The association between dental caries and steroid-sensitive nephrotic syndrome in children

BACKGROUND

Pathogenesis and relapse of steroid-sensitive nephrotic syndrome (SSNS) are primarily associated with infection. Dental caries is the most common chronic progressive oral infection in children. However, clinical studies of SSNS combined with dental caries in children are rare.

METHODS

In our retrospective cohort study from January 2021 to June 2022, 145 children with SSNS were included in the baseline analysis and 105 in the follow-up analysis. The follow-up period was 1 year. The primary study endpoints were the relapse-free period and frequently relapsing nephrotic syndrome (FRNS). Secondary endpoints included the number and triggers of relapses and concomitant medications.

RESULTS

The median age was 5.5 years, with a caries rate of 60.7%, the mean DMFT/dmft was 3.86, and the caries filling rate was 1.6%. Except for the lower proportion of high household income and high parental education observed in the caries group, no statistical differences were found when comparing the other baseline data with the non-caries group. The caries group had a shorter relapse-free period and a lower 1-year cumulative relapse-free survival rate (HR = 1.90, 95% CI 1.17-3.09, P = 0.009). Univariate regression analysis showed caries associated with FRNS (OR = 2.714, 95% CI 1.021-7.219, P = 0.045), but the correlation no longer remained in the multivariate analysis. Additionally, seven cases of caries-derived pulpal periapical inflammation triggered SSNS relapses. The caries group had more infection triggers and concomitant medication use.

CONCLUSION

Dental caries and relapse of SSNS are potentially associated, but careful evaluation is needed.

External validation of the pediatric International IgA Nephropathy Prediction Tool in a central China cohort

BACKGROUND

This study aimed to externally validate the pediatric International IgA Nephropathy (IgAN) Prediction Tool updated from the adult IgAN Prediction Tool.

METHODS

439 children with biopsy-confirmed idiopathic IgAN were enrolled in this external validation study. The primary outcome was a 30% decline in eGFR or end-stage kidney disease. We evaluated the discrimination using Harrell's C-index, the receiver operating characteristic (ROC) curve, and Kaplan-Meier curves for four risk groups (< 16th [low risk], ∼16 to < 50th [intermediate risk], ∼50 to < 84th [high risk], and ≥ 84th percentiles [highest risk] of linear predictor). Calibration was assessed using calibration plots.

RESULTS

The median follow-up time of the 439 patients was 4.5 (2.7-6.8) years, and 27 patients reached the primary outcome. Compared with the reported cohorts, our cohort was more contemporary, with milder proteinuria at biopsy, and had lower proportions of S1 and T1 lesions. Harrell's C-index and area under the ROC curve at 5 years were < 0.7 for both the models with and without race. The Kaplan-Meier curves of the risk groups were not well separated for the two models, only separated completely between the highest-risk group and the others for the model without race. The two models generally overestimated the risk of the primary outcome, CONCLUSION: The model without race could accurately distinguish the highest-risk patients from patients with low, intermediate, and high risk for kidney progression. Discrimination and calibration for the full model with or without race were unsatisfactory in this contemporary cohort in central China.

Incidence of relapse and frequently relapsing/steroid-dependent nephrotic syndrome in Chinese children with steroid-sensitive nephrotic syndrome: A cohort study

AIM

This study aimed to investigate the incidence of relapse and FR/SDNS in Chinese children with SSNS and to develop clinical prediction models for relapse and FR/SDNS.

METHODS

This retrospective cohort study involved 339 newly onset SSNS patients between 2006 and 2016. The incidence of relapse and FR/SDNS were estimated using the Kaplan-Meier method. Prediction models were constructed based on Cox proportional-hazards regression.

RESULTS

The median follow-up time was 8.7 years. The cumulative incidence of relapse at 1-, 2-, and 5-year was 51.0%, 62.5%, and 66.6%. The cumulative incidence of FR/SDNS at 1-, 2-, and 5-year was 18.4%, 29.0%, and 32.9%. The final prediction model for first relapse included four variables (serum albumin, triglycerides, IgM, and time to first remission). The model's discriminative ability was low (Harrell's C index = 0.62). The final prediction model for FR/SDNS included four variables (serum albumin, lipoprotein(a), time to first remission, and time to first relapse). The discrimination and calibration of the prediction model for FR/SDNS were acceptable (Harrell's C index = 0.73, Brier score at 1- and 2-year were 0.11 and 0.17).

CONCLUSION

The first relapse and FR/SDNS mainly occurred in the first 2 years after initial SSNS onset. The prediction model for relapse developed using common clinical parameters performed poorly, while the prediction model for FR/SDNS might be useful.

