Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of MAFB Gene and Literature Review

Multicentric carpo-tarsal osteolysis (MCTO) is a rare osteolysis syndrome mainly involving carpal and tarsal bones usually presenting in early childhood. MCTO has autosomal dominant inheritance with heterozygous mutation in the MAFB gene. The skeletal disorder is often associated with chronic kidney disease. Data on clinical characterization and best treatment option of MCTO-associated nephropathy are scarce and mostly limited to case reports. With the aim to better define the phenotype and long-term outcomes of MCTO-associated nephropathy, we launched an online survey through the Workgroup for hereditary glomerulopathies of the European Rare Kidney Disease Network (ERKNet). Overall, we collected clinical and genetic data of 54 MCTO patients, of which 42 previously described and 12 new patients. We observed a high rate of kidney involvement (70%), early age of kidney disease onset, nephrotic-range proteinuria, and a kidney survival around of 40% at long-term follow-up. Our finding confirmed the heterogeneity of clinical manifestations and widen the spectrum of phenotypes resulting from MCTO-associated nephropathy. Furthermore, we report the first case of complete remission after treatment with cyclosporine A. We demonstrated that multidisciplinary care is essential for MCTO patients and early referral to nephrologists is therefore warranted to facilitate prompt treatment.

FC067: Long-Term Outcome of Childhood Onset Idiopathic Nephrotic Syndrome

BACKGROUND AND AIMS

Little is known about the long-term outcome during adulthood of childhood onset idiopathic nephrotic syndrome (INS). We aimed to determine which patients require long-term follow up after transition, to identify risk factors of relapse and to analyze treatment strategies.

METHOD

In this monocentric retrospective study, we included all patients admitted in our adult nephrology department with INS diagnosed during childhood. Patients who reached kidney failure during childhood were excluded. Data regarding the outcome at adult age were obtained through clinical database and medical charts.

RESULTS

Eighty-two patients (male/female = 2/1) were included, with a median age at diagnosis of 3.9 years (1.2–16.5). Sixty-eight patients had steroid-sensitive INS, including 52 with steroid-dependent nephrotic syndrome or frequently relapsing nephrotic syndrome. Fourteen patients had steroid-resistant nephrotic syndrome. A total of 89% of patients received corticosteroid sparing treatment during childhood. Median follow-up during adulthood was 6.2 (0.3–25) years. A total of 71% of patients experienced at least one relapse during adulthood. The total number of relapses during childhood and the number of relapses per year during childhood, reflecting disease activity, were significantly higher in patients who experienced relapses during adulthood than in patients who did not (Figure 1). The risk of relapse during adulthood was also significantly associated with the need for immunosuppressive regimen at the time of the transition visit (P = 0.002). To promote the successful transition of young people, we propose to organize a transition visit where the adolescent/young adult is seen jointly by pediatric and adult nephrologists, as it was done for 68% of patients in this study. The relapse rate was significantly lower (50%) in the subgroup of patients who had such a transition visit. We also found that relapse during the first two-years of adulthood follow-up was significantly associated with the risk of further relapse, highlighting the need for a close follow-up during the transition period. A total of 45% of patients received corticosteroid sparing treatment during adulthood, mainly mycophenolate mofetil (N = 23), calcineurin inhibitors (N = 21) and rituximab (N = 12). The main complications were high blood pressure (20/82, 26%) and osteopenia (19/26, 73% when bone densitometry was performed). Only one thrombo-embolic event and three severe infections were reported. At last follow-up, median eGFR was 87.1 (23.4–150.8) mL/min/1.73 m².

CONCLUSION

The incidence of relapses in adulthood is high in patients with active disease during childhood. A long-term follow-up is mandatory in these patients. Whereas renal function remained normal in most patients, high blood pressure and osteopenia were frequent and should be carefully monitored during adulthood. Transition visit should be carefully coordinated to prevent the risk of nonadherence.

Psychrotrophic lactic acid bacteria used to improve the safety and quality of vacuum-packaged cooked and peeled tropical shrimp and cold-smoked salmon

Previously isolated lactic acid bacteria (LAB) from seafood products have been investigated for their capacity to increase the sensory shelf life of vacuum-packaged shrimp and cold-smoked salmon and to inhibit the growth of three pathogenic bacteria. Two different manufactured batches of cooked, peeled, and vacuum-packaged shrimp were inoculated with seven LAB strains separately at an initial level of 5 log CFU g-t, and the spoilage was estimated by sensory analysis after 7 and 28 days of storage at 8 degrees C. Two Leuconostoc gelidum strains greatly extended the shelf life of both batches, two Lactococcus piscium strains had a moderate effect, two bacteria were spoilers (Lactobacillus fuchuensis and Carnobacterium alterfunditum), and the last one (another Leuconostoc gelidum strain) showed highly variable results depending on the batch considered. The four strains showing the best results (two Leuconostoc gelidum and two Lactococcus piscium strains) were selected for the same experiment in cold-smoked salmon. In this product, Lactococcus piscium strains showed better inhibiting capacities, improving the sensory quality significantly at 14 and 28 days of storage. Finally, the inhibiting capacities of two strains (one Leuconostoc gelidum strain and one Lactococcus piscium strain) were tested against three pathogenic bacteria (Vibrio cholerae, Listeria monocytogenes, and Staphylococcus aureus) by challenge tests in shrimp. LAB and pathogenic bacteria were coinoculated in vacuum-packaged shrimp and enumerated during 5 weeks. Lactococcus piscium strain EU2241 was able to reduce significantly the number of Listeria monocytogenes and S. aureus organisms in the product by 2 log throughout the study for Listeria monocytogenes and up to 4 weeks for S. aureus.

