Changing Pattern of Presentation in Monoclonal Gammopathy of Undetermined Significance: A Study on 1400 Cases

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2706-2706
Author(s):  
Marzia Varettoni ◽  
Gian Matteo Pica ◽  
Federica Cocito ◽  
Silvia Mangiacavalli ◽  
Cristiana Pascutto ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Malignant Transformation ◽  
Monoclonal Gammopathy ◽  
M Protein ◽  
Group Iii ◽  
Β2 Microglobulin ◽  
Group I ◽  
Group Ii ◽  
Over Time ◽  
Undetermined Significance

Abstract Background. Monoclonal gammopathy of undetermined significance (MGUS) is defined by the presence of a serum M-protein <3 g/dL, bone marrow plasma cells (BMPC) <10% and absence of end-organ damage. The risk of malignant transformation is 1% per year. Size and type of M-protein and an abnormal serum free-light chains (FLC) ratio at diagnosis are reported as the main risk factors for transformation. Aims of the study. To evaluate whether the pattern of presentation of MGUS has changed over the last three decades. Patients and methods. The charts of MGUS patients (pts) diagnosed from 1975 to 2007 were reviewed. The following data were gathered: age, sex, haemoglobin (Hgb), type and size of serum M-protein, uninvolved Ig levels, serum FLC, urine M-protein, BMPC, serum albumin and β2-microglobulin. The study included 1400 pts divided into three groups according to the date of diagnosis: 1975–1987 (group I, 102); 1988–1997 (group II, 380); 1998–2007 (group III, 918). Differences among groups were evaluated using chi-square test for categorical variables and Kruskal-Wallis non-parametric Anova for numerical variables. A P-value ≤0.05 was considered statistically significant. Results., The median age of patients was 63 years (range 20–92), 740 were males and 660 females. The median time from the first detection of M-protein to diagnosis of MGUS was 3.2 months (range 1–264). Serum M-protein was 73% IgG, 13% IgM, 11% IgA, 3% biclonal; light chain was k in 63% of pts, λ in 37%. The serum M-protein was <1 g/dL in 284 patients (21%), 1–1.5 g/dL in 502 (36%), 1.5–2 g/dL in 373 (27%) and ≥2 g/dL in 216 (16%). M-protein size was not reported in 25 cases. The median levels of uninvolved IgG, IgM and IgA were 1350 mg/dL (range 110–7460), 94 mg/dL (range 40–4680) and 162 mg/dL (range 22–2370) respectively. In 236 evaluable pts, median levels of serum FLC k and λ were 17.1 mg/L (range: 1.4–423) and 17.3 mg/L (range: 2–299). Urine M-protein was detected in 19% of pts with a median level of 23.8 mg/L (range 4–450). The median BMPC percentage was 5 (range: 1–10). The median values of Hgb, serum albumin and β2-microglobulin were 14 g/dL (range: 8.6–19.7), 4.3 g/dL (range 2.5–6) and 1930 mcg/L (range 865–44300) respectively. The comparison among the three groups showed statistically significant reduction of serum M-protein levels (p<0.0001), BMPC (p<0.0001), β2-microglobulin (p=0.0001) and increase of Hgb (p<0.0001) and albumin (p=0.0001) over time. In particular, the proportion of pts with a serum M-protein <1 g/dL increased from 4% in group I to 12% in group II and to 26% in group III. A serum M-protein ≥2 g/dL was present in 35%, 22%, 11% of pts in the three groups respectively (p<0.0001). With a median follow-up was 40 months (range: 3–396), corresponding to 7577 person-year, the cumulative probability of malignant transformation was 9%, 18%, 28% at 5, 10, 15 years respectively. Group III pts had a significantly lower 5-year probability of transformation (5%) as compared to groups I and II (20% and 11% respectively). Conclusions. The pattern of presentation of MGUS has changed over time. Patients diagnosed in the last decade have more favourable presenting features as compared to those diagnosed before. This could be due to the availability of more sensitive diagnostic techniques able to detect minimal M-proteins. Another possible explanation is that pts are more frequently and promptly referred by their treating physicians to an hematologic centre, allowing an earlier diagnosis. Both circumstances could led to the identification of a subset of pts with different presentation and maybe a better outcome with respect to the MGUS diagnosed in the past decades. This could entail a different approach of physicians in the management of MGUS patients.

