Endocrine Manifestations in POEMS Syndrome: a case report and literature review.

BACKGROUND: POEMS syndrome, a rare systemic disease, is characterized by 5 components: Peripheral neuropathy, Organomegaly, Endocrinopathy, M protein elevation, and Skin changes. It usually presents with multiplex endocrine manifestations and is easily misdiagnosed and incorrectly treated. CASE PRESENTATION: We report herein a case of POEMS syndrome that initially presented as hyperpigmentation and severe pitting edema of the lower extremities. Throughout the patient's multiple hospitalizations for more than one year, he was treated erroneously for Addison's disease and primary hypothyroidism due to the presence of limb numbness and weight loss. In addition, he was misdiagnosed with diabetic peripheral neuropathy due to a history of type 2 diabetes mellitus. CONCLUSION: Endocrinopathy is a critical feature of POEMS syndrome but its mechanisms are still poorly understood. The most common endocrine abnormality is hypogonadism, and the second is adrenal insufficiency, followed by hypothyroidism and subclinical hypothyroidism, then diabetes or glucose intolerance. In cases of the coexistence of endocrinopathy and unexplained peripheral neuropathy, especially in multisystem disorders, POEMS syndrome should be considered. Endocrine evaluation including thyrotropin, free thyroxine, fasting glucose, gonadal hormones, prolactin, cortisol, ACTH, and calcium should be assessed. The purpose of the current report was to provide increased awareness of POEMS syndrome.

[Efficacy and safety of alogliptin in treatment of type 2 diabetes mellitus: a multicenter, randomized, double-blind, placebo-controlled phase III clinical trial in mainland China].

OBJECTIVE: To evaluate the efficacy and safety of alogliptin in Chinese patients with type 2 diabetes (T2DM). METHODS: This was a multicenter, randomized, double-blind, placebo-controlled phase III trial. A total of 491 subjects with T2DM were randomized in a 1:1 ratio to receive alogliptin (25 mg once daily) or placebo for 16 weeks. Among them, 181 were in the monotherapy group (group A), 186 were in the add-on to metformin group (group B), and 124 were in the add-on to pioglitazone group (group C). RESULTS: After 16 weeks of therapy, glycosylated hemoglobin A1c (HbA1c) levels decreased in both alogliptin and placebo groups. The mean changes in HbA1c for alogliptin and placebo were 1.00% and 0.43% (P<0.001), 0.91% and 0.23% (P<0.001), and 0.76% and 0.25% (P<0.001) in group A, B and C, respectively. Compared with placebo, alogliptin treatment led to a greater decrease in fasting plasma glucose (FPG) and a higher percentage of subjects who achieved HbA1c targets of ≤ 6.5% and ≤ 7.0%. The percentage of subjects who experienced all adverse events including hypoglycemia with alogliptin were comparable to those with placebo. CONCLUSIONS: Alogliptin 25 mg once daily reduced HbA1c and FPG, and increased a greater proportion of subjects achieving HbA1c goals of ≤6.5% and ≤7.0% compared with placebo when used as a monotherapy, add-on to metformin, or add-on to pioglitazone. The hypoglycemia rates and safety profiles with alogliptin were similar to those with placebo.

[The design and baseline characteristics of a phase III study to evaluate the efficacy and safety of alogliptin versus placebo in type 2 diabetes mellitus in Mainland China].

OBJECTIVE: To assess the design and the Mainland China subgroup baseline characteristics of the study to evaluate the efficacy and safety of alogliptin versus placebo in subjects with type 2 diabetes (T2DM) as monotherapy, add-on to metformin or add-on to pioglitazone. METHODS: This was a multi-center, randomized, double-blind, placebo-controlled, 16-week study comparing alogliptin (ALO, 25 mg, 1/d) versus placebo (PLA) as monotherapy (A), add-on to metformin (B) or add-on to pioglitazone ± metformin (C). The T2DM subjects with glycosylated hemoglobin A1c(HbA1c) between 7% and 10% and aged between 18 years and 75 years were enrolled and randomized to the alogliptin group and the placebo group in 1: 1 ratio with 16 weeks treatment. All patients were followed up every 4 weeks. The safety endpoints consisted of the incidence of hypoglycemia and other adverse events. RESULTS: A total of 491 patients were enrolled in the Mainland China subgroup of the study (181 in group A, 186 in group B and 124 in group C). In each treatment group, the baseline characteristics including age, gender, body mass index, diabetes duration, HbA1c, fasting plasma glucose, body weight, daily dosage of metformin and daily dosage of pioglitazone were all well balanced. CONCLUSION: The demographic data, medical history, glycemic profile and treatment regimen at baseline in Mainland China subgroup are well balanced. The result of this study will provide the clinical evidence for the use of alogliptin in Chinese T2DM patients.