Management of the multiple limb amputee

ISSUE

Multiple limb amputations involving at least one upper extremity are very uncommon. The amputation of both an upper and lower limb is even more uncommon. Due to the rarity of these amputations therapists are uncertain regarding the most appropriate treatment methods. While the majority of the protocols used for single limb amputations are appropriate for these multiple limb amputees, there are differences. Loss of multiple limbs creates a problem of overheating for the individual. Loss of an arm and leg results in difficulty donning the prostheses and difficulty using crutches and parallel bars during mobilization.

METHOD

A review is given of 16 multiple limb amputees seen in our rehabilitation centre in the last 15 years. Return to work was seen in one third and was not related to the number of the amputations. A higher proportion of these multiple limb amputations occur through alcoholism or attempted suicide behaviour than occurs with either single upper limb amputations or lower limb amputations. This existing behaviour can create a management problem for the rehabilitation team during rehabilitation.

CONCLUSION

Guidelines as to appropriate prosthetic and preprosthetic care are provided to assist the practitioner who has the acute and long term care of these patients. All multiple limb amputees should be referred to a specialized rehabilitation centre to discuss prosthetic options and long term rehabilitation requirements. This paper does not discuss bilateral lower limb amputations when not combined with an upper limb amputation.

Metalation of 4-oxazolinyloxazole derivatives. A convenient route to 2,4-bifunctionalized oxazoles

The synthesis of an array of 5-phenyloxazole derivatives bearing a variety of hydroxyalkyl groups at the C-2 position of the heterocyclic nucleus and possessing a formyl or a carboxyl function at C-4 is reported. These bifunctionalized compounds have been efficiently prepared by addition of carbonylated electrophiles to the 2-lithio derivative of 5-phenyloxazole preliminarily equipped with an oxazoline unit at the 4-position of the oxazole nucleus. It is demonstrated that this protocol offers a double advantage since it suppresses the troublesome electrocyclic ring-opening reaction and allows access to the target compounds by simple chemical transformation of the oxazoline ring system.

Synthesis and activity of a new methoxytetrahydropyran derivative as dual cyclooxygenase-2/5-lipoxygenase inhibitor

Dual COX-2/5-LO inhibitors are described as potential new therapeutic agents for inflammatory diseases. A surprisingly potent effect of a 5-LO pharmacophoric group on the COX-2 inhibition is presented as well as pharmacological in vitro and in vivo results.

Vinblastine-C4 alkyl maleoyl and amino acid maleoyl derivatives: III. Experimental antitumor activities of lactosaminated serum albumin conjugates

Vinblastine-C4 acyl derivatives were synthesized by linking alkyl maleoyl or amino acid maleoyl compounds through an ester linkage at C4 position of the Vindoline moiety of Vinblastine. To target these derivatives selectively to hepatoma, conjugates were prepared with a neoglycoprotein i.e. lactosaminated human albumin, as a specific carrier. The method of preparation of lactosaminated albumin and of coupling to Vinca alkaloid derivatives is described and the mechanism of addition of the protein to the derivative is discussed. The experimental antitumor activity of these conjugates has been screened against the experimental P-388 Leukemia. The activity of the best conjugate has been evaluated in several human tumor xenografts. Further, the therapeutic potential of this type of conjugate has been demonstrated in a model of hepatoma xenograft developed in our laboratory, the HepG2 carcinoma.

[Occlusive syndromes in pregnancy and puerperium. Apropos of 2 cases]

The authors recall the aetio-pathogenesis of intestinal obstruction in pregnancy and stress the difficulty of the diagnosis. They insist upon the importance of a simple and rapid surgical procedure which can be completed in the post-partum period if need be to prevent further episodes. From the obstetric point of view, the pregnancy usually progresses favourably, provided that an early delivery is induced routinely. Vaginal delivery is permissible, but should be assisted. The maternal prognosis depends on how early the diagnosis is made, but usually seems to be favourable. However, foetal mortality still remains high, between 10 and 15%.

Clinical evaluation of sequentially scheduled cisplatin and VM26 in neuroblastoma: response and toxicity

Cis-dichlorodiammineplatinum (CDDP) and VM26, both of which have been proven efficient in treating neuroblastoma, were combined in a sequential schedule and administered to 22 children with disseminated neuroblastomas resistant to treatment with cyclophosphamide and doxorubicin (Adriamycin). During this same study, 14 children were prospectively evaluated for the effect of CDDP on magnesium metabolism and the effect of the induced hypomagnesemia on parathyroid function. Complete or partial tumor responses were achieved in six and nine cases. Respectively and were of prolonged duration (longer than six months) in eight of the 15 responding. It was also shown that CDDP-induced hypomagnesemia is the result of excessive renal loss and is severe enough to interfere with the normal parathormone response to hypocalcemia.