ABSTRACT
OBJECTIVES: To evaluate perioperative morbidity, oncological outcome and predictors of pT3a upstaging after partial nephrectomy (PN). MATERIALS AND METHODS: Retrospective study of 1042 patients who underwent PN for cT1N0M0 renal cell carcinoma between 2007 and 2015. A total of 113 cT1 patients were upstaged to pT3a, while 929 were staged as pT1. Demographic, perioperative and pathological variables were reviewed. We compared the clinico-pathological characteristics, perioperative morbidity and oncological outcomes between pT3a and pT1 groups. Multivariate regression evaluates variables associated with T3a upstaging. Recurrence-free survival (RFS) and overall survival analyses were performed. Survival curves were compared using log-rank test. RESULTS: The pT3a tumors were high complexity tumors (median RENAL score 8 vs. 7, p < 0.01), higher hilar (h) location (27.5 vs. 14.8%, p < 0.01), higher grade (57.5 vs. 38.2%, p < 0.01), and higher positive surgical margins (18.6 vs. 5.8%, p < 0.01. Patients with pT3a had a higher estimated blood loss, transfusion rate, ischemia time and overall complications, though there were no differences in median e-GFR decline and major (Grade III-V) complications. Five-year RFS was 78.5% for pT3a group vs. 94.6% for pT1 group (log-rank p < 0.01). Male gender (OR 2.2, p < 0.01), and R.E.N.A.L. score (OR 2.3, p = 0.01) were preoperative predictors of upstaging. We acknowledge limitations in our study, most are inherent problems of retrospective studies. CONCLUSION: Perioperative morbidity, after partial nephrectomy, is acceptable in cT1/pT3 tumors in comparison to cT1/pT1; however, upstaged patients had a worse oncological outcome. cT1/pT3a tumors are associated with adverse clinico-pathological features. Preoperative risk predictors of upstaging were higher R.E.N.A.L. score and male gender.
Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Postoperative Complications/epidemiology , Aged , Blood Loss, Surgical , Blood Transfusion/statistics & numerical data , Carcinoma, Renal Cell/pathology , Cold Ischemia/statistics & numerical data , Disease-Free Survival , Female , Glomerular Filtration Rate , Humans , Kidney Neoplasms/pathology , Logistic Models , Male , Middle Aged , Morbidity , Multivariate Analysis , Neoplasm Staging , Nephrectomy , Patient Readmission/statistics & numerical data , Perioperative Period , Renal Insufficiency/epidemiology , Reoperation , Retrospective Studies , Risk Factors , Sex Factors , Survival Analysis , Treatment Outcome , Warm Ischemia/statistics & numerical dataABSTRACT
Temporal organization of physiology is critical for human health. In the past, humans experienced predictable periods of daily light and dark driven by the solar day, which allowed for entrainment of intrinsic circadian rhythms to the environmental light-dark cycles. Since the adoption of electric light, however, pervasive exposure to nighttime lighting has blurred the boundaries of day and night, making it more difficult to synchronize biological processes. Many systems are under circadian control, including sleep-wake behavior, hormone secretion, cellular function and gene expression. Circadian disruption by nighttime light perturbs those processes and is associated with increasing incidence of certain cancers, metabolic dysfunction and mood disorders. This review focuses on the role of artificial light at night in mood regulation, including mechanisms through which aberrant light exposure affects the brain. Converging evidence suggests that circadian disruption alters the function of brain regions involved in emotion and mood regulation. This occurs through direct neural input from the clock or indirect effects, including altered neuroplasticity, neurotransmission and clock gene expression. Recently, the aberrant light exposure has been recognized for its health effects. This review summarizes the evidence linking aberrant light exposure to mood.
Subject(s)
Affect , Brain/physiopathology , Circadian Rhythm , Light , Lighting , Mood Disorders/physiopathology , Humans , Neural Pathways/physiopathology , Photoperiod , Time FactorsABSTRACT
The rhythm of life on earth is shaped by seasonal changes in the environment. Plants and animals show profound annual cycles in physiology, health, morphology, behaviour and demography in response to environmental cues. Seasonal biology impacts ecosystems and agriculture, with consequences for humans and biodiversity. Human populations show robust annual rhythms in health and well-being, and the birth month can have lasting effects that persist throughout life. This review emphasizes the need for a better understanding of seasonal biology against the backdrop of its rapidly progressing disruption through climate change, human lifestyles and other anthropogenic impact. Climate change is modifying annual rhythms to which numerous organisms have adapted, with potential consequences for industries relating to health, ecosystems and food security. Disconcertingly, human lifestyles under artificial conditions of eternal summer provide the most extreme example for disconnect from natural seasons, making humans vulnerable to increased morbidity and mortality. In this review, we introduce scenarios of seasonal disruption, highlight key aspects of seasonal biology and summarize from biomedical, anthropological, veterinary, agricultural and environmental perspectives the recent evidence for seasonal desynchronization between environmental factors and internal rhythms. Because annual rhythms are pervasive across biological systems, they provide a common framework for trans-disciplinary research.