566 Persistent Sleep Apnea and Desaturation in Preterm Children at 18 Months of Age at High Altitude (2640 M)

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A223-A224
Author(s):  
Elida Duenas-Meza ◽  
Maria Escamilla ◽  
Laura Rincon ◽  
Andrea Parra ◽  
Maria Bazurto-Zapata ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
High Altitude ◽  
Apnea Hypopnea Index ◽  
Age Group ◽  
Preterm Children ◽  
Desaturation Index ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Over Time

Abstract Introduction Children born at term who live at high altitude (HA) (≥ 2500 m) have different respiratory patterns from those that live at sea level. It is essential to determine these patterns in preterm children due to their high risk of Sleep Apnea-Hypopnea Syndrome (SAHS). The evolution of the apnea hypopnea index (AHI), desaturation index (ODI), and oxygen saturation (SpO2) is unknown in this group at HA. The objective was to characterize the respiratory patterns during sleep of preterm children living at HA and compare it with those of healthy children born at term. Methods We conducted a cross-sectional study in Bogotá, Colombia (altitude: 2640 m). We included 302 children, 127 were preterm with an average of gestational age of 31weeks (SD: 2.9) and an average weight at birth of 1600 g (SD: 594) and 175 healthy full-term infants. Three groups were defined according to age: Group I: 3–4 months, Group II: 6–7 months,, Group III: 10–18 months. All children underwent nocturnal polysomnogram to evaluate their respiratory variables: AHI, average and minimum SpO2, ODI, and T90 during sleep and analyzed the data according to the parameters of the American Academy of Sleep Medicine Results 302 polysomnograms were performed, 54.3% were girls and were distributed by groups as follows: Group I:105 patients (34.8%), 16 preterm, Group II: 107 patients (35.4%), 46 preterm and Group III: 90 patients (29.8%), 65 preterm. We observed higher respiratory parameters within each age strata in premature infants compared to children born at term. Preterm infants had higher ODI, AHI, obstructive apnea hypopnea index (O-AHI), and Central Apnea hypopnea index (C-AHI). Although the effect decreases over time, we found a significant difference in the first age group. There was a high persistence index in children with a history of preterm birth living at high altitude. We also found a significant decrease in AHI, ODI across time in healthy and preterm children p<0.01 Conclusion Premature children living at HA persist with higher ODI and AHI compared to children of similar ages born at term. The high desaturation index indicates the presence of intermittent hypoxia that persists in these children over time Support (if any):

Long-Term Correction of Albumin Levels in the Nagase Analbuminemic Rat: Repopulation of the Liver by Transplanted Normal Hepatocytes under a Regeneration Response

1996 ◽  
Vol 5 (4) ◽  
pp. 499-503 ◽  
Author(s):  
Albert D. Moscioni ◽  
Jacek Rozga ◽  
Steve Chen ◽  
Arjang Nam ◽  
Henri S. Scott ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Genetic Defect ◽  
Experimental Period ◽  
Sprague Dawley ◽  
Portal Branch ◽  
Group Iii ◽  
Group I ◽  
Portal Branch Ligation ◽  
Group Ii

