• Association between Serum Cystatin C and Diabetic Foot Ulceration in Patients with Type 2 Diabetes: A Cross-Sectional Study

      Zhao, Jie; Deng, Wuquan; Zhang, Yuping; Zheng, Yanling; Zhou, Lina; Boey, Johnson; Armstrong, David G.; Yang, Gangyi; Liang, Ziwen; Chen, Bing; et al. (HINDAWI PUBLISHING CORP, 2016)
      Serum cystatin C (CysC) has been identified as a possible potential biomarker in a variety of diabetic complications, including diabetic peripheral neuropathy and peripheral artery disease. We aimed to examine the association between CysC and diabetic foot ulceration (DFU) in patients with type 2 diabetes (T2D). 411 patients with T2D were enrolled in this cross-sectional study at a university hospital. Clinical manifestations and biochemical parameters were compared between DFU group and non-DFU group. The association between serum CysC and DFU was explored by binary logistic regression analysis. The cut point of CysC for DFU was also evaluated by receiver operating characteristic (ROC) curve. The prevalence of coronary artery disease, diabetic nephropathy (DN), and DFU dramatically increased with CysC ( P < 0.01 ) in CysC quartiles. Multivariate logistic regression analysis indicated that the significant risk factors for DFU were serum CysC, coronary artery disease, hypertension, insulin use, the differences between supine and sitting TcPO 2 , and hypertension. ROC curve analysis revealed that the cut point of CysC for DFU was 0.735 mg/L. Serum CysC levels correlated with DFU and severity of tissue loss. Our study results indicated that serum CysC was associated with a high prevalence of DFU in Chinese T2D subjects.
    • Continuous Quadrupole Magnetic Separation of Islets during Digestion Improves Purified Porcine Islet Viability

      Weegman, Bradley P.; Kumar Sajja, Venkata Sunil; Suszynski, Thomas M.; Rizzari, Michael D.; Scott III, William E.; Kitzmann, Jennifer P.; Mueller, Kate R.; Hanley, Thomas R.; Kennedy, David J.; Todd, Paul W.; et al. (HINDAWI PUBLISHING CORP, 2016)
      Islet transplantation (ITx) is an emerging and promising therapy for patients with uncontrolled type 1 diabetes. The islet isolation and purification processes require exposure to extended cold ischemia, warm-enzymatic digestion, mechanical agitation, and use of damaging chemicals for density gradient separation (DG), all of which reduce viable islet yield. In this paper, we describe initial proof-of-concept studies exploring quadrupole magnetic separation (QMS) of islets as an alternative to DG to reduce exposure to these harsh conditions. Three porcine pancreata were split into two parts, the splenic lobe (SPL) and the combined connecting/duodenal lobes (CDL), for paired digestions and purifications. Islets in the SPL were preferentially labeled using magnetic microparticles (MMPs) that lodge within the islet microvasculature when infused into the pancreas and were continuously separated from the exocrine tissue by QMS during the collection phase of the digestion process. Unlabeled islets from the CDL were purified by conventional DG. Islets purified by QMS exhibited significantly improved viability (measured by oxygen consumption rate per DNA, p < 0.03 ) and better morphology relative to control islets. Islet purification by QMS can reduce the detrimental effects of prolonged exposure to toxic enzymes and density gradient solutions and substantially improve islet viability after isolation.
    • Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O’odham Students

      Davis, Amy L.; Harvey, Erin M.; Twelker, J. Daniel; Miller, Joseph M.; Leonard-Green, Tina K.; Campus, Irene; Univ Arizona, Dept Ophthalmol & Vis Sci; Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth; Univ Arizona, Coll Opt Sci; Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, AZ 85711, USA; et al. (HINDAWI PUBLISHING CORP, 2016)
      Purpose. To determine rate of convergence insufficiency (CI) and accommodative insufficiency (AI) and assess the relation between CI, AI, visual symptoms, and astigmatism in school-age children. Methods. 3rd-8th-grade students completed the Convergence Insufficiency Symptom Survey (CISS) and binocular vision testing with correction if prescribed. Students were categorized by astigmatism magnitude (no/low: <1.00D, moderate: 1.00D to <3.00D, and high: >= 3.00 D), presence/absence of clinical signs of CI and AI, and presence of symptoms. Analyses determine rate of clinical CI and AI and symptomatic CI and AI and assessed the relation between CI, AI, visual symptoms, and astigmatism. Results. In the sample of 484 students (11.67 +/- 1.81 years of age), rate of symptomatic CI was 6.2% and symptomatic AI 18.2%. AI was more common in students with CI than without CI. Students with AI only (p = 0.02) and with CI and AI (p = 0.001) had higher symptom scores than students with neither CI nor AI. Moderate and high astigmats were not at increased risk for CI or AI. Conclusions. With-the-rule astigmats are not at increased risk for CI or AI. High comorbidity rates of CI and AI and higher symptoms scores with AI suggest that research is needed to determine symptomatology specific to CI.
    • Emotion Dysregulation and Inflammation in African-American Women with Type 2 Diabetes

