BACKGROUND: TGF-beta1 is the main fibrogenic cytokine associated with human glomerulonephritis. TGF-beta1 levels were found to be significantly increased in the urine of patients with IgA nephropathy. However, urinary TGF-beta1 excretion has so far not been evaluated with respect to the risk of kidney disease progression. METHODS: In the current study, urine samples were taken for TGF-beta1 protein analysis from 37 patients diagnosed with IgA nephropathy on the day of renal biopsy, and patients were followed until either the date of serum creatinine doubling or until the end of the follow-up period. RESULTS: The median follow-up was 3.6 years (range, 0.4-6.2 years). Urinary TGF-beta1/creatinine ratios (TGF-beta1/Cr, pg/mg) were significantly higher in IgA nephropathy patients than in normal controls (10.7+/-1.92 versus 2.38+/-0.52). The area under the receiver-operating-characteristics curve was 0.78 (P<0.05, 95% confidence interval 0.61-0.90), indicating that urinary TGF-beta1/Cr is an excellent predictor of kidney disease progression. Univariate Cox regression analysis showed that urinary TGF-beta1/Cr was the most powerful predictor of serum creatinine doubling (p=0.0026, relative risk 1.09, 95% confidence interval 1.03-1.15). Furthermore, multivariate Cox regression analysis adjusted for other confounders revealed that urinary TGF-beta1/Cr was the only significant predictor of serum creatinine doubling. In contrast, serum TGF-beta1 levels were not found to be a risk factor of kidney disease progression. CONCLUSION: Our findings provide new evidence of a robust association between urinary TGF-beta1 and kidney disease progression in patients with IgA nephropathy.
Biopsy ; Creatinine ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Kidney Diseases* ; Kidney* ; Risk Factors ; Transforming Growth Factor beta1

The aim of the present study was to examine the functional changes that occur when a rabbit carotid artery is cultured in serum-free medium. In endothelium (EC)-intact arteries cultured under serum-free conditions, acetylcholine (ACh)-induced relaxation responses were partially, yet significantly, reduced when compared with freshly isolated arteries. After pretreatment with N(G)-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, application of ACh resulted in a significant contraction in organ cultured arteries. The amplitude of the ACh-induced contractions increased with the duration of culture. In EC-denuded arteries cultured under serum-free conditions, ACh induced responses similar to those in EC-intact arteries pretreated with L-NAME. Furthermore, ACh caused a significant increase in intracellular Ca2+ concentration ([Ca2+]i) in EC-denuded arteries cultured under serum-free condition for 7 days. There was little change in either [Ca2+]i or tension in freshly isolated carotid rings. There was no difference in sodium nitroprusside-induced relaxation responses between fresh and cultured arteries. These results suggest that prolonged culture of carotid arteries under serum-free conditions changes the functional properties of vascular reactivity in rabbit carotid arteries.
Time Factors ; Rabbits ; Organ Culture Techniques/*methods ; Nitroprusside/pharmacology ; NG-Nitroarginine Methyl Ester/metabolism/pharmacology ; *Muscle Contraction ; Models, Statistical ; Dose-Response Relationship, Drug ; Culture Media, Serum-Free/metabolism ; Carotid Arteries/*drug effects/metabolism/*pathology ; Calcium/metabolism ; Animals ; Acetylcholine/*pharmacology

Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a highfrequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.

Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a highfrequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.

Objective: To categorize multiparametric MRI features of Bacillus Calmette–Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer. Materials and Methods: The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50–88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm2 ) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types. Results: The median lesion size was 22 mm with the interquartile range (IQR) of 18–26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen’s kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4–8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions. Conclusion BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.