Design of a birefringent Michelson interferometer-based interleaver with ultra-low dispersion and low cost.

We design and demonstrate a birefringent Michelson interferometer based interleaver with ultra-low dispersion and low cost. The interleaver consists of polarizing beam splitters (PBS's) and quarter-wave plates and half-wave plates. The PBS's based Michelson interferometers provide the optical path difference for interference between the two orthogonal polarization components and the half-wave plates provide the birefringent needed to minimize ripple of output. The designed interleaver with two-stage interferometer in a 50 GHz channel spacing application exhibits a 0.5 dB passband and a 25 dB stopband both 27 GHz; a channel isolation higher than 35 dB and chromatic dispersion less than ±5 ps/nm within 0.5 dB passband; 1.3 dB insertion loss and 0.3 dB PDL; 0.04 GHz/°C thermal stability. Since all of the optical components can be optically bonded together, the device is robust and easy to be aligned, which reduces labor cost.

Induction of G1 cell cycle arrest and apoptosis by berberine in bladder cancer cells.

Bladder cancer is the ninth most common type of cancer, and its surgery is always followed by chemotherapy to prevent recurrence. Berberine is non-toxic to normal cells but has anti-cancer effects in many cancer cell lines. This study was aimed to determine whether berberine inhibits the cell proliferation and induces cell cycle arrest and apoptosis in BIU-87 and T24 bladder cancer cell line. The superficial bladder cancer cell line BIU-87 and invasive T24 bladder cancer cells were treated with different concentrations of berberine. MTT assay was used to determine the effects of berberine on the viability of these cells. The cell cycle arrest was detected through propidium iodide (PI) staining. The induction of apoptosis was determined through Annexin V-conjugated Alexa Fluor 488 (Alexa488) staining. Berberine inhibited the viability of BIU-87 and T24 cells in a dose- and time-dependent manner. It also promoted cell cycle arrest at G0/G1 in a dose-dependent manner and induced apoptosis. We observed that H-Ras and c-fos mRNA and protein expressionswere dose-dependently and time-dependently decreased by berberine treatment. Also, we investigated the cleaved caspase-3 and caspase-9 protein expressions increased in a dose-dependent manner. Berberine inhibits the cell proliferation and induces cell cycle arrest and apoptosis in BIU-87, bladder cancer cell line and T24, invasive bladder cancer cell line. Berberine can inhibit the oncogentic H-Ras and c-fos in T24 cells, and can induce the activation of the caspase-3 and caspase-9 apoptosis. Therefore, berberine has the potential to be a novel chemotherapy drug to treat the bladder cancer by suppressing tumor growth.

[Primary cutaneous T-cell lymphoma of the penis complicated by Fournier gangrene: a case report].

OBJECTIVE: To explore the clinical presentation, pathologic characteristics, diagnosis and treatment of cutaneous T-cell lymphoma of the penis. METHODS: A 49-year-old man presented with painful swelling and inflammation of the foreskin, failed to respond to antibiotic treatment and dorsal incision, and was instead complicated by Fournier gangrene. Then he underwent debridement and pathological examination. RESULTS: Pathological results indicated cutaneous T-cell lymphoma of the penis. Immunohistochemistry showed CD3 and CD45 RO to be positive, but CD30, CD79a, CD20 and HMB negative. The patient was treated by interferon alpha and ultraviolet B for 2 weeks, followed by total removal of the external genitalia because of necrosis of the corpus spongiosum, which involved the scrotum and right testis on pathological examination. CONCLUSION: Cutaneous T-cell lymphoma of the penis is a rare condition and easily mis diagnosed in the early phase. Definitive diagnosis depends on pathological study.

Aggressive fibromatosis in the urological system. Report of two adult patients and review of the literature.

Aggressive fibromatoses (AF) are locally aggressive neoplasms that do not metastasize but are frequently associated with one or more recurrences and subsequent associated morbidity. AF in the urological system is quite rare and has mainly been described in single case reports or as isolated cases in a large series of extra-abdominal desmoid tumors. We report 2 cases of AF in the bladder and scrotum, and provide a review of similar published cases.

