, and the definitive diagnosis was KNIN. Most patients with KNIN-like nephropathy who receive ifosfamide are concomitantly treated with cisplatin, indicating that ifosfamide and cisplatin might act synergistically to increase the risk for KNIN-like nephropathy. Further investigation in case series is warranted to reveal potential treatment approaches and to evaluate prognosis.
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Affiliation(s)
- Yohei Kita
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Sayuri Shirai
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan.
| | - Teppei Koyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Ryuichiro Makinouchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Shinji Machida
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Katsuomi Matsui
- Department of Nephrology, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Junki Koike
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naohiko Imai
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
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17
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Chanoine JP, Thompson DM, Lehman A. Diabetes Associated With Maternally Inherited Diabetes and Deafness (MIDD): From Pathogenic Variant to Phenotype. Diabetes 2025; 74:153-163. [PMID: 39556456 PMCID: PMC11755681 DOI: 10.2337/db24-0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 11/13/2024] [Indexed: 11/20/2024]
Abstract
ARTICLE HIGHLIGHTS Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disorder characterized primarily by hearing impairment and diabetes. m.3243A>G, the most common phenotypic variant, causes a complex rewiring of the cell with discontinuous remodeling of both mitochondrial and nuclear genome expressions. We propose that MIDD depends on a combination of insulin resistance and impaired β-cell function that occurs in the presence of high skeletal muscle heteroplasmy (approximately ≥60%) and more moderate cell heteroplasmy (∼25%-72%) for m.3243A>G. Understanding the complex mechanisms of MIDD is necessary to develop disease-specific management guidelines that are presently lacking.
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Affiliation(s)
- Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, Department of Pediatrics, BC Children’s Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
| | - David M. Thompson
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Lehman
- Department of Medical Genetics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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18
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Hua F, Cai Y. PAX2 induces endometrial cancer by inhibiting mitochondrial function via the CD133-AKT1 pathway. Mol Cell Biochem 2025:10.1007/s11010-025-05216-z. [PMID: 39891863 DOI: 10.1007/s11010-025-05216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 01/22/2025] [Indexed: 02/03/2025]
Abstract
Endometrial cancer (EC) is a malignancy of the endometrial epithelium. The prevalence and mortality rates associated with the disease are on the rise globally. A total of 20 cases of type I EC tissues were collected for transcriptomic sequencing, our findings indicate that PAX2 is highly expressed in EC tissues and is closely related to the pathogenesis of EC. PAX2 is a member of the paired homeobox domain family and has been linked to the development of a number of different tumours. In normal endometrial tissue, PAX2 is methylated; however, in EC, it is demethylated. Nevertheless, few studies have focused on its role in EC. A protein-protein interaction (PPI) analysis revealed a regulatory relationship between PAX2 and CD133, which in turn affects the activity of AKT1. CD133 is a well-known marker of tumor stem cells and is involved in tumor initiation, metastasis, recurrence, and drug resistance; AKT1 promotes cell survival by inhibiting apoptosis and is considered a major promoter of many types of cancer. Nevertheless, further investigation is required to ascertain whether PAX2 affects the progression of EC by regulating the CD133-AKT1 pathway. The present study demonstrated that PAX2 promoted cell proliferation, migration, invasion and adhesion, and inhibited apoptosis. Its mechanism of action was found to be the inhibition of mitochondrial oxidative phosphorylation, promotion of glycolysis, increase in mitochondrial copy number, and increase in the levels of reactive oxygen species (ROS) and hexokinase, as well as the concentration of mitochondrial calcium ions. This was achieved through the promotion of CD133 expression and the phosphorylation of AKT1. In conjunction with the aforementioned regulatory pathways, the progression of EC is facilitated.
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Affiliation(s)
- Fu Hua
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, No.87 Dingjiaqiao, Nanjing, 210009, China
- Department of Gynecology, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - YunLang Cai
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, No.87 Dingjiaqiao, Nanjing, 210009, China.