Subject(s)
Ecosystem , Food Supply , Periodicity , Seasons , Agriculture , Animals , Biodiversity , Climate Change , Humans , PlantsABSTRACT
We conducted a survey of aflatoxin and fumonisin in maize in western Kenya. In a regional survey of aflatoxin conducted in 2009 across three agroecological zones within three administrative regions, milled maize samples were collected from 985 patrons of 26 hammer mills. Aflatoxin contamination was detected in 49% of samples and was above the regulatory (10 ppb) in 15% of the samples overall; 65% of samples from a drought-prone area were over the limit. In a detailed survey in Bungoma County, we investigated aflatoxin and fumonisin contamination in four popular maize varieties at harvest and after 2 and 4 months of storage. We collected whole-grain samples from farmers' storage sheds and milled samples from patrons of local mills. Mean aflatoxin contamination was identical for storage sheds and mills at 2.3 ppb. In all, 41% of the samples from mills had detectable aflatoxin, with 4% over the regulatory limit, whereas 87% had detectable fumonisin, with 50% over the regulatory limit (1 ppm). Mean contamination levels did not change during storage. Maize varieties differed in fumonisin contamination, with the most popular varieties vulnerable to both mycotoxins and weevils, which are potential factors in exacerbating mycotoxin contamination. Mycotoxin surveillance is important not just in areas known previously for aflatoxin contamination and acute poisoning but also is needed in all maize-producing regions.
Subject(s)
Aflatoxins/analysis , Food Contamination , Fumonisins/analysis , Mycotoxins/analysis , Plant Diseases/microbiology , Zea mays/microbiology , Geography , Humans , KenyaABSTRACT
The prevalence of aflatoxin and fumonisin was investigated in maize intended for immediate human consumption in eastern Kenya at a time in 2010 when an aflatoxin outbreak was recognized. Samples were collected from people who brought their maize for processing at local commercial mills. Sites were selected using a geographical information system overlay of agroecological zones and Kenya's administrative districts. Interviews and collection of maize flour samples was conducted from 1,500 people who processed maize at 143 mills in 10 administrative districts. Mycotoxins were analyzed using enzyme-linked immunosorbent assays for aflatoxin and fumonisin, leading to detection at levels above the respective maximum tolerable limits in 39 and 37% of the samples, respectively. Samples with aflatoxin contamination above the legal limit ranged between 22 and 60% across the districts. A higher occurrence of aflatoxin was associated with smaller maize farms, lower grain yield, and monocropping systems, while a larger magnitude of the toxin was observed in the subhumid agroecological zone, in samples with more broken kernels, and, curiously, less maize ear damage at harvest. Analysis of paired grain samples (visually sorted and unsorted) showed that sorting reduced fumonisin by 65%, from above to below the legal limit of 1,000 ppb. Sorting did not, however, reduce aflatoxin levels. Although the aflatoxin problem is widely acknowledged, the high prevalence of fumonisin has not previously been reported. There is need for surveillance of the two mycotoxins and establishment of intervention strategies to reach vulnerable small-scale farmers.