[Change of nerve growth factor mRNA in human detrusor in bladder outlet obstruction with benign prostatic hyperplasia and their implication].

OBJECTIVE: To investigate the change of nerve growth factor (NGF) mRNA in human detrusor in bladder outlet obstruction (BOO) with benign prostatic hyperplasia (BPH) and their implication. METHODS: Eight cases of bladder cancer and 40 patients with BPH were included in this study. All patients were divided into three groups, a control group, an obstructive detrusor stability group and an obstructive detrusor instability group. NGF mRNA in detrusor from all patients was measured using a RT-PCR. RESULTS: The RT-PCR study indicated that NGF mRNA was expressed in detrusor of three groups of patients. There were significant differences among the three groups (P < 0.01). The expression of NGF mRNA in the obstructive instability group was higher than that in the obstructive stability group and in the control group. The NGF mRNA level in the obstructive stability group was higher than that in the control group. CONCLUSION: The expression of NGF mRNA in detrusor was elevated in BOO with BPH. The elevated expression of NGF mRNA might be correlated with detrusor instability (DI) due to BOO.

[Association of uPA and uPAR expression with invasive behaviors of urinary transitional cell carcinoma].

BACKGROUND & OBJECTIVE: Urokinase-type plasminogen activator (uPA)/its receptor (uPAR), serine protease system, plays a key role in the degradation of extracellular matrix and basement membranes, and intensifying the tumor invasion. The study was designed to investigate the expression of uPA and uPAR in urinary transitional cell carcinoma. The correlation between their expression and tumor invasion was evaluated. METHODS: The expression and localization of uPA and uPAR were examined among 50 cases of renal pelvic and ureter carcinoma and 40 cases of bladder cancer using the PicTure(TM) current type of immunohistochemical two-step method. RESULTS: The normal pelvic, ureter, and bladder did not express uPA and uPAR. The positive expression of uPA and uPAR were concentrated in tumor tissues compared with that in the adjacent tissues. The positive rates of uPA and uPAR expressed the tissues were 33.33% and 50.00% in G1 grade; 88.47% and 96.15% in G3 grade; 37.50% and 50.00% in Ta-T1 tissues; 100.0% and 100.0% in T4 tissues, respectively. The positive rates of uPA and uPAR expression in tumor tissues with higher grade and stage were obviously increased (P< 0.05); meanwhile, there were close correlation between uPA and uPAR (rs=0.979). CONCLUSION: The co-expression of uPA and uPAR was one of the characteristics of urinary transitional cell carcinoma and significantly correlated with tumor stage and grade.

[Psychological hindrance and its treatment in chronic prostatitis patients].

OBJECTIVE: To improve the knowledge of psychological hindrance in chronic prostatitis (CP) patients and study the treatment strategy of it. METHODS: Two hundred and fifty-eight CP patients with psychological hindrance, aged 16 to 65 years (average 33 years), were divided into the psychotherapy group (148 cases) and the control (110 cases). The control were only treated with antibiotics and Chinese traditional medicines, while the psychotherapy group were treated with cognitive therapy besides the above medicines. RESULTS: The symptoms in the psychotherapy group were improved obviously compared with those in the control. Both the cure rate (P < 0.05) and the effective rate (P < 0.001) of the psychotherapy group were higher than those of the control. CONCLUSION: Psychotherapy is an effective way to treat CP patient with psychological hindrance.

[The expression of urokinase-type plasminogen activator and its receptor in urinary transitional cell carcinoma].

OBJECTIVE: To probe into the expression and clinical significance of urokinase-type plasminogen activator (uPA) and its receptor (uPAR) in urinary transitional cell carcinoma. METHODS: Expression of uPA and uPAR were detected in 50 cases of renal pelvis and ureter carcinoma and 40 cases of bladder cancer immunohistochemically. RESULTS: The positive rates of uPA and uPAR were closely correlated to the grade and the stage of urinary transitional cell carcinoma (r = 0.979, P < 0.01), whereas uPA and uPAR were not detected in normal kidney, ureter and bladder tissue. CONCLUSION: uPA and uPAR are highly expressed in urinary transitional cell carcinoma and they may be responsible for the tumor invasion and metastasis.