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19
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Li Y, Zhou L, Wang K, Luo X, Zhang L, Cai K. An interference in bilirubin detection: Pulmonary marginal zone lymphoma presenting monoclonal cryoglobulin. Clin Chim Acta 2025; 567:120066. [PMID: 39647570 DOI: 10.1016/j.cca.2024.120066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 10/24/2024] [Accepted: 11/26/2024] [Indexed: 12/10/2024]
Abstract
Marginal zone lymphoma (MZL) of the lung is an indolent B-cell lymphoma. The peripheral blood of most patients with pulmonary MZL contains low or undetectable monoclonal immunoglobulin (M protein) levels. In this case, the clinical laboratory discovered that the pulmonary MZL patient not only associated with high concentration of monoclonal IgG-type protein but also exhibited obvious gel formation characteristics that interfered with clinical biochemistry tests. Thus, the role of M protein in total bilirubin determination was examined in this study. Total bilirubin detection curve difference comparison between monoclonal IgG protein and polyclonal immunoglobulin, interference experiments, and dilution elimination experiments were conducted. These experiments revealed not only a positive correlation between M protein interference in bilirubin detection with its concentration, but also M protein-specific interference distinct from polyclonal immunoglobulin. We employed the R and EmpowerStat statistical systems to evaluate the correlation between serum monoclonal protein and total bilirubin absorbance curve data. Multivariate analysis revealed a nonlinear correlation between with globulin (GLB) and square root transformed curve optical density (OD) data. The receiver operating characteristic (ROC) curve analysis indicated an area under the curve (AUC) of 0.852 for the GLB ≥ 31.9 g/L subgroup using combined curve indicators. Our findings can enhance clinical M protein screening and scientific assessment of the populations requiring serum protein electrophoresis testing, thereby reducing the rate of missed diagnoses in the M protein population.
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Affiliation(s)
- Yi Li
- Department of Clinical Laboratory, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China; Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Liangqiong Zhou
- Department of Clinical Laboratory, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Kangyi Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xiaoge Luo
- Department of Clinical Laboratory, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Liqun Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China.
| | - Kaiyong Cai
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.
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20
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Meier M, Ansong B, Awobusuyi D, Lee-Oyagha R, Lopez S. Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitor-Related Euglycemic Diabetic Ketoacidosis: A Case Series. J Pharm Pract 2025; 38:193-197. [PMID: 39123293 DOI: 10.1177/08971900241273169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Objectives: Sodium-glucose transporter-2 inhibitors (SGLT2i) are commonly used for the treatment of Type 2 Diabetes Mellitus, offering additional benefits in non-diabetic patients with conditions such as chronic kidney disease and heart failure. However, SGLT2i have been associated with an increased risk of euglycemic diabetic ketoacidosis (DKA). This case series describes three cases of patients who developed euglycemic DKA while taking SGLT2i. Key Findings: Each of the three patients with euglycemic DKA were taking SGLT2i for the treatment of diabetes and all had additional risk factors for the development of DKA. These factors included reduced oral intake, major acute illness, chronic pancreatitis, and a history of previous DKA episodes. Unfortunately, the absence of hallmark symptoms like hyperglycemia, polyuria, and polydipsia led to delayed diagnosis of euglycemic DKA in two of the three patients. Conclusion: Early recognition of risk factors and a high level of suspicion are critical in identifying euglycemic DKA in patients taking SGLT2i. Healthcare providers should conduct thorough medication reconciliation upon admission and closely monitor patients for concurrent issues, especially in cases of minimal oral intake, acute illnesses, and chronic pancreatitis. Prompt diagnosis and management of euglycemic DKA can significantly improve patient outcomes.
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Affiliation(s)
- Mackenzi Meier
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA
- School of Pharmacy, South University, Savannah, GA, USA
| | | | | | | | - Sarah Lopez
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA
- School of Pharmacy, South University, Savannah, GA, USA
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21
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Devuyst O, Ahn C, Barten TR, Brosnahan G, Cadnapaphornchai MA, Chapman AB, Cornec-Le Gall E, Drenth JP, Gansevoort RT, Harris PC, Harris T, Horie S, Liebau MC, Liew M, Mallett AJ, Mei C, Mekahli D, Odland D, Ong AC, Onuchic LF, P-C Pei Y, Perrone RD, Rangan GK, Rayner B, Torra R, Mustafa R, Torres VE. KDIGO 2025 Clinical Practice Guideline for the Evaluation, Management, and Treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD). Kidney Int 2025; 107:S1-S239. [PMID: 39848759 DOI: 10.1016/j.kint.2024.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 01/25/2025]
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22
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Alexander K, Goodall J, Allen BJ. Supporting Transgender, Nonbinary, and Gender Diverse Youth During Solid Organ Transplantation. Pediatr Transplant 2025; 29:e14864. [PMID: 39620485 PMCID: PMC11610667 DOI: 10.1111/petr.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/09/2024] [Accepted: 09/13/2024] [Indexed: 12/11/2024]
Abstract
As gender diversity becomes more understood and accepted in mainstream culture, medical systems and health care providers must learn to provide comprehensive and affirming care to gender diverse individuals. As the number of gender diverse pediatric patients continues to grow, these patients will be cared for by pediatric solid-organ transplant programs. This review summarizes the basic principles of gender-affirming care and describes how transplant teams can provide equitable and affirming care to young gender diverse patients undergoing solid organ transplant (SOT). In addition, this review uses kidney transplant as a framework to explore gender-affirming hormone therapy and gender-affirming surgery in the setting of transplant, laboratory value interpretation in gender diverse individuals, and the importance of an individualized approach in care of the gender diverse transplant recipient.