Application of adrenocorticotropic hormone in recurrent focal segmental glomerulosclerosis post-transplantation: A case report and literature review

BACKGROUND

The recurrence rate of focal segmental glomerulosclerosis (FSGS) post-renal transplantation is as high as 30%-50%. However, the pathogenesis is unclear. At present, there is no unified standard for the treatment of recurrent FSGS post-transplantation. Its treatment is full of risks and challenges.

METHODS

We report a child with recurrent FSGS with massive proteinuria 6~9 g/m² /day and resistance to plasma exchange (PE) and rituximab (RTX). On the basis of receiving anti-rejection therapy of prednisone, tacrolimus, and mycophenolate mofetil (MMF), we treated the child with adrenocorticotropic hormone (ACTH), and reviewed the literature on the application of ACTH in the recurrence of FSGS post-transplantation.

RESULTS

After 1 year of treatment with ACTH, the patient's urinary protein decreased and fluctuated between 0.6 and 1.1 g/m² /day. The albumin (ALB) and cholesterol (CHOL) returned to the normal range. The patient achieved complete remission after 19 months of ACTH treatment and maintained until now. There was no obvious adverse reaction. Literature review showed that up to February 2021, a total of 8 studies showed the use of ACTH in kidney transplant patients, and all the patients in the study achieved remission.

CONCLUSIONS

ACTH is a potential option for treating recurrent FSGS post-transplantation with fewer side effects and relatively safe for patients. However, further evaluation is needed to better adapt to different populations.

Long-Term Outcome of Secondary Steroid-Resistant Nephrotic Syndrome in Chinese Children

Introduction

Secondary steroid-resistant nephrotic syndrome (SRNS) refers to the condition when patients with initial steroid-sensitive nephrotic syndrome develop steroid resistance in subsequent relapses. Long-term outcomes of secondary SRNS in children are uncertain.

Methods

This was a single-center retrospective study of 56 children with secondary SRNS between 2006 and 2016. The survival curve was estimated using the Kaplan-Meier method. Independent risk factors for end-stage renal disease (ESRD) were determined using Cox proportional hazards model.

Results

The median time from nephrotic syndrome onset to secondary SRNS was 7.8 months. Biopsy results at diagnosis secondary SRNS showed that 64.3% of cases were minimal change disease (MCD). No remission was observed in seven (12.5%) patients within the first year. The mean follow-up time was 7.8 ± 3.2 years. Eight patients were clinically cured, one died before ESRD, 10 reached ESRD, and 75.0% (3 of 4) of patients recurred post-transplantation. The 10-year ESRD-free survival rate was 85.8%. No response to intensified immunosuppression (IIS) in the first year was the independent predictor for ESRD. Repeat biopsies were performed in 20 cases, revealing that the reclassification from MCD to mesangial hypercellularity and focal segmental glomerulosclerosis (FSGS) in two when secondary steroid resistance appeared, from MCD and mesangial hypercellularity to FSGS in seven who developed multidrug resistance, and from FSGS to MCD and mesangial hypercellularity in two with favorable outcomes.

Conclusions

The long-term outcome in children with secondary SRNS was heterogeneous, and no response to IIS in the first year was the independent predictor for ESRD. In patients with repeat biopsy, changes in histological appearance to FSGS were associated with multidrug resistance.

Association Between Macrophage Migration Inhibitory Factor -173 G>C Gene Polymorphism and Childhood Idiopathic Nephrotic Syndrome: A Meta-Analysis

Background: Studies have identified that MIF -173 G>C gene polymorphism is associated with idiopathic nephrotic syndrome (INS) susceptibility and steroid resistance, but the results remain inconclusive. Methods: We searched PubMed, Embase, and Web of Science for relevant studies published before 31 March 2021. Pooled data were reported as odds ratio (OR) with 95% confidence interval (CI). Noteworthiness of significant OR was estimated by the false positive report probability (FPRP) test. Trial sequential analysis (TSA) was used to control type I and type II errors. Results: We selected seven case-control studies that included 1,026 INS children (362 were steroid-resistant NS and 564 were steroid-sensitive NS) and 870 controls. The results showed that MIF -173 G>C polymorphism was significantly associated with INS susceptibility in allelic, heterozygous and dominant genetic models (C vs. G: OR = 1.325, 95% CI: 1.011-1.738; GC vs. GG: OR = 1.540, 95% CI: 1.249-1.899; CC + GC vs. GG: OR = 1.507, 95% CI: 1.231-1.845), and FPRP test and TSA indicated that the associations were true in heterozygous and dominant models. The pooled results also revealed that MIF -173 G>C polymorphism was significantly associated with steroid resistance in allelic, homozygous and recessive models (C vs. G: OR = 1.707, 95% CI: 1.013-2.876; CC vs. GG: OR = 4.789, 95% CI: 2.109-10.877; CC vs. GC + GG: OR = 4.188, 95% CI: 1.831-9.578), but FPRP test indicated that all these associations were not noteworthy. Furthermore, TSA revealed that the non-significant associations between MIF -173 G>C polymorphism and steroid resistance in heterozygous and dominant models were potential false negative. Conclusions: This meta-analysis could draw a firm conclusion that MIF -173 G>C polymorphism was significantly associated with increased INS risk in heterozygous and dominant genetic models. MIF -173 G>C polymorphism was not likely to affect steroid responsiveness, but more studies were needed to confirm.