Numerous studies have reported successful transplantation of hepatocytes with demonstration of function. However, none have shown long-term correction of a liver-related metabolic defect. Male Nagase analbuminemic rats, immunosuppressed with cyclosporin-A, were transplanted with normal hepatocytes (2 × 107 cells/rat) isolated from allogeneic male Sprague–Dawley rat donors. Hepatocytes were selectively transplanted via the portal vein tributary into the posterior liver lobes of Nagase analbuminemic rats. Following 2 wk, to allow engraftment, selected transplanted rats (Group I) were reoperated and the portal venous branch supplying the anterior liver lobes was permanently ligated, resulting in their atrophy and induction of regeneration in the residual transplant-bearing lobes. Control rats consisted of: Group II—transplanted with normal hepatocytes without portal branch ligation; Group III—transplanted with analbuminemic hepatocytes with portal branch ligation; and Group IV—nontransplanted analbuminemic rats with portal branch ligation. The experimental period extended to 3 mo posttransplantation. All rats transplanted with normal hepatocytes demonstrated a significant elevation in serum albumin levels (ELISA). Group I rats had dramatic elevations in serum albumin to near normal levels (1.78 ± 0.20 g/dl), and maintained these levels until the end of the experiment Albumin levels in Group II rats reached 0.26 ± 0.07 g/dl (p < 0.001), whereas Group III and IV rats showed no changes in serum albumin levels throughout the experiment Immunohistology of liver tissue obtained from Group I rats, demonstrated large numbers (22.6 ± 7.5%) of albumin-positive hepatocytes populating the recipient liver. This is the first report of near-total and sustained correction of a genetic defect in liver function in an experimental animal model following allogeneic hepatocyte transplantation.

Ultrastructural Lesions Produced by Alcohol and Sucrose in the Heart and Liver of C57BL Mice

1970 ◽  
Vol 28 ◽  
pp. 208-209
Author(s):  
K.K. SEKHRI ◽  
C.S. ALEXANDER ◽  
H.T. NAGASAWA
Keyword(s):  
Osmium Tetroxide ◽  
Male Mice ◽  
Alcohol Group ◽  
Group Iii ◽  
Group I ◽  
C57bl Mice ◽  
Group Ii

C57BL male mice (Jackson Lab., Bar Harbor, Maine) weighing about 18 gms were randomly divided into three groups: group I was fed sweetened liquid alcohol diet (modified Schenkl) in which 36% of the calories were derived from alcohol; group II was maintained on a similar diet but alcohol was isocalorically substituted by sucrose; group III was fed regular mouse chow ad lib for five months. Liver and heart tissues were fixed in 2.5% cacodylate buffered glutaraldehyde, post-fixed in 2% osmium tetroxide and embedded in Epon-araldite.

Heterogeneity and Immunochemical Properties of Anti-β2-glycoprotein I Autoantibodies

1998 ◽  
Vol 80 (09) ◽  
pp. 393-398 ◽  
Author(s):  
V. Regnault ◽  
E. Hachulla ◽  
L. Darnige ◽  
B. Roussel ◽  
J. C. Bensa ◽  
...  
Keyword(s):  
Fluid Phase ◽  
Anticardiolipin Antibodies ◽  
Dual Reactivity ◽  
Group Iii ◽  
Important Group ◽  
Epitope Specificity ◽  
Glycoprotein I ◽  
Group I ◽  
Group Ii ◽  
Sufficient Concentration

SummaryMost anticardiolipin antibodies (ACA) associated with antiphospholipid syndrome (APS) are directed against epitopes expressed on β2-glycoprotein I (β2GPI). Despite a good correlation between standard ACA assays and those using purified human β2GPI as the sole antigen, some sera from APS patients only react in the latter. This is indicative of heterogeneity in anti-β2GPI antibodies. To characterize their reactivity profiles, human and bovine β2GPI were immobilized on γ-irradiated plates (β2GPI-ELISA), plain polystyrene precoated with increasing cardiolipin concentrations (CL/β2GPI-ELISA), and affinity columns. Fluid-phase inhibition experiments were also carried out with both proteins. Of 56 selected sera, restricted recognition of bovine or human β2GPI occurred respectively in 10/29 IgA-positive and 9/22 IgM-positive samples, and most of the latter (8/9) were missed by the standard ACA assay, as expected from a previous study. Based on species specificity and ACA results, IgG-positive samples (53/56) were categorized into three groups: antibodies reactive to bovine β2GPI only (group I) or to bovine and human β2GPI, group II being ACA-negative, and group III being ACA-positive. The most important group, group III (n = 33) was characterized by (i) binding when β2GPI was immobilized on γ-irradiated polystyrene or cardiolipin at sufficient concentration (regardless of β2GPI density, as assessed using 125I-β2GPI); (ii) and low avidity binding to fluid-phase β2GPI (Kd in the range 10–5 M). In contrast, all six group II samples showed (i) ability to bind human and bovine β2GPI immobilized on non-irradiated plates; (ii) concentration-dependent blockade of binding by cardiolipin, suggesting epitope location in the vicinity of the phospholipid binding site on native β2GPI; (iii) and relative avidities approximately 100-fold higher than in group III. Group I patients were heterogeneous with respect to CL/β2GPI-ELISA and ACA results (6/14 scored negative), possibly reflecting antibody differences in terms of avidity and epitope specificity. Affinity fractionation of 23 sera showed the existence, in individual patients, of various combinations of antibody subsets solely reactive to human or bovine β2GPI, together with cross-species reactive subsets present in all samples with dual reactivity namely groups III and II, although the latter antibodies were poorly purified on either column. Therefore, the mode of presentation of β2GPI greatly influences its recognition by anti-β2GPI antibodies with marked inter-individual heterogeneity, in relation to ACA quantitation and, possibly, disease presentation and pathogenesis.