Lysophosphatidylcholine (LPC), a metabolite of membrane phospholipids by phospholipase A(2), has been considered responsible for the development of abnormal vascular reactivity during atherosclerosis. Ca2+ influx was shown to be augmented in atherosclerotic artery which might be responsible for abnormal vascular reactivity. However, the mechanism underlying Ca2+ influx change in atherosclerotic artery remains undetermined. The purpose of the present study was to examine the effects of LPC on L-type Ca2+ current (ICa(L)) activity and to elucidate the mechanism of LPC-induced change of ICa(L) in rabbit portal vein smooth muscle cells using whole cell patch clamp. Extracellular application of LPC increased ICa(L) through whole test potentials, and this effect was readily reversed by washout. Steady state voltage dependency of activation or inactivation properties of ICa(L) was not significantly changed by LPC. Staurosporine (100 nanometer) or chelerythrine (3 micrometer, which is a potent inhibitor of PKC, significantly decreased basal ICa(L), and LPC-induced increase of ICa(L) was significantly suppressed in the presence of PKC inhibitors. On the other hand, application of PMA, an activator of PKC, increased basal ICa(L) significantly, and LPC-induced enhancement of ICa(L) was abolished by pretreatment of the cells with PMA. These findings suggest that LPC increased ICa(L) in vascular smooth muscle cells by a pathway that involves PKC, and that LPC-induced increase of ICa(L) might be, at least in part, responsible for increased Ca2+ influx in atherosclerotic artery.
Arteries ; Atherosclerosis ; Benzophenanthridines ; Dependency (Psychology) ; Hand ; Lysophosphatidylcholines ; Membranes ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Phospholipases ; Phospholipids ; Portal Vein ; Protein Kinase C ; Protein Kinases ; Staurosporine

Kaposi's sarcoma is one of the most serious complications associated with immune suppression treatment after kidney transplantation. Because it usually manifestations as skin lesions or lymphadenopathies, its clinical suspicion and tissue diagnosis is relatively easy. However, Kaposi's sarcoma presented as multiple pulmonary nodules without skin manifestations is not easily detected early and usually has a deadly prognosis. We present the case of a 36-year-old male who underwent kidney transplantation 13 months ago and has been on tacrolimus and mycophenolate mofetil (MMF)-based immune suppression presented dry cough, blood tinged sputum, and multiple pulmonary nodules without any skin lesions. Both bronchoscopic washing cytology and fine needle aspiration cytology of peripheral lung tissues were performed but failed due to low cellular yields. A video-assisted thoracoscopic biopsy subsequently revealed Kaposi's sarcoma. Following the diagnosis, we changed the immune suppression from a tacrolimus and MMF-based regimen to a sirolimus-based regimen. Respiratory symptoms gradually disappeared and we found complete remission on follow-up radiologic evaluations. Thus sirolimus may be the preferred method of treatment for patients with immune suppression after kidney transplantation.
Biopsy ; Biopsy, Fine-Needle ; Cough ; Follow-Up Studies ; Humans ; Kidney ; Kidney Transplantation ; Lung ; Male ; Multiple Pulmonary Nodules ; Mycophenolic Acid ; Prognosis ; Sarcoma, Kaposi ; Sirolimus ; Skin ; Skin Manifestations ; Sputum ; Tacrolimus ; Tolnaftate

PURPOSE: To describe the long-term results of deep sclerectomy with collagen implant (DSCI) with or without adjuvant mitomycin C in Korean patients with primary or secondary open-angle glaucoma (OAG). METHODS: This retrospective review was comprised of 65 Korean patients who received DSCI with or without adjuvant mitomycin C due to primary or secondary OAG. Patients were followed for 72 months after surgery. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with or without medication. RESULTS: Mean postoperative follow-up period was 53.0 +/- 16.2 months. Mean IOP was 30.5 +/- 11.7 mmHg preoperatively, 8.4 +/- 4.3 mmHg at postoperative day one and 13.4 +/- 3.8 mmHg 60 months after surgery. The mean number of glaucoma medications was decreased from 3.6 +/- 1.1 to 1.6 +/- 1.3 at 60 months after the operation. Complete and qualified success rates were 36.7% and 79.6% at postoperative 60 months, respectively (Kaplan-Meier survival curve). No shallow or flat anterior chamber, endophthalmitis, or surgery-induced significant cataract was observed. CONCLUSIONS: The results of DSCI in Korean patients presented here seem reasonably excellent with qualified success rates of over 70% at six years with negligible complications.
Adult ; Anterior Chamber/*surgery ; Collagen/*administration & dosage ; Drug Implants/*administration & dosage ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle/physiopathology/*surgery ; Humans ; Incidence ; Intraocular Pressure ; Male ; Postoperative Complications/epidemiology ; Postoperative Period ; Republic of Korea/epidemiology ; Retrospective Studies ; Sclera/*surgery ; Sclerostomy/*methods ; Time Factors ; Treatment Outcome ; Visual Acuity