Subject(s)
Aflatoxins/analysis , Fumonisins/analysis , Mycotoxins/analysis , Plant Diseases/microbiology , Zea mays/microbiology , Enzyme-Linked Immunosorbent Assay , Food Contamination , Geography , Kenya , Seeds/microbiology , Surveys and QuestionnairesABSTRACT
Rapid remodeling of neurons provides the brain with flexibility to adjust to environmental fluctuations. In Siberian hamsters, hippocampal dendritic morphology fluctuates across the day. To reveal the regulatory mechanism of diurnal remodeling of hippocampal neurons, we investigated the effects of light signals applied under different photoperiodic conditions on dendritic morphology. A 4-h dark pulse during the morning of long days (LD) increased basilar dendritic length, as well as complexity of basilar dendrites of neurons in the CA1. A light pulse during the late night in short days (SD) reduced basilar dendrite branching and increased primary apical dendrites of CA1 neurons. Spine density of dentate gyrus (DG) dendrites was increased by a dark pulse in LD and spine density of CA1 basilar dendrites was decreased by a light pulse in SD. These results indicate that light signals induce rapid remodeling of dendritic morphology in a hippocampal subregion-specific manner. A light pulse in SD decreased hippocampal expression of fetal liver kinase 1 (Flk1), a receptor for vascular endothelial growth factor (VEGF), raising the possibility that VEGF-FLK1 signaling might be involved in the rapid decrease of branching or spine density of CA1 basilar dendrites by light.
Subject(s)
Circadian Rhythm/physiology , Hippocampus/cytology , Neurons/cytology , Photic Stimulation/methods , Photoperiod , Animals , Brain-Derived Neurotrophic Factor/metabolism , CA1 Region, Hippocampal/cytology , CA1 Region, Hippocampal/physiology , Darkness , Dendrites/physiology , Dendritic Spines/physiology , Dentate Gyrus/cytology , Dentate Gyrus/physiology , Gene Expression , Hippocampus/physiology , Male , Neurons/physiology , Phodopus , Receptor, trkB/metabolism , Vascular Endothelial Growth Factor A/metabolism , Vascular Endothelial Growth Factor Receptor-2/metabolismSubject(s)
Advisory Committees , Endocrine Disruptors/standards , Endocrine Disruptors/toxicity , Animals , HumansSubject(s)
Advisory Committees , Endocrine Disruptors/standards , Endocrine Disruptors/toxicity , Animals , HumansSubject(s)
Advisory Committees , Endocrine Disruptors/standards , Endocrine Disruptors/toxicity , Animals , HumansSubject(s)
Advisory Committees , Endocrine Disruptors/standards , Endocrine Disruptors/toxicity , Animals , HumansABSTRACT
Photoperiodism is a biological phenomenon, common among organisms living outside of the tropics, by which environmental day length is used to ascertain the time of year to engage in seasonally-appropriate adaptations. White-footed mice (Peromyscus leucopus) are small photoperiodic rodents which display a suite of adaptive winter responses to short day lengths mediated by the extended duration of nightly melatonin secretion. Exposure to short days alters hippocampal dendritic morphology, impairs spatial learning and memory, and impairs hippocampal long-term potentiation (LTP). To determine the role of melatonin in these photoperiod-induced alterations of behavioral, neuroanatomical, and neurophysiological processes in this species, we implanted male mice subcutaneously with melatonin or empty Silastic capsules and exposed them to long or short day lengths. After 10 weeks, mice were assessed for hippocampal LTP, tested for spatial learning and memory in the Barnes maze, and morphometric analysis of neurons in the hippocampus using Golgi staining. Extending the duration of melatonin exposure, by short-day exposure or via melatonin implants, impaired both Schaffer collateral LTP in the CA1 region of the hippocampus and spatial learning and memory, and altered neuronal morphology in all hippocampal regions. The current results demonstrate that chronic melatonin implants reproduce the effects of short days on the hippocampus and implicate melatonin signaling as a critical factor in day-length-induced changes in the structure and function of the hippocampus in a photoperiodic rodent.