      Powers, Abigail; Michopoulos, Vasiliki; Conneely, Karen; Gluck, Rachel; Dixon, Hayley; Wilson, Joseph; Jovanovic, Tanja; Pace, Thaddeus W. W.; Umpierrez, Guillermo E.; Ressler, Kerry J.; et al. (HINDAWI PUBLISHING CORP, 2016)
      C-reactive protein (CRP), a marker of systemic inflammation, has been associated with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Emotion dysregulation is a transdiagnostic risk factor for many psychological disorders associated with chronic inflammatory state. The objective of this study was to determine whether inflammation is associated with emotion dysregulation in women with type 2 diabetes mellitus (T2DM). We examined associations between trauma exposure, MDD, PTSD, emotion dysregulation, and CRP among 40 African-American women with T2DM recruited from an urban hospital. Emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale. PTSD and MDD were measured with structured clinical interviews. Child abuse and lifetime trauma load were also assessed. Analyses showed that both emotion dysregulation and current MDD were significantly associated with higher levels of CRP ( p < 0.01 ). Current PTSD was not significantly related to CRP. In a regression model, emotion dysregulation was significantly associated with higher CRP ( p < 0.001 ) independent of body mass index, trauma exposure, and MDD diagnosis. These findings suggest that emotion dysregulation may be an important risk factor for chronic inflammation beyond already known risk factors among women with T2DM, though a causal relationship cannot be determined from this study.
    • Oxygenation of the Intraportally Transplanted Pancreatic Islet

      Suszynski, Thomas M.; Avgoustiniatos, Efstathios S.; Papas, Klearchos K.; Univ Arizona, Inst Cellular Transplantat, Dept Surg; Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA (HINDAWI PUBLISHING CORP, 2016)
      Intraportal islet transplantation (IT) is not widely utilized as a treatment for type 1 diabetes. Oxygenation of the intraportally transplanted islet has not been studied extensively. We present a diffusion-reaction model that predicts the presence of an anoxic core and a larger partly functional core within intraportally transplanted islets. Four variables were studied: islet diameter, islet fractional viability, external oxygen partial pressure (P) (in surrounding portal blood), and presence or absence of a thrombus on the islet surface. Results indicate that an islet with average size and fractional viability exhibits an anoxic volume fraction (AVF) of 14% and a function loss of 72% at a low external P. Thrombus formation increased AVF to 30% and function loss to 92%, suggesting that the effect of thrombosis may be substantial. External.. and islet diameter accounted for the greatest overall impact on AVF and loss of function. At our institutions, large human alloislets (>200 mu m diameter) account for similar to 20% of total islet number but similar to 70% of total islet volume; since most of the total transplanted islet volume is accounted for by large islets, most of the intraportal islet cells are likely to be anoxic and not fully functional.
    • Polymicrobial Pituitary Abscess Predominately Involving Escherichia coli in the Setting of an Apoplectic Pituitary Prolactinoma

      Beatty, Norman; Medina-Garcia, Luis; Al Mohajer, Mayar; Zangeneh, Tirdad T.; Univ Arizona, Coll Med, Dept Med, Div Infect Dis,Banner Univ Med Ctr (HINDAWI PUBLISHING CORP, 2016)
      Pituitary abscess is a rare intracranial infection that can be life-threatening if not appropriately diagnosed and treated upon presentation. The most common presenting symptoms include headache, anterior pituitary hypofunction, and visual field disturbances. Brain imaging with either computed tomography or magnetic resonance imaging usually reveals intra- or suprasellar lesion(s). Diagnosis is typically confirmed intra- or postoperatively when pathological analysis is done. Clinicians should immediately start empiric antibiotics and request a neurosurgical consult when pituitary abscess is suspected. Escherichia coli ( E. coli ) causing intracranial infections are not well understood and are uncommon in adults. We present an interesting case of an immunocompetent male with a history of hypogonadism presenting with worsening headache and acute right eye vision loss. He was found to have a polymicrobial pituitary abscess predominantly involving E.   coli in addition to Actinomyces odontolyticus and Prevotella melaninogenica in the setting of an apoplectic pituitary prolactinoma. The definitive etiology of this infection was not determined but an odontogenic process was suspected. A chronic third molar eruption and impaction in close proximity to the pituitary gland likely led to contiguous spread of opportunistic oral microorganisms allowing for a polymicrobial pituitary abscess formation.
    • Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population

