ABSTRACT
BACKGROUND: Acute mesenteric ischemia (AMI) is a life-threatening surgical emergency with a poor prognosis. This study assessed the association of diffuse reduction of spleen density (DROSD) with postoperative complications and identified risk factors for adverse outcomes in AMI patients after surgery. METHODS: Patients who were diagnosed with AMI and underwent surgical operations between April 2006 and July 2021 were enrolled. Spleen density was assessed using preoperative non-enhanced computed tomography. The lowest quartile of spleen density in all patients was regarded as the cutoff value for DROSD. Univariate and multivariate analyses were performed to determine the risk factors related to postoperative outcomes after surgery. RESULTS: According to the diagnostic cutoff, patients with a spleen density ≤49.07 HU were defined as DROSD. In a cohort of 97 patients, 34.0% developed complications within 30 days of surgery. The multivariate analysis illustrated that DROSD was an independent risk factor for prognostic outcomes in AMI patients after surgery. CONCLUSION: Patients with low spleen density were prone to postoperative complications. As an imaging method, preoperative assessment of spleen density is a novel predictor that can be used clinically to identify high-risk AMI patients with poor prognosis.
ABSTRACT
The genes of the major histocompatibility complex (MHC) are an important component of the vertebrate immune system and play a significant role in mate choice in many species. However, it remains unclear whether female mate choice in non-human primates is based on specific functional genes and/or genome-wide genes. The golden snub-nosed monkey (Rhinopithecus roxellana) lives in a multilevel society, which consists of several polygynous one-male-several-female units. Although adult females tend to mainly socialize with one adult male, females often initiate extra-pair copulations with other males resulting in a high proportion of offspring being fathered by extra-pair males. We investigated the effects of adaptive MHC genes and neutral microsatellites on female mate choice in a wild R. roxellana population. We sequenced 54 parent-offspring triads using two MHC class II loci (Rhro-DQA1 and Rhro-DQB1) and 20 microsatellites from 3 years of data. We found that the paternities of offspring were non-randomly associated with male MHC compositions not microsatellite genotypes. Our study showed that the fathers of all infants had significantly less variance for several estimates of genetic similarity to the mothers compared with random males at both MHC loci. Additionally, the MHC diversity of these fathers was significantly higher than random males. We also found support for choice based on specific alleles; compared with random males, Rhro-DQA1∗ 05 and Rhro-DQB1∗ 08 were more common in both the OMU (one-male unit) males and the genetic fathers of offspring. This study provides new evidence for female mate choice for MHC-intermediate dissimilarity (rather than maximal MHC dissimilarity) and highlights the importance of incorporating multiple MHC loci and social structure into studies of MHC-based mate choice in non-human primates.
ABSTRACT
RATIONALE: Epithelioid angiomyolipoma (EAML) is a subtype of angiomyolipoma with malignant potential. A diagnosis of malignant EAML of the kidney is based on extrarenal metastasis, and predicting early transformation is difficult. To propose criteria for indicators of malignant transformation, herein we report 2 cases and review 17 cases reported in the literature (2000-2017). PATIENT CONCERNS: Tumor of the kidney was determined in 2 patients, and tissues after nephrectomy were pathologically, histologically, and immunochemically examined. DIAGNOSIS: Malignant EAML. INTERVENTION: The 2 present patients were treated with nephrectomy only. OUTCOMES: Case 1 involved a 48-year-old woman with a 7.5-cm solid mass in the right kidney who underwent nephrectomy. CT detected a mass in the liver after 13 months, which was speculated to be metastasis from the kidney lesion. Case 2 involved a 62-year-old man with a 7-cm cystic solid mass in the left kidney who accepted nephrectomy and at 10 months post-surgery lived with no disease. Both cases presented a large tumor, atypical epithelioid cells, mitotic figures, and necrosis; tested positive for melanocytic markers (HMB45, MelanA). LESSONS: The literature review of malignant EAML led to the identification of 8 malignant features: size ≥5âcm; metastasis; infiltration; necrosis; ≥50% atypical epithelioid cells; cytologic atypia; atypical mitosis; and vessel invasion. The co-existence of at least 5 of these is proposed to indicate malignant EAML. Features of our 2 new cases of primary malignant EAML of the kidney matched these criteria. Our proposal of criteria for predicting malignant feature, based on 2 new cases and 17 cases in the literature, should aid understanding and avoid misdiagnosis. Nephrectomy is currently the common treatment strategy for malignant EAML, but more effective treatment strategies are needed to provide a better prognosis for patients.