[Time characteristics of imported malaria cases in Yunnan Province]

Objective To investigate the time distribution characteristics and the epidemic trends of imported malaria cases in Yunnan Province. Methods The malaria case records and epidemiological history data of Yunnan Province were collected, and the local infection cases were excluded. The data were statistical analyzed. Results The imported malaria cases had a significantly seasonal periodicity (Q = 26.574, P < 0.05) and epidemic trends (Q = 35.487, P < 0.05). The imported peak was in May, while February was the lowest month of imported cases, and the difference was significant (Z = -2.619, P < 0.05). The simple seasonal prediction model was the best model (R² = 0.677, BIC = 4.867) for forecast while the residual sequence was white noise (Q = 14.226, P > 0.05). By using the model to predict the cases in January, February and March of 2016, the number (95% CI) were 29 (7-50), 22 (0-44) and 31 (8-54), and the actual number of imported malaria cases were 29, 24 and 38 cases respectively and all cases were included in the 95% CI. Conclusion The imported malaria cases in Yunnan Province had a significantly seasonal periodicity and epidemic trends, and the established model has good prediction on the recent cases.

Compound heterozygous mutations in TTC7A cause familial multiple intestinal atresias and severe combined immunodeficiency

Familial multiple intestinal atresias is an autosomal recessive disease with or without combined immunodeficiency. In the last year, several reports have described mutations in the gene TTC7A as causal to the disease in different populations. However, exact correlation between different genotypes and various phenotypes are not clear. In this study, we report identification of novel compound heterozygous mutations in TTC7A gene in a Malay girl with familial multiple intestinal atresias and severe combined immunodeficiency (MIA-SCID) by whole exome sequencing. We found two mutations in TTC7A: one that destroyed a putative splicing acceptor at the junction of intron 17/exon 18 and one that introduced a stop codon that would truncate the last two amino acids of the encoded protein. Reviewing the recent reports on TTC7A mutations reveals correlation between the position and nature of the mutations with patient survival and clinical manifestations. Examination of public databases also suggests carrier status for healthy individuals, making a case for population screening on this gene, especially in populations with suspected frequent founder mutations.

Impact of nursing home residence on hospital epidemiology of meticillin-resistant Staphylococcus aureus: a perspective from Asia

In a Singapore hospital practising meticillin-resistant Staphylococcus aureus (MRSA) admission screening, the relative risk for MRSA colonization for those admitted from nursing homes was 6.89 (95% confidence interval: 5.74-8.26; 41% of 190 vs 6.0% of 14,849). However, the MRSA burden on admission attributable to nursing home residence was low (6.9%). Risk factors independently associated with MRSA colonization in patients admitted from nursing homes were previous hospital admissions, broken skin, prior use of antibiotics and Chinese ethnicity. Low rates of nursing home use means that the overall impact of nursing home residence on MRSA in our hospital is low.

Diffusion-weighted magnetic resonance imaging in patients with known or suspected breast malignancy: Correlation between apparent diffusion coefficient and histopathologic diagnoses

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Background: Magnetic resonance imaging (MRI) is an important imaging modality for evaluating patients at high risk for breast malignancy. However, the role and utility of diffusion-weighted imaging (DWI) in breast MRI has not been fully elucidated. This study was designed to investigate the relationship between apparent diffusion coefficient (ADC) values and histopathologic diagnoses in benign and malignant breast pathologies as well as to assess the relative diagnostic value of this parameter.

Methods: We searched our database for patients who received breast MRI studies from February 2010 through March 2011. We then identified those patients who had either known or suspected breast malignancy and who had also undergone DWI. Breast abnormalities were identified through a review of the short tau inversion recovery (STIR) and T1-weighted pre- and post-contrast images. DWI images were evaluated and the corresponding ADC values were calculated. These lesions were correlated with histopathologic results when available.