      Pedersen, Mark R.; Choi, Myunghan; Brink, Jeffrey A.; Seetharam, Anil B.; Univ Arizona, Coll Med, Banner Univ, Dept Internal Med,Med Ctr; Univ Arizona, Coll Med, Banner Transplant & Adv Liver Dis Ctr; Univ Arizona, Coll Med, Banner Univ, Div Gastroenterol,Med Ctr; Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, USA; Arizona State University College of Nursing and Health Care Innovation, Phoenix, AZ, USA; Arizona Transplant Associates, Phoenix, AZ, USA; et al. (HINDAWI PUBLISHING CORP, 2016)
      Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01 ). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001 ). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.
    • Rare Leiomyoma of the Tunica Dartos: A Case Report with Clinical Relevance for Malignant Transformation and HLRCC

      Bell, Robert C.; Austin, Evan T.; Arnold, Stacy J.; Lin, Frank C.; Walker, Jonathan R.; Larsen, Brandon T.; Univ Arizona, Dept Pathol; Univ Arizona, Div Urol, Dept Surg; Department of Pathology, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA; Division of Urology, Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA; et al. (HINDAWI PUBLISHING CORP, 2016)
      Background . Genital leiomyomas fall under the broader category of cutaneous leiomyomas, which are rare smooth muscle neoplasms accounting for 5% of all leiomyomas. Genital leiomyomas arising from the dartos muscle are exceedingly rare with fewer than 30 cases reported in the literature. They are typically benign and adequately treated with simple surgical excision; however, previously reported cases of malignant transformation and a possible link to the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome warrant closer follow-up. Case Presentation . We report a case of a 47-year-old male refugee from Rwanda found to have a mobile, pea-sized, mildly painful scrotal lesion near the left penoscrotal junction and 1.5 cm indeterminate vascular mass in the right kidney. Surgical excision of the scrotal nodule was performed and the diagnosis of a dartoic leiomyoma was rendered. The presence of moderate nuclear atypia, rare mitotic activity, and close surgical margins prompted a wide reexcision. We report the surgical approach, pathologic findings, and clinical follow-up related to this scrotal lesion. Conclusion . Scrotal leiomyomas demonstrate a high rate of recurrence and pose a risk for malignant transformation. They may also indicate an underlying autosomal dominant syndrome associated with increased risk for development of an aggressive form of renal cell carcinoma. When discovered, management should include surgical excision, screening for syndromic features, and routine follow-up.
    • Refractory IgD Multiple Myeloma Treated with Daratumumab: A Case Report and Literature Review

      Husnain, Muhammad; Kurtin, Sandra; Barkett, Nikki; bin Riaz, Irbaz; Agarwal, Amit; Univ Arizona, Dept Med; niv Arizona, Banner Univ Med Ctr Tucson, Dept Hematol Oncol; Department of Medicine, University of Arizona, Tucson, AZ, USA; Banner University Medical Center Tucson, Department of Hematology Oncology, University of Arizona, Tucson, AZ, USA; Banner University Medical Center Tucson, Department of Hematology Oncology, University of Arizona, Tucson, AZ, USA; et al. (HINDAWI PUBLISHING CORP, 2016)
      Patients with relapsed and refractory multiple myeloma have poor prognosis. A recent analysis of patients with relapsed and refractory multiple myeloma who were refractory to both proteasome inhibitors and immunomodulatory drugs showed the median overall survival of 9 months only. Daratumumab is the first-in-class human monoclonal antibody against CD38 cells which was studied in phase I/II trials for treatment of these patients with relapsed refractory multiple myeloma. It showed an overall response rate of 36% and a median overall survival (OS) of 17 months in these patients. We report a case of 40-year-old man with immunoglobulin D (IgD) multiple myeloma whose disease was refractory to at least 5 different chemotherapy regimens including proteasome inhibitors and immunomodulatory drugs. The clinical studies assessing daratumumab did not include any patients with IgD myeloma which is a rare form of multiple myeloma and to our knowledge is the first study reporting use of daratumumab in IgD myeloma.