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Affiliation(s)
- Kelsi Alexander
- Department of Pediatrics, Division of NephrologyUniversity of Washington MedicineSeattleWashingtonUSA
| | - Joanne Goodall
- Department of Pediatrics, Division of Adolescent and Young Adult MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Brittany J. Allen
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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23
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Cagino KA, Trotter RD, Lambert KE, Kumar SC, Sibai BM. Expectant management of preeclampsia with severe features diagnosed at less than 24 weeks. Am J Obstet Gynecol 2025; 232:212.e1-212.e8. [PMID: 38697342 DOI: 10.1016/j.ajog.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The recent American College of Obstetricians and Gynecologists Practice Bulletin offers no guidance on the management of preeclampsia with severe features at <24 weeks of gestation. Historically, immediate delivery was recommended because of poor perinatal outcomes and high maternal morbidity. Recently, advances in neonatal resuscitation have led to increased survival at periviable gestational ages. OBJECTIVE This study aimed to report perinatal and maternal outcomes after expectant management of preeclampsia with severe features at <24 weeks of gestation. STUDY DESIGN This was a retrospective case series of preeclampsia with severe features at <24 weeks of gestation at a level 4 center between 2017 and 2023. Individuals requiring delivery within 24 hours of diagnosis were excluded. Perinatal and maternal outcomes were analyzed. Categorical variables from our database were compared with previously published data using chi-square tests. RESULTS A total of 41 individuals were diagnosed with preeclampsia with severe features at <24 weeks of gestation. After the exclusion of delivery within 24 hours, 30 individuals (73%) were evaluated. The median gestational age at diagnosis was 22 weeks (interquartile range, 22-23). Moreover, 16% of individuals had assisted reproductive technology, 27% of individuals had chronic hypertension, 13% of individuals had pregestational diabetes mellitus, 30% of individuals had previous preeclampsia, and 73% of individuals had a body mass index of >30 kg/m2. The median latency periods at 22 and 23 weeks of gestation were 7 days (interquartile range, 4-23) and 8 days (interquartile range, 4-13). In preeclampsia with severe features, neonatal survival rates were 44% (95% confidence interval, 3%-85%) at 22 weeks of gestation and 29% (95% confidence interval, 1%-56%) at 23 weeks of gestation. There were 2 cases of acute kidney injury (7%) and 2 cases of pericardial or pleural effusions (7%). Overall perinatal survival at <24 weeks of gestation was 30% in our current study vs 7% in previous reports (P=.02). CONCLUSION For cases of expectant management of preeclampsia with severe features at <24 weeks of gestation, our findings showed an increased perinatal survival rate with decreased maternal morbidity compared with previously published data. This information may be used when counseling on expectant management of preeclampsia with severe features at <24 weeks of gestation.
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Affiliation(s)
- Kristen A Cagino
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
| | - Rylee D Trotter
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Katherine E Lambert
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Saloni C Kumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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24
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Tagetti A, Cattazzo F, Marcon D, Romano S, Giontella A, Bortolotti S, Minuz P, Pecoraro L, Brugnara M, Fava C. Subclinical target organ damage in a sample of children and adolescents with solitary functioning kidney. A pilot study. J Hypertens 2025; 43:221-227. [PMID: 39748738 DOI: 10.1097/hjh.0000000000003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 08/18/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Patients with solitary functioning kidney appear to be exposed to an increased cardiovascular risk. This study aimed to evaluate the impact of peripheral and central blood pressure on subclinical cardiovascular organ damage in a sample of children and adolescents with solitary functioning kidney. METHODS Carotid ultrasonography was performed to measure the carotid intima-media thickness (cIMT) and the carotid distensibility coefficient. The carotid-femoral pulse wave velocity (PWV) was assessed by tonometry. Cardiac mass and remodeling were estimated using transthoracic echocardiography. Central and peripheral (both office and 24-h ambulatory) BP measurements were collected. RESULTS Forty-four patients were included. Eighteen subjects (45%) were hypertensive as assessed by 24-h ABPM, with a prevalence of masked hypertension of 43%. Twenty-three subjects (52%) had an increased cIMT, while 2 and 3 patients (5% and 7%) demonstrated an impaired carotid distensibility coefficient and PWV, respectively. Nineteen subjects (43%) showed concentric cardiac remodeling. Central systolic blood pressure (cSBP) correlated with cIMT (r = 0.35) and left ventricular mass index (LVMi) (r = 0.32) demonstrating a positive independent association with an increased cIMT (odds ratio 1.14, 95% confidence interval 1.01-1.29) in multivariate regression analysis. CONCLUSION Children and adolescents with solitary functioning kidney exhibited a high prevalence of masked hypertension and subclinical cardiovascular organ damage. These findings support the use of 24-h ABPM to identify patients with a higher cardiovascular risk who would benefit from hypertension treatment and closer monitoring during growth and into adulthood. Additionally, cSBP measurement should be considered as part of a more detailed cardiovascular risk assessment in these patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Luca Pecoraro
- Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Milena Brugnara
- Department of Pediatrics, University Hospital of Verona, Verona, Italy
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Takaki R, Kohatsu K, Kuwano K, Yazawa M. Hyperkalemia presentation at a clinic during the cold season. CEN Case Rep 2025; 14:34-38. [PMID: 38896354 PMCID: PMC11785838 DOI: 10.1007/s13730-024-00902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
Familial pseudohyperkalemia (FP) is an underrecognized cause of pseudohyperkalemia, caused by the leaking of potassium from red blood cells. This extracellular shift of potassium is temperature-dependent and occurs when blood samples are stored below room temperature or for a long time, manifesting as apparent hyperkalemia. We report a suspicious case of FP, which demonstrated an apparent seasonal trajectory of serum-potassium levels at the local clinic. At first, laboratory test results did not show an increase in the serum-potassium levels in our tertiary hospital. However, by replicating the clinic's storage conditions, the patient's serum sample showed hyperkalemia only when it was stored at a temperature of 4 °C or 20 °C for 4-8 h. Hyperkalemia was not observed in the patient's sample when it was stored at 37 °C, or in the healthy control's sample at a temperature of 20 °C or 37 °C. When encountering hyperkalemia without an obvious cause and symptoms, physicians should consider pseudohyperkalemia in the differential diagnosis. In particular, if a seasonal trajectory of serum-potassium levels is observed, FP should be suspected as a potential cause of pseudohyperkalemia. Although a genetic test is needed to properly diagnose FP, confirming it by verifying the sample storage conditions or proving it by replicating the test using different storage conditions is easy and very important, as it can prevent unnecessary treatment.
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Affiliation(s)
- Ryo Takaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-Shi, Nagasaki, 852-8501, Japan
| | - Kaori Kohatsu
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Katsuhisa Kuwano
- Department of General Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka City, Fukuoka, 820-8505, Japan
| | - Masahiko Yazawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
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Yikilmaz AS, Hernandez CMR. A Rare But Fatal Toxicity: Immune Checkpoint Inhibitor-Related Acquired Thrombotic Thrombocytopenic Purpura. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2025; 8:15-22. [PMID: 39811422 PMCID: PMC11728379 DOI: 10.36401/jipo-24-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 09/11/2024] [Accepted: 10/02/2024] [Indexed: 01/16/2025]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is characterized by thrombotic microangiopathy resulting from decreased activation of the von Willebrand factor-cleaving protease (ADAMTS13). TTP can cause organ damage and is often fatal if the appropriate treatment is not started immediately. Although primary immune TTP is the most common form of TTP, secondary immune etiologies, including complications from immune checkpoint inhibitors (ICIs), have also been reported. ICIs are used as neoadjuvant and adjuvant therapy for metastatic and nonmetastatic solid tumors and hematologic cancers. ICIs stimulate the T-cell-mediated antitumor response, and the subsequent upregulation of the immune system can cause ICI-related adverse events (AEs). ICI-associated AEs may result in various hematological outcomes. Therefore, TTP, as a rare ICI-related AE, requires awareness. TTP has been mentioned as a rare ICIrAE in a few case reports. When using ICIs, the differential diagnosis of TTP should be considered if hemolytic anemia is accompanied by thrombocytopenia. Low ADAMTS13 activity can be used to diagnose TTP and support the need for plasma exchange. This review will assess the approach for ICI-related acquired TTP by scanning a limited number of reported case series in the literature. Low ADAMTS13 activity can be used to diagnose TTP and support the need for plasma exchange. Treatment in the cases that have been published includes combinations of rituximab and caplacizumab, corticosteroids, and plasma exchange. Furthermore, acquired TTP associated with ICI is encountered during the initial and subsequent cycles of ICI treatment. It is essential to detect ICI-related acquired TTP early, a highly fatal AE of ICIs, and to increase awareness of TTP, which will likely be encountered more frequently with the use of new ICI agents.
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Stumpff F, Manneck D. Prebiotics as modulators of colonic calcium and magnesium uptake. Acta Physiol (Oxf) 2025; 241:e14262. [PMID: 39803707 PMCID: PMC11726438 DOI: 10.1111/apha.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] |