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

2015 ◽  
Vol 18 (3) ◽  
pp. 098
Author(s):  
Cem Arıtürk ◽  
Serpil Ustalar Özgen ◽  
Behiç Danışan ◽  
Hasan Karabulut ◽  
Fevzi Toraman
Keyword(s):  
Body Temperature ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Extracorporeal Circulation ◽  
Group Iii ◽  
Oxygen Fraction ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

<p class="p1"><span class="s1"><strong>Background:</strong> The inspiratory oxygen fraction (FiO<sub>2</sub>) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO<sub>2</sub>) to reach hyperoxemic levels (&gt;180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO<sub>2</sub> levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO<sub>2</sub> levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO<sub>2</sub> during cardiac surgery.</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO<sub>2</sub> adjustment strategies applied to the patients in the groups were as follows: FiO<sub>2</sub> levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).</span></p><p class="p1"><span class="s1"><strong>Results:</strong> Mean PaO<sub>2</sub> was significantly higher in Group I than in Group II at T2 and T3 (<em>P</em> = .0001 and <em>P</em> = .0001, respectively); in Group I than in Group III at T1 (<em>P</em> = .02); and in Group II than in Group III at T2, T3, and T4 <br /> (<em>P</em> = .0001 for all). </span></p><p class="p1"><span class="s1"><strong>Conclusion: </strong>Adjustment of FiO<sub>2</sub> according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO<sub>2</sub> between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO<sub>2</sub> levels in concordance with the body temperature in the <br /> rewarming period.</span></p>

Features of the cervix uteri in women of reproductive age with endometrial polyps and micropolyps

2016 ◽  
pp. 108-111
Author(s):  
T.F. Tatarchuk ◽  
◽  
D.G. German ◽  
Keyword(s):  
Reproductive Age ◽  
Cervix Uteri ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Endometrial Polyps ◽  
Group Iii ◽  
Aggressive Form ◽  
Group I ◽  
Group Ii ◽  
Control Group Group

The article presents the comparative analysis of the state of the cervix in women with endometrial polyps and micropolyps. Patients and methods. The study involved 130 patients aged 18-35 years: 70 patients with endometrial polyps (group I), 30 patients with micropolyps (group II) and 30 patients of the control group (group III). Results. According to the anamnesis of women in the I group were significantly more frequent diseases of the cervix, which corrected physical surgery methods, in particular cryodestruction. In group II, the representatives of these indicators were similar to healthy. Normal colposcopic picture met significantly less frequently in patients and I, and II group. The differences in the incidence of HPV high oncogenic risk in all groups were not statistically significant. Conclusion. Destructive methods used in the detection of any changes in the cervix are often overly aggressive, form scars and contributing to inflamaciones process. In the chain of events leading to the formation of PE, cervical pathology and its correction can take the basic place. Key words: endometrial polyp, micropolyps, chronic endometritis, uterine cervix, colposcopy.