Results: A total of 174 patient MRI studies were evaluated. Single dominant lesions were assessed and included biopsy-proven infiltrating ductal carcinoma (IDC), biopsy-proven ductal carcinoma in situ (DCIS), and benign lesions including cysts. The median ADC value for IDC was 118 x 10-5 mm2 s-1. The median ADC value for DCIS was 123 x 10-5 mm2 s-1. Finally, the median ADC value for breast cysts was 217 x 10-5 mm2 s-1.

Conclusions: As the role of MRI continues to evolve in the evaluation of breast pathology, the addition of DWI may increase diagnostic confidence for breast cancer, allowing for further differentiation from benign lesions. DWI is feasible to implement in many clinical practices and correlates with imaging features of breast cancer. The DWI images are acquired rapidly and without intravenous contrast. This method of imaging could be used in short intervals to assess treatment response to therapies such as biologic inhibitors or radiation therapy.

Analysis of Kerr effect in resonator fiber optic gyros with triangular wave phase modulation

We present an in-depth analysis of the Kerr effect in resonator fiber optic gyros (R-FOGs) based on triangular wave phase modulation. Formulations that relate gyro output to the rotation rate, the Kerr nonlinearity, and other fiber and gyro parameters are derived and used to study the effect of Kerr nonlinearity on the gyro performance. Numerical investigation shows that the Kerr effect results in a nonzero gyro output even when the gyro is at stationary, which is interpreted as an error in the measurement of rotation rate. This error was found to increase as the frequencies of the two triangular phase modulations deviate from each other, and is not zero even if the intensities of the two counterpropagating beams are exactly the same. For fixed frequencies of the triangular phase modulations, there exists an optimal intensity splitting ratio for the two counterpropagating beams, which leads to zero gyro error. Calculation shows that the measurement error due to the Kerr effect for an R-FOG with a hollow-core photonic bandgap fiber as the fiber loop can be one to two orders of magnitude smaller than an R-FOG with a conventional single mode fiber loop.

Comparative observation with MRI and pathology of brain edema at the early stage of severe burn

OBJECTIVE

To investigate the correlation between MRI features and pathology in brain edema at the early stage of severe burn (5 0% TBSA III degree) in dogs.

METHODS

Fifty-two dogs were randomized into control, simple b urn (SB), burn plus sodium lactate (BSL), and burn plus glucose solution groups (BGS). The manifestation of the brain of control group was compared with that of burn groups at 6, 12, 18 and 24 hours postburn with MRI and pathological examination (gross appearance, electron microscopy and light microscopy).

RESULTS

The earliest findings of brain edema were seen at 12 h ours after burn in BGS group, in which brain swelling was the main feature of MR I. The decrease of SIR on T(1)WI was not observed until it was exceeded 10%. Sig nal of T(2)WI increased by 8.29% at 24 hours after burn. It was difficult to distinguish the gray matter from the white matter at the boundary line, which became blurred later. Histological changes of brain edema were observed as early as 6 hours after burn, being accompanied by swelling of endothelial cells and peri-vescular astrocytes, and vacuolation took place in neurons at 12 hours after burn, with different degrees of necrosis of capillary endothelium, neurons, and axons. These changes became more marked with elapse of time. The BGS group showed the most obvious changes mentioned above at 24 hours after burn.

CONCLUSIONS

The model of the brain edema after severe burn has the feature of both vasogenic edema and cytotoxic edema on the MRI and pathology. Positive MRI findings lagged behind that of the pathomorphological changes.

[Application of triple-color flow cytometry for minimal residual disease detection in acute B-lymphoblastic leukemia]

OBJECTIVE

To set up a sensitive triple-color flow cytometric assay (FCM) for detection of residual leukemia cells.

METHODS

Application of triple-color flow cytometry to the patients for detecting CD(10)(+)CD(22)(+)CD(45)(- or dim) leukemic cells in acute B lymphoblastic leukemia (B-ALL).

RESULTS

Leukemic cells in B-ALL patients' bone marrow (BM) consistently showed the CD(10)(+)CD(22)(+)CD(45)(- or dim) phenotype. FCM analysis could detect leukemic cells at the level of 1 per 10(4) cells. The CD(10)(+)CD(22)(+)CD(45)(- or dim) cell population was absent in normal BM, regenerating BM, and BM from leukemia patients in continuous complete remission. This assay could identify residual leukemic cells in 50 days after starting induction chemotherapy. Furthermore, a gradual increase of leukemic cell population could be monitored by this assay before morphological confirmation of BM relapse.