PURPOSE: The prognostic significance of perineural invasion by prostate cancer is debated. We investigated the association between perineural invasion and clinicopathological factors and the effect of perineural invasion on survival in patients with prostate cancer. MATERIALS AND METHODS: A total of 361 patients with prostate cancer without any neoadjuvant therapies prior to surgery from 1999 to 2010 were analyzed retrospectively. Whole-mount sections of surgical specimens from all patients who underwent radical prostatectomy were evaluated. Positive perineural invasion was defined as infiltration of cancer cells in the perineurium or neural fascicles. The relationship of perineural invasion with clinicopathological features and prognosis of prostate cancer was studied. We also researched preoperative factors that were associated with perineural invasion. RESULTS: Perineural invasion in a prostatectomy specimen (PNIp) was positive in 188 of 361 patients (52.1%). In the multivariate analysis of the preoperative variables, PNIp was related to the primary Gleason grade (p=0.020), the number of positive cores (p=0.008), and the percentage of tumor cells in positive cores (p=0.021), but not to perineural invasion of a prostate biopsy. In the evaluation between PNIp and pathologic findings of the prostatectomy specimen, PNIp was related to the Gleason score (p=0.010), T-stage (p=0.015), and lymphovascular invasion (p=0.019). However, by multivariate analysis, the PNIp was not an independent prognostic factor of biochemical serum recurrence (p=0.364) or cancer-specific survival (p=0.726). CONCLUSIONS: PNIp was significantly related to biologically aggressive tumor patterns but was not a prognostic factor for biochemical serum PSA recurrence or cancer-specific survival in patients with prostate cancer.
Biopsy ; Humans ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Grading ; Neoplasm Invasiveness ; Peripheral Nerves ; Prognosis ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Retrospective Studies

Objectives: The aim of this study was to examine the clinical presentation, treatment delivery, and cisplatin eligibility of Korean patients with urothelial carcinoma (UC) in a real-world setting. Methods: We performed a retrospective cohort study of patients initially diagnosed with UC from March 2013 to June 2018. Creatinine clearance >60 mL/min and Eastern Cooperative Oncology Group performance status (0–1) were adopted as cisplatin eligibility criteria. Results: This study included 557 eligible patients. Median age was 71.0 years (range, 33–94 years), and males were dominant (80%). Primary tumor sites were: upper genitourinary tract, 18%; bladder, 81%; and urethra, 0.4%. Initial disease status was non-muscle invasive bladder cancer (313, 56%), diffuse infiltrating non-muscle invasive bladder cancer (19, 3%), cTanyN0 upper tract UC (75, 13%), cT2-4N0 bladder UC (82, 15%), TanyN1-3 UC (36, 7%), or initially metastatic UC (32, 6%). At the time of analysis (June 2019), following treatments were delivered to 134 patients with localized UC: radical operation with or without perioperative treatment (89, 67%), definitive chemoradiation (7, 5%), and palliative surgery or supportive care only (36, 28%). In total, 89 patients had metastatic UC, including those with recurrent disease (n=57), and 34 (38%) of the 89 were eligible for cisplatin. Conclusion Clinical presentations in East Asian UC patients were consistent with those of previous studies in other countries, except for a relatively high incidence of upper genitourinary tract. Our results can serve as a benchmark for further advances and future research for treatments of UC in East Asian patients.