Month: May 2017

Background and Purpose Although bevacizumab (BV) has been approved as second-line therapy for recurrent glioblastoma (GB) the efficacy and safety of BV for patients with newly diagnosed GB remain unclear. 3.33 95 CI 2.73-4.06 p<0.00001) and 12 months (OR 2.10 95 CI 1.74-2.54 p<0.00001). There were no significant differences in median overall survival between the BV and ST groups (OR 1.01 95 0.83 P = 0.95). The BV group had higher survival rates at 6 months (OR 1.41 95 CI 1.09 P Carfilzomib = 0.01) and 12 months (OR 1.23 95 CI 1.02 P = 0.03) but a low survival rate at the 36-month follow-up (OR 0.57 95 CI 0.32 P = 0.04). For the incidence of adverse events three adverse outcomes were found to be significantly different between BV and ST groups including hypertension (8.37% vs. 1.62% p<0.000001) proteinuria (7.65% vs. 0% p<0.001) and fatigue (14.54% vs. 9.01% p = 0.05). Conclusions/Significance Our Carfilzomib study indicates that combination of BV with ST for newly diagnosed GB did not improve the median overall survival but result in longer median PFS maintaining the quality of life and functional status. However the long-term use of BV is associated with a higher incidence of adverse events and mortality. Study Registration This research was registered at PROSPERO. (Registration Number: CRD42016038247). Introduction Glioblastoma (GB) the most common primary malignant brain tumor in adults has a dismal prognosis with a median survival of 14 to 16 months [1]. Even with the best available standard therapies (surgical resection followed by radiotherapy and temozolomide) the prognosis of patients with GB remains low [2 3 When GB recurs the median overall survival is typically 3 to 9 months and available therapies have a limited impact on outcome [4]. Therefore development of new therapies is essential to improve the overall survival and prognosis of patients with newly diagnosed GB. During the past decade a large number of Carfilzomib targeted therapeutic agents have been developed and evaluated. GB is highly vascular and typically overexpresses vascular endothelial growth factor (VEGF) which promotes tumor angiogenesis contributing to tumor growth and progression [5-7]. Several clinical trials have suggested that VEGF could be a therapeutic target [8 9 The U.S. Food and Drug Administration (FDA) approved bevacizumab (BV) a humanized monoclonal antibody to VEGF for second-line treatment of recurrent GB [10 11 Despite its prolongation of progression-free survival (PFS) in patients with recurrent GB the impact of BV on overall survival remains undefined. Several clinical trials have reported that treatment with combinations of BV and other chemotherapeutic agents results in stable responses and a prolonged 6-month PFS rate in patients with recurrent high-grade Carfilzomib glioma but do not significantly prolong overall survival (OS) compared with previous trials [12-16]. Furthermore most of the complications caused by the toxicity of the combined chemotherapy led to discontinuation of treatment for patients with GB [17]. In 2009 2009 Zhang et al. conducted a meta-analysis to assess the efficacy and safety of BV alone compared with BV and irinotecan for recurrent GB [18]. The results indicated that the combination of BV and irinotecan may increase the rate of discontinuation and that there was no obvious improvement in overall survival in patients with recurrent GB. Furthermore this research included only nonrandomized control trials or small-sample retrospective studies. The data from low-quality research results in significant heterogeneity. From 2009 onward several randomized controlled trials (RCTs) were conducted to assess the effectiveness of BV for newly diagnosed GB [19-26]. Therefore it became necessary to Carfilzomib conduct a meta-analysis to assess the clinical efficacy of BV compared with standard therapy (ST) or other chemotherapies for newly diagnosed GB and Carfilzomib to evaluate the safety and adverse effects of these combinations. Materials and Methods There is no necessary for ethic approval in this meta-analysis which mainly based on the published studies. This Hsh155 study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [27]. Literature Search and Study Selection Two reviewers (GY.L and MZ.H) performed the literature searching on the BV for patients with newly diagnosed GB to identify relevant articles published between January 1966 and August 2016. Electronic search used “bevacizumab” “avastin” “chemotherapy” “glioblastoma” “newly diagnosed glioblastoma” “GB” in Mesh and free terms. We searched PubMed EMBASE and the Cochrane Library to identify relevant studies. Manual searches.