CONCLUSION

Triple-color FCM was a sensitive method for detecting BM CD(10)(+)CD(22)(+)CD(45)(minus sign or dim) leukemic cells and could be an additional useful tool to monitor MRD in B-ALL patients.

[A canine model of brain edema established in the early postburn stage]

OBJECTIVE

To establish a canine model of brain edema in the early stage of severe burn.

METHODS

Mongrel dogs were inflicted by napalm with 50% TBSA III degree burn. The dogs were randomized into normal control (C), burn (B), burn with balanced salt solution (S) and burn with glucose (G) groups. The macropathological, histopathological and ultrastructural changes of brain tissue and brain water (%) were examined at 6, 12, 18 and 24 postburn hours (PBH), respectively, with simultaneous evaluation of blood brain barrier by (99) TC -- ECD.

RESULTS

Pathological evidence of brain edema exhibited at as early as 6 PBH in B, S and G groups, which included cellular swelling of partial endothelia and pericapillary astrocytes, and ischemic necrosis of endothelia, neurons and axons to varying degrees. All the changes exhibited more and more obvious with the elapse of postburn time. The brain water content in each burn group, especially in G group at 24 PBH, was more than that in C group. It was indicated by nuclide imaging that there appeared gradual increasing of the concentration of (99) TC -- ECD in brain tissue in B and C groups since 6 PBH.

CONCLUSION

This model was established for the convenience of burn scholars to study the pathogenesis and management of postburn brain edema.

[Cord blood plasma selectively stimulates the expansion of hematopoietic pregenitor cells in vitro]

OBJECTIVE

To explore the effect of cord blood (CB) plasma on the expansion of hematopoietic progenitor cells.

METHODS

The effect of CB plasma on the expansion of CB and bone marrow (BM)-derived hematopoietic progenitor cells was studies and compared with those of adult's peripheral blood (PB) plasma and cytokines such as IL-3 and SCF.

RESULTS

(1) CB plasma increased CFU yields of CB-derived progenitor cells by 2.23 +/- 0.52-fold and this expansion was dependent on CB plasma concentrations supplemented in the cultures. Greater expansion of progenitor cells was found when ABO was unmatched between the CB-derived cells and CB plasma. (2) Stimulating effect of CB plasma on BM-derived progenitor cells was also related to ABO type. CFU yields were increased by 1.55 +/- 0.43-fold when ABO was unmatched and not increased when ABO was matched. (3) Expansion of CB-derived progenitor cells by IL-3 and SCF was revealed. Significant increase in CFU yields occurred in the addition of both the cytokine and the CB plasma. (4) No expansion occurred in CB-and BM-derived cell cultures supplemented with PB plasma.

CONCLUSION

There is factor(s) selectively stimulating expansion of progenitor cells in CB plasma. It may be beneficial that CB plasma was transfused with CB-derived stem cell transplantation.

Psychosis and genes with trinucleotide repeat polymorphism

Abnormal expansion of genes with trinucleotide repeat (TNR) polymorphism has been found in a number of neuropsychiatric disorders. These disorders and the major psychoses, schizophrenia and bipolar affective disorder, appear to share an interesting phenomenon: genetic anticipation. Because TNR expansion correlates with anticipation, these unstable DNA sites are considered important candidate loci for the major psychoses. We investigated genes with TNR polymorphisms, including B1, B33, B37, and the N-cadherin gene, in unrelated Caucasian North American and Italian schizophrenics (n = 53 to 74), and matched controls. Also, unrelated Caucasian North American patients with bipolar I affective disorder were screened for the B33 and N-cadherin genes (n = 49 and 63, respectively). No unusually long alleles that would suggest abnormal expansion of the TNR were observed for any of these genes. Also, no statistically significant results were found in tests for genetic association between any of these genes and schizophrenia. For B37, a trend toward a difference in allele counts between schizophrenics and controls was observed. However, no clear evidence for a role of these TNR-containing genes in schizophrenia or bipolar affective disorders was found.

Collateral circulatory development in skeletal muscle

The arterial collateral anastomoses in rectus abdominis of the dog are employed as an animal model. The dynamic changes of collateral channels have been uncovered during roestablishment of collateral circulation. The experimental results display the 3 morphological characters, calibre dilatation, cell proliferation, and vessel reconstruction, at different time intervals in the collateral development. It provides evidence that some useful programme can be added to get a more effective collateral circulatory function in clinical practice.