Nutcracker syndrome: a case-based review.

The nutcracker phenomenon, also known as left renal vein entrapment, occurs when there is extrinsic compression of the left renal vein, most often between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome refers to the constellation of clinical symptoms that may arise from the nutcracker phenomenon, typically inclusive of haematuria, flank/pelvic pain, orthostatic proteinuria and (in male patients) varicocele. We provide a short review of the nutcracker syndrome including various diagnostic and therapeutic modalities. We utilise our own experience with a patient as a case study and highlight the modern management option of endovascular stenting.

The emerging role of lncRNA MEG3 and MEG3 rs7158663 in hepatocellular carcinoma.

OBJECTIVE: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy in Egypt. Genetic and environmental factors play a role in its development. This study explored the association between the long non-coding RNA (lncRNA) MEG3 rs7158663 polymorphism, MEG3 expression, and the risk of HCC and other clinicopathologic characteristics in an Egyptian population. PATIENTS AND METHODS: This case-control study included 114 patients with HCC and 110 healthy controls. TaqMan Real-time PCR was used to analyze lncRNA MEG3 rs7158663. Serum MEG3 expression levels were measured using RT-PCR. RESULTS: The AA, GA+AA, and A alleles were associated with increased risk for HCC (adjusted odds ratio (OR) 11.84%, 95% CI 4.07-34.45, p < 0.0001; adjusted OR 3.18, 95% CI 1.79-5.67, p < 0.0001; and adjusted OR 2.87, 95% CI 1.91-4.34, p < 0.0001, respectively). The mutant genotype and allele were linked to an increased risk in male patients and patients ≥ 50 years old. MEG3 serum expression level was downregulated in HCC patients. The rs7158663 G > A polymorphism and downregulated MEG3 were significantly associated with larger tumor size and advanced disease stage. CONCLUSIONS: MEG3 rs7158663 single nucleotide polymorphisms and downregulated lncRNA MEG3 were associated with HCC risk and may represent diagnostic and bad prognostic factors for HCC patients.

Impact of miR-155 (rs767649 A>T) and miR-146a (rs57095329 A>G) polymorphisms in System Lupus Erythematosus susceptibility in an Egyptian cohort.

OBJECTIVE: Systemic Lupus Erythematosus (SLE) is an autoimmune inflammatory disease. miR-155 and miR-146a were expressed in many autoimmune diseases such as rheumatoid arthritis. The aim of this study was to examine miR-155 rs767649 and miR-146a rs57095329 polymorphisms in SLE susceptibility in an Egyptian cohort and to investigate the correlation between them and clinical data and disease activity. PATIENTS AND METHODS: The two SNPs were analyzed in 120 patients with SLE and 100 healthy controls using RT-PCR. RESULTS: The TT genotype and T allele of miR-155 rs767649 were associated with a significant increase in the risk of SLE, particularly in females. On the other hand, miR-146a (rs57095329) polymorphism was not associated with SLE risk. The AT/TT genotypes of miR-155 rs767649 showed higher distributions among patients with higher SLEDAI and nephritis. CONCLUSIONS: This study had demonstrated for the first time the association between miR-155 rs767649 and the risk of development of SLE in an Egyptian cohort, mostly in females.

Purification of a fraction of Giardia lamblia trophozoite extract associated with disaccharidase deficiencies in immune Mongolian gerbils (Meriones unguiculatus).

The effects on disaccharidase activities of challenging gerbils previously exposed to Giardia lamblia with fradions of the crude trophozoite extract were examined. Gel filtration of the soluble extract on a Sephacryl S-200 HR column resulted in 3 fradions: F1, F2 and F3. Only a challenge with fraction F1 (0.1 mg total dose) was found to induce disaccharidase deficiencies. Boiling F1 prior to challenge did not change this effect on the enzyme activities. However, the decreases were not obtained when the total F1 dose was reduced to 0.05 mg. Column chromatography of fraction F1 under dissociating and reducing conditions resulted in 2 further fractions: F1a and F1b. Challenging immune gerbils with F1b led to impairments of disaccharidose activity similar to those obtained with F1. Protein analysis of the crude extract, as well as the fractions of the extract, revealed several high and low molecular weight bonds. These findings indicate that a constituent(s) of fraction F1b is the portion of the parasite which induces disaccharidase deficiencies in immune gerbils. This fraction consists of proteins ranging in molecular weight from 32 to 200 kDa. In addition the G. lamblia fraction involved in the decreases in enzyme activity is heat-stable.

Disaccharidase deficiencies in Mongolian gerbils (Meriones unguiculatus) protected against Giardia lamblia.

The activities of the disaccharidases lactase, maltase, sucrase and trehalase were examined in gerbils during Giardia lamblia infections. In a primary infection with trophozoites, the activities of all four enzymes were reduced from day 10 post-infection (p.i.) and remained at low levels well past the elimination phase of the infection. However, during a challenge infection, the disaccharidase decreases were short-lived, with impairments being seen only on days 2 and/or 4 post-challenge (p.c.). Sucrase activity was not affected by a challenge infection. When 0.1 mg of a soluble extract of G. lamblia trophozoites was used to challenge gerbils previously exposed to the live parasite, the pattern and duration of enzyme deficiencies were comparable with those observed after the challenge with the live parasite. In addition, decreasing the extract dose used to challenge the gerbils led to smaller disaccharidase deficiencies. G. lamblia-infected gerbils were also challenged with a soluble extract of Entamoeba histolytica trophozoites, and this had no effect on the disaccharidase activities. Therefore, the presence of the intact parasite was not necessary to induce enzyme reductions in immune animals. In addition, the effects seen during the secondary infection were parasite-specific and may have involved the host's immune response to Giardia antigens. Immune gerbils were further challenged with the in vitro-released excretory/secretory products of G. lamblia. Under our experimental conditions, disaccharidase activities were found to be affected by these products in a manner that was inconsistent with the results of the live parasite challenge, and this merits further study.