[Diagnostic workup of brain-dead organ donors and organ retrieval]. / Diagnostik des hirntoten Organspenders und Organentnahme.

Renal transplantation is well established as the best and often the only treatment for many patients with end-stage kidney failure. Because of an increasing shortfall between the diminishing number of deceased donor organs available and the increasing waiting list of patients in need of transplantation the shortage of suitable donors remains one of the most pressing challenges. The success of organ transplantation can be attributed to many factors but ultimately depends upon retrieval and preservation techniques to maintain the quality of an organ. Although the literature on organ retrieval is extensive, the level of evidence provided is mainly low. But as techniques and treatments improve, it may be possible to use organs from donors who were previously thought to be unsuitable. This article provides the reader an overview on the topic of organ donation.

Identification of high-risk patients with clear cell renal cell carcinoma based on interphase-FISH.

BACKGROUND: The aim of this study was to examine the prognostic value of four significant aberrations based on our previous studies by array-CGH to develop a prognostic Fluorescence-in situ-hybridisation (FISH) assay for clear cell renal cell carcinomas (ccRCC). METHODS: Fluorescence-in situ-hybridisation experiments were performed on 100 ccRCCs (52 metastasised out of 48 non-metastasised). The mean/median follow up of patients was 59/54 months. Commercially available FISH probes were used for each critical chromosomal region (1q21.3, 7q36.3, 9p21.3p24.1 and 20q11.21q13.32). The total number of specific aberrations (TNSA) was calculated for each tumour based on the specific genomic alterations. RESULTS: Total number of specific aberrations was the best predictor of metastasis (area under the curve (AUC)=0.814) compared with single aberrations (AUC: 0.619-0.708) and to 11 different combinations of these 4 aberrations in the receiver operating characteristic curve analysis. Total number of specific aberrations, tumour grade and tumour size were independent predictors of metastasis in the multivariate analysis (P<0.001) for the whole cohort as well as for organ-confined tumours. Total number of specific aberrations and grade could also independently predict cancer-specific mortality (CSM). Total number of specific aberrations demonstrated the highest significance in COX proportional hazard models of overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS). CONCLUSIONS: We identified TNSA as an independent prognostic factor which is associated with metastasis occurrence, CSM, OS, CSS and PFS in patients with ccRCCs.

[19th annual conference of the working group on kidney transplantation of the academy of german urologists : mainz, 10-12 november 2011]. / 19. Jahrestagung des Arbeitskreises Nierentransplantation der Akademie der Deutschen Urologen : Mainz 10. bis 12. November 2011.

The 19th Annual Conference of the Working Group on Kidney Transplantation (KTX) of the Academy of German Urologists took place on 10-12 November 2011 in Mainz. The main topics at the meeting were surgical and technical aspects, immunosuppressive therapy, transplant rejection, pregnancy, sexuality, and psychological conflicts of kidney transplant recipients. The speakers documented the pertinence of interdisciplinarity for KTX and were not only from the field of urology but also from anesthesiology, gynecology, surgery, dermatology, nephrology, radiology, and psychosomatic medicine. The Bernd Schönberger Prize was awarded at the end of the event.

Application of an optimized system for the well-defined exposure of human lung cells to trichloramine and indoor pool air.

In this study an in vitro exposure test to investigate toxicological effects of the volatile disinfection by-product trichloramine and of real indoor pool air was established. For this purpose a set-up to generate a well-defined, clean gas stream of trichloramine was combined with biotests. Human alveolar epithelial lung cells of the cell line A-549 were exposed in a CULTEX(®) device with trichloramine concentrations between 0.1 and 40 mg/m(3) for 1 h. As toxicological endpoints the cell viability and the inflammatory response by the cytokines IL-6 and IL-8 were investigated. A decreasing cell viability could be observed with increasing trichloramine concentration. An increase of IL-8 release could be determined at trichloramine concentrations higher than 10 mg/m(3) and an increase of IL-6 release at concentrations of 20 mg/m(3). Investigations of indoor swimming pool air showed similar inflammatory effects to the lung cells although the air concentrations of trichloramine of 0.17 and 0.19 mg/m(3) were much lower compared with the laboratory experiments with trichloramine as the only contaminant. Therefore it is assumed that a mixture of trichloramine and other disinfection by-products in the air of indoor pool settings contribute to that effect.

B domain containing Tenascin-C: a new urine marker for surveillance of patients with urothelial carcinoma of the urinary bladder?

BACKGROUND: ECM remodelling during tumorigenesis entails the re-occurrence of different Tn-C(L) splicing variants. In patients with urothelial carcinoma of the urinary bladder (UBC), B and C domain containing Tenascin-C (B(+) and C(+) Tn-C) urine levels were shown to be increased in case of muscle invasiveness. Thus, the present study was aimed at examining the ability of B(+) and C(+) Tn-C as potential urinary surveillance markers of UBC patients. METHODS: Urine levels of B(+) and C(+) Tn-C were determined by ELISA in 35 UBC patients during a 2 year follow-up period after therapy and related to clinical diagnosis and histological stage in 4 defined groups representing typical courses of disease. RESULTS: B(+) Tn-C levels showed significant differences between cases of tumour progression or regression. The urine levels of B(+) Tn-C could be used to discriminate between cases without tumour recurrence and such with tumour existence (cut-off value: 0.8 ng/ml) or between non-muscle invasive and muscle invasive tumour growth (cut-off value: 3.5 ng/ml). CONCLUSIONS: Progression of UBC with time is accompanied by significant changes in urinary levels of B(+) Tn-C. Urinary B(+) Tn-C can therefore be suggested as a valuable urine surveillance marker in UBC follow-up care.

Measuring entanglement in condensed matter systems.

We show how entanglement may be quantified in spin and cold atom many-body systems using standard experimental techniques only. The scheme requires no assumptions on the state in the laboratory, and a lower bound to the entanglement can be read off directly from the scattering cross section of neutrons deflected from solid state samples or the time-of-flight distribution of cold atoms in optical lattices, respectively. This removes a major obstacle which so far has prevented the direct and quantitative experimental study of genuine quantum correlations in many-body systems: The need for a full characterization of the state to quantify the entanglement contained in it. Instead, the scheme presented here relies solely on global measurements that are routinely performed and is versatile enough to accommodate systems and measurements different from the ones we exemplify in this work.

Measurement of diffusion and thermal diffusion in ternary fluid mixtures using a two-color optical beam deflection technique.

We have developed a highly sensitive two-color beam deflection setup to measure