Subject(s)
Hippocampus/cytology , Long-Term Potentiation/physiology , Melatonin/pharmacology , Memory/drug effects , Neurons/drug effects , Photoperiod , Animals , CA1 Region, Hippocampal/cytology , Delayed-Action Preparations , Dendrites , Drug Implants , Hippocampus/anatomy & histology , Hippocampus/physiology , Long-Term Potentiation/drug effects , Male , Maze Learning/drug effects , Melatonin/administration & dosage , Mice , Neurons/cytology , Neurons/physiology , Peromyscus , Spatial Behavior/drug effectsABSTRACT
OBJECTIVE: The increasing prevalence of obesity and related metabolic disorders coincides with increasing exposure to light at night. Previous studies report that mice exposed to dim light at night (dLAN) develop symptoms of metabolic syndrome. This study investigated whether mice returned to dark nights after dLAN exposure recover metabolic function. DESIGN AND METHODS: Male Swiss-Webster mice were assigned to either: standard light-dark (LD) conditions for 8 weeks (LD/LD), dLAN for 8 weeks (dLAN/dLAN), LD for 4 weeks followed by 4 weeks of dLAN (LD/dLAN), and dLAN for 4 weeks followed by 4 weeks of LD (dLAN/LD). RESULTS: After 4 weeks in their respective lighting conditions both groups initially placed in dLAN increased body mass gain compared to LD mice. Half of the dLAN mice (dLAN/LD) were then transferred to LD and vice versa (LD/dLAN). Following the transfer dLAN/dLAN and LD/dLAN mice gained more weight than LD/LD and dLAN/LD mice. At the conclusion of the study dLAN/LD mice did not differ from LD/LD mice with respect to weight gain and had lower fat pad mass compared to dLAN/dLAN mice. Compared to all other groups dLAN/dLAN mice decreased glucose tolerance as indicated by an intraperitoneal glucose tolerance test at week 7, indicating that dLAN/LD mice recovered glucose metabolism. dLAN/dLAN mice also increased MAC1 mRNA expression in peripheral fat as compared to both LD/LD and dLAN/LD mice, suggesting peripheral inflammation is induced by dLAN, but not sustained after return to LD. CONCLUSION: These results suggest that re-exposure to dark nights ameliorates metabolic disruption caused by dLAN exposure.
Subject(s)
Light , Obesity/epidemiology , Photoperiod , Animals , Body Mass Index , Energy Intake , Gene Expression , Glucose Tolerance Test , Male , Mice , Obesity/etiology , Weight GainABSTRACT
Humans and other organisms have adapted to a consistent and predictable 24-h solar cycle, but over the past ~130 years the widespread adoption of electric light has transformed our environment. Instead of aligning behavioral and physiological processes to the natural solar cycle, individuals respond to artificial light cycles created by social and work schedules. Urban light pollution, night shift work, transmeridian travel, televisions and computers have dramatically altered the timing of light used to entrain biological rhythms. In humans and other mammals, light is detected by the retina and intrinsically photosensitive retinal ganglion cells project this information both to the circadian system and limbic brain regions. Therefore, it is possible that exposure to light at night, which has become pervasive, may disrupt both circadian timing and mood. Notably, the rate of major depression has increased in recent decades, in parallel with increasing exposure to light at night. Strong evidence already links circadian disruption to major depression and other mood disorders. Emerging evidence from the past few years suggests that exposure to light at night also negatively influences mood. In this review, we discuss evidence from recent human and rodent studies supporting the novel hypothesis that nighttime exposure to light disrupts circadian organization and contributes to depressed mood.
Subject(s)
Circadian Rhythm/physiology , Lighting/adverse effects , Mood Disorders/physiopathology , Animals , Humans , PhotoperiodABSTRACT
Humans and other organisms have adapted to a 24-h solar cycle in response to life on Earth. The rotation of the planet on its axis and its revolution around the sun cause predictable daily and seasonal patterns in day length. To successfully anticipate and adapt to these patterns in the environment, a variety of biological processes oscillate with a daily rhythm of approximately 24 h in length. These rhythms arise from hierarchally-coupled cellular clocks generated by positive and negative transcription factors of core circadian clock gene expression. From these endogenous cellular clocks, overt rhythms in activity and patterns in hormone secretion and other homeostatic processes emerge. These circadian rhythms in physiology and behaviour can be organised by a variety of cues, although they are most potently entrained by light. In recent history, there has been a major change from naturally-occurring light cycles set by the sun, to artificial and sometimes erratic light cycles determined by the use of electric lighting. Virtually every individual living in an industrialised country experiences light at night (LAN) but, despite its prevalence, the biological effects of such unnatural lighting have not been fully considered. Using female Siberian hamsters (Phodopus sungorus), we investigated the effects of chronic nightly exposure to dim light on daily rhythms in locomotor activity, serum cortisol concentrations and brain expression of circadian clock proteins (i.e. PER1, PER2, BMAL1). Although locomotor activity remained entrained to the light cycle, the diurnal fluctuation of cortisol concentrations was blunted and the expression patterns of clock proteins in the suprachiasmatic nucleus and hippocampus were altered. These results demonstrate that chronic exposure to dim LAN can dramatically affect fundamental cellular function and emergent physiology.