THE USE OF BOLUSES REDUCES THE NEGATIVE EFFECT OF SUBCLINICAL KETOSIS ON THE REPRODUCTIVE FUNCTION OF HIGHLY PRODUCTIVE COWS

2020 ◽  
Author(s):  
Г.В. ШИРЯЕВ ◽  
Ю.Г. ТУРЛОВА ◽  
Г.С. НИКИТИН
Keyword(s):  
Reproductive Function ◽  
Sexual Cycle ◽  
Feed Additive ◽  
Hydroxybutyric Acid ◽  
Subclinical Ketosis ◽  
Group Iii ◽  
Group I ◽  
Negative Effect ◽  
Group Ii ◽  
Reproductive Indices

Изучено влияние кормовой добавки в форме индивидуальных болюсов Метраболь на возможность снижения негативного влияния субклинического кетоза (СКК) и результативность искусственного осеменения высокопродуктивных молочных коров в посттранзитный период. Животные были подобраны по принципу условных аналогов и разделены на 3 группы в зависимости от концентрации β-оксимасляной кислоты в их крови. В I группе (n=18) у коров не было СКК, концентрация кислоты составляла <1,0 ммоль/л, во II группе (n=21) у животных зарегистрирован СКК, концентрация кислоты — 1,0…1,4 ммоль/л. С целью поиска решения по снижению негативного влияния СКК на репродуктивные показатели была сформирована III группа коров, переболевших СКК (n=24) с концентрацией β-оксимасляной кислоты в крови 1,0…1,4 ммоль/л, но с использованием болюсов, применяемых для ускоренного восстановления репродуктивной функции коров после отела. Важной составляющей опыта явилось то, что к моменту гормональной синхронизации у коров всех 3 групп фиксировалось отсутствие СКК (снижение β-оксимасляной кислоты до уровня <1,0 ммоль/л). Для синхронизации полового цикла выбрана схема Пресинх-овсинх. Установлено, что гормональная синхронизация животных, перенесших СКК, в сравнении со здоровыми, не позволяет снизить негативное влияние данного нарушения обмена веществ. Во II группе у животных зафиксированы самые низкие репродуктивные показатели (количество использованных доз; индекс осеменения, сервис-период; время от первого до успешного осеменения; результат первичного осеменения; количество животных, осемененных 3 и более раз). В III группе применение болюсов позволило, в сравнении с животными II группы, не только избежать отрицательного воздействия СКК, но и превзойти по изучаемым параметрам животных из I группы. The effect of the feed additive in the form of individual boluses Metrabol on the possibility of reducing the negative effect of subclinical ketosis (CCK) and the effectiveness of artificial insemination of highly productive dairy cows in the post-transit period was studied. The animals were selected according to the principle of conditional analogs and divided into 3 groups depending on the concentration of β-hydroxybutyric acid in their blood. In group I (n=18), the cows did not have SSC, the acid concentration was <1.0 mmol/L, in group II (n=21), SSC was registered in animals — 1.0...1.4 mmol / L. In order to find a solution to reduce the negative effect of CCB on reproductive indices, a group III of cows was formed who had CCB (n = 24) with a concentration of β-hydroxybutyric acid in their blood of 1.0...1.4 mmol/L, but using boluses, used to accelerate the restoration of the reproductive function of cows after calving. An important component of the experiment was that by the time of hormonal synchronization, cows of all 3 groups had no SSC (decrease in β-hydroxybutyric acid to a level of <1.0 mmol/L). To synchronize the sexual cycle, the Pressinh-ovsinh scheme was chosen. It was found that hormonal synchronization of animals that underwent SSC, in comparison with healthy ones, does not allow reducing the negative effect of this metabolic disorder. In group II, animals had the lowest reproductive indices (number of doses used; insemination index, service period; time from first to successful insemination; result of primary insemination; number of animals inseminated 3 or more times). In group III, the use of boluses made it possible, in comparison with animals of group II, not only to avoid the negative effect of SSC, but also to surpass the animals from group I in terms of the studied parameters.

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