Renal cortical necrosis (RCN) is a rare cause of acute renal failure (ARF). case report of RCN in a live kidney donor in world literature. Keywords: Acute renal failure hemolytic uremic syndrome live kidney donor renal cortical necrosis Introduction Renal cortical necrosis (RCN) is usually a rare entity and is secondary to ischemic necrosis of renal cortex caused by vascular spasm microvascular injury or intravascular coagulation. RCN accounts for 3% of all cases of acute kidney injury (AKI) in adults.[1] Obstetric and nonobstetrical causes account for 50 to 70% and 20 to 30% cases of RCN respectively.[1-3] Severe sepsis with shock is the PD173074 most common (30-40%) nonobstetrical cause of RCN.[2 3 Drug-induced thrombotic microangiopathy is an important cause of RCN.[4 5 However RCN has not been previously reported in a live kidney donor. Case Report A 48-year-old normotensive nondiabetic healthy female donor was admitted for left nephrectomy for kidney transplantation to her daughter. Computed tomography (CT) renal angiography showed normal kidneys and urinary tracts as well as normal renal arteries originating from the aorta and branching well into the renal parenchyma [Physique ?[Physique1a1a and ?andb].b]. Diethylene-triamine-penta-acetic acid (DTPA) scan revealed total glomerular filtration rate (GFR) of 100.1 ml/min with differential function of 51.8% and 48.2% for the right and left kidneys respectively. Left nephrectomy was done and was transplanted successfully to the recipient. The donor was hemodynamically stable throughout the operation. The medications used during the operation were glycopyrrolate vecuronium propofol isoflurane nitrous oxide neostigmine bupivacaine fentanyl furosemide 120 mg and mannitol 70 g (350 ml of 20% answer). She received total of 5200 ml PD173074 of fluid and urine output was 3400 ml during the time she was in operation theater for 2 hours. The surgery was uneventful as was the immediate postoperative recovery from anesthesia. She did well with urine output of >1.48 l/h for 2 hours and 1.25 l/h in subsequent 2 hours. In the fifth postoperative hour her urine output decreased to 750 ml/h and subsequently to 50-60 ml/h in sixth and seventh hours after surgery and she became anuric at eighth postoperative hour. After ruling out catheter obstruction and dehydration she was given furosemide infusion at 60 mg/h which resulted in only 110 ml of urine output in next 2 hours followed by no output. Doppler study revealed patent renal vessels PD173074 with good blood flow and absence of obstruction of urinary tract. Around the first postoperative day (POD) she was hemodialyzed for 3 hours because of fluid overload. Laboratory investigations on POD1 revealed hemoglobin of 7.7 g/ dl thrombocytopenia leukocytosis hyperbilirubinemia elevated lactate dehydrogenase (LDH) (1222 IU/l) and INR of 1 1.12. Peripheral PD173074 smear revealed anisocytosis and few normoblasts with fragmented red blood cells PD173074 (RBCs). In view of low platelet count raised LDH drop in hemoglobin along with normal INR a diagnosis of hemolytic uremic syndrome (HUS) was made [Table 1]. She was transfused with two models of whole blood on POD3 due to drop in hemoglobin concentration to 5.3 g/dl. Chest X-ray on POD3 showed right lower zone pneumonia and she was treated Rabbit polyclonal to ACC1.ACC1 a subunit of acetyl-CoA carboxylase (ACC), a multifunctional enzyme system.Catalyzes the carboxylation of acetyl-CoA to malonyl-CoA, the rate-limiting step in fatty acid synthesis.Phosphorylation by AMPK or PKA inhibits the enzymatic activity of ACC.ACC-alpha is the predominant isoform in liver, adipocyte and mammary gland.ACC-beta is the major isoform in skeletal muscle and heart.Phosphorylation regulates its activity.. with cefpirome 2 g/day ofloxacin 200 mg/time and azithromycin 250 mg OD. She became afebrile on POD4. Her upper body infections improved; thrombocytopenia raised LDH and bilirubin became regular; and leucocytosis demonstrated a downward craze at POD11. Body 1 Kidney ureter and renal vessels of living donor (Mom). (a) Volume-rendered (VR) picture showing regular kidneys and urinary tracts bilaterally; (b) Optimum strength of projection (MIP) displaying bilateral regular renal arteries from aorta … Desk 1 Clinical features of kidney donor pursuing nephrectomy Because of consistent anuria she was put through contrast-enhanced CT (CECT) check of abdominal on POD28 which uncovered features of severe RCN in correct kidney [Body ?[Body1c1c and ?andd].d]. She was discharged on POD30 with great BP control on amlodipine (15 mg/time) and clonidine (0.3 mg/day) and informed to keep maintenance hemodialysis. At two-month follow-up her antihypertensive necessity reduced as well as her urine output increased to 125 ml/day and at the end of fourth month her urine output was 400 ml/ day. Three months after operation she developed right lower lobe pneumonitis which.