Subject(s)
CLOCK Proteins/blood , Hydrocortisone/blood , Light , Animals , CLOCK Proteins/genetics , Cricetinae , Female , Locomotion , PhodopusABSTRACT
The prevalence of major depression has increased in recent decades and women are twice as likely as men to develop the disorder. Recent environmental changes almost certainly have a role in this phenomenon, but a complete set of contributors remains unspecified. Exposure to artificial light at night (LAN) has surged in prevalence during the past 50 years, coinciding with rising rates of depression. Chronic exposure to LAN is linked to increased risk of breast cancer, obesity and mood disorders, although the relationship to mood is not well characterized. In this study, we investigated the effects of chronic exposure to 5 lux LAN on depression-like behaviors in female hamsters. Using this model, we also characterized hippocampal brain-derived neurotrophic factor expression and hippocampal dendritic morphology, and investigated the reversibility of these changes 1, 2 or 4 weeks following elimination of LAN. Furthermore, we explored the mechanism of action, focusing on hippocampal proinflammatory cytokines given their dual role in synaptic plasticity and the pathogenesis of depression. Using reverse transcription-quantitative PCR, we identified a reversible increase in hippocampal tumor necrosis factor (TNF), but not interleukin-1ß, mRNA expression in hamsters exposed to LAN. Direct intracerebroventricular infusion of a dominant-negative inhibitor of soluble TNF, XPro1595, prevented the development of depression-like behavior under LAN, but had no effect on dendritic spine density in the hippocampus. These results indicate a partial role for TNF in the reversible depression-like phenotype observed under chronic dim LAN. Recent environmental changes, such as LAN exposure, may warrant more attention as possible contributors to rising rates of mood disorders.
Subject(s)
Depression/etiology , Photoperiod , Tumor Necrosis Factor-alpha/metabolism , Animals , Brain-Derived Neurotrophic Factor/metabolism , Cricetinae , Dendritic Spines/ultrastructure , Depression/prevention & control , Female , Hippocampus/cytology , Hippocampus/drug effects , Hippocampus/metabolism , Interleukin-1beta/metabolism , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
A retained microcatheter is a rare complication of endovascular treatment of cerebral aneurysms. We describe such a case that was complicated by delayed microcatheter fracture within the internal carotid artery and subsequent thrombo-embolism resulting in transient ischaemic attacks. We also describe endovascular management of this complication through the use of several carotid stents.
Subject(s)
Catheters/adverse effects , Embolization, Therapeutic/adverse effects , Endovascular Procedures/methods , Foreign Bodies/complications , Ischemic Attack, Transient/etiology , Stents , Carotid Artery, Internal/diagnostic imaging , Cerebral Angiography , Embolization, Therapeutic/instrumentation , Endovascular Procedures/instrumentation , Equipment Failure , Foreign Bodies/diagnosis , Foreign Bodies/therapy , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/prevention & control , Male , Middle Aged , Thromboembolism/diagnosis , Thromboembolism/etiology , Thromboembolism/prevention & control , Tomography, X-Ray Computed , UltrasonographyABSTRACT
In response to changing day lengths, small photoperiodic rodents have evolved a suite of adaptations to survive the energetic bottlenecks of winter. Among these adaptations are changes in metabolism, adiposity, and energy balance. Whereas hypothalamic and neuroendocrine regulation of these adaptations has been extensively studied, the impact of day length, and interaction of day length and stress, on the energy balance of neurons within the central nervous system remains unspecified. Thus, we exposed male Siberian hamsters (Phodopus sungorus) to either short or long day lengths for 14 weeks to induce the full suite of adaptive responses, exposed them to 4h of restraint, and then measured relative mRNA expression in the hippocampus for low- and high-affinity glucocorticoid receptors (glucocorticoid receptor (GR), mineralocorticoid receptor (MR)), brain-derived neurotrophic factor (BDNF), and the neuron-specific glucose transporter GLUT3. Independent of photoperiod, restraint elevated plasma cortisol (CORT) concentrations and reduced expression of GR, MR, and BDNF. Neither restraint nor photoperiod significantly altered GLUT3 expression. Among all groups, plasma cortisol concentrations were negatively correlated with GR and MR expression. MR, BDNF, and GLUT3 levels were positively correlated with one another, even when controlling for photoperiod and CORT. Taken together, these results suggest that, as peripheral energy balance changes across day length in this photoperiodic species, the neurons of the hippocampus do not alter relative gene expression levels of three proteins involved in monitoring neuronal glucose regulation and morphology.