PURPOSE: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a prognostic factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations and diagnostic methods of VUR after living donor kidney transplantation and their proper management with the results of each treatment. METHODS: We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Twenty-three patients underwent a corrective surgical procedure, ureteroneocystostomy, and we excluded 3 patients who underwent the procedure less than 1 year. The patients were divided into three groups: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI) and graft function were assessed for 1~7 years. Voiding cystoureterography (VCUG) was performed in patients with recurrent urinary tract infections and reflux was classified from Grade I to Grade IV. RESULTS: We examined immunological and non-immunological risk factors such as age, sex, primary diseases, duration on dialysis, diuresis prior to the treatment, donor selection, the degree of HLA mismatches, cold ischemia time, the incidence of acute rejection. There was no significant demographic difference among study groups except sex (female). Analysis of patients and grafts survival rates revealed no statistical differences among three groups. CONCLUSION: VUR dose not seem to negatively affect graft function if surgical correction were performed in proper period after the diagnosis. The indication of surgical correction of VUR is clinically significant UTIs, UTI sepsis, Grade III or IV VUR. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.
Cold Ischemia ; Diagnosis ; Dialysis ; Diuresis ; Donor Selection ; Follow-Up Studies ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Living Donors ; Prevalence ; Risk Factors ; Sepsis ; Survival Rate ; Transplantation ; Transplants ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

INTRODUCTION: Advanced breast cancer (ABC) remains common in Singapore. In 2019, 22.1% of breast cancer patients presented with ABC in our institution. Despite increasing affluence and the advent of national mammographic screening, the incidence of ABC has not changed significantly. This suggests inherent differences in women who present late. We aim to explore the socio-economic background, knowledge and attitudes of women who present with ABC. METHODS: Between December 2013 and July 2015, 100 patients who presented consecutively with ABC in a tertiary institution in Singapore were recruited to participate in an interviewer-led questionnaire exploring psychosocial and economic issues. RESULTS: Among the 100 patients, 63 and 37 presented with stages 3 and 4 breast cancer respectively. Median age was 57 (27-86), 52% had at least secondary education, 53% had no formal employment and 71% were married; 88% were aware of breast cancer symptoms, 82% were aware that mammography can help detect cancer, 82% believed that current treatment modality for breast cancer is effective, 96% had never undergone a mammography and 52.9% felt mammograms were unnecessary. A total of 64% presented symptomatic from the breast tumour, with a median duration of 3 months. Many of the patients were aware of breast cancer symptoms and the utility of mammography. However, a group of patients did not comply with screening. This may be due to poor understanding about breast screening and detection in its asymptomatic phase. CONCLUSION Further public education to improve understanding of breast cancer and screening mammography may help to improve rates for earlier detection of breast cancer.

The impact the metabolic syndrome (MetS) components on the severity of insulin resistance (IR) has not been reported. We enrolled 564 subjects with MetS and they were divided into quartiles according to the level of each component; and an insulin suppression test was performed to measure IR. In males, steady state plasma glucose (SSPG) levels in the highest quartiles, corresponding to body mass index (BMI) and fasting plasma glucose (FPG), were higher than the other three quartiles and the highest quartiles, corresponding to the diastolic blood pressure and triglycerides, were higher than in the lowest two quartiles. In females, SSPG levels in the highest quartiles, corresponding to the BMI and triglycerides, were higher than in all other quartiles. No significant differences existed between genders, other than the mean SSPG levels in males were greater in the highest quartile corresponding to BMI than that in the highest quartile corresponding to HDL-cholesterol levels. The factor analysis identified two underlying factors (IR and blood pressure factors) among the MetS variables. The clustering of the SSPG, BMI, triglyceride and HDLcholesterol was noted. Our data suggest that adiposity, higher FPG and triglyceride levels have stronger correlation with IR and subjects with the highest BMI have the highest IR.
Waist-Hip Ratio ; Triglycerides/blood ; Middle Aged ; Metabolic Syndrome X/*metabolism ; Male ; *Insulin Resistance ; Humans ; Female ; Fasting/blood ; Cholesterol, HDL/blood ; Body Mass Index ; Blood Glucose/analysis ; Aged ; Adult

Objective : To investigate the mechanism of sertoli/spermatogenic injury induced by cigarette smoke extract(CSE) based on ROS/NLRP3 signaling pathway. Methods : The sertoli/spermatogenic of rat were cultured in vitro , and they were divided into control group , cigarette Smoke extract (CSE) group and CSE + NLRP3 inflammosome inhibitor MCC950 group. Cell viability was detected by CCK⁃8 assay; Lactate dehydrogenase ( LDH) was used to detect cell membrane damage ; reactive oxygen species ( ROS) production was used to detect oxidative stress level ; Hoechst/PI fluorescent staining was used to detect cell pyroptosis. Real⁃time quantitative PCR ( RT⁃qPCR) was used to determine the mRNA level of NLRP3 , ASC , Caspase⁃1 , GSDMD , IL⁃1β and IL⁃18. Western blot was used to determine the protein level of NLRP3 , ASC , Caspase⁃1 , GSDMD , IL⁃1β and IL⁃18. Results: CCK⁃8 assay showed that cell viability decreased in CSE group (P < 0. 001) , LDH leakage rate (P < 0. 001) and ROS (P < 0. 001) production increased. Compared to the CSE group , cell viability increased (P < 0. 001) , LDH leakage rate (P < 0. 01) and ROS (P < 0. 001) production decreased in CSE + MCC950 group. The number of PI staining cells in CSE group was more than that in control group and CSE + MCC950 group , but staining cells in CSE + MCC950 group was less than that in CSE group. RT⁃qPCR and Western blot results showed that the expression levels of NLRP3 , ASC , Caspase⁃1 , GSDMD , IL⁃1β and IL⁃18 increased in CSE group but decreased in CSE+ MCC950 group. Conclusion The oxidative stress and inflammation of sertoli/spermatogenic induced by ciga⁃ rette smoke may be related to the activation of ROS/NLRP3 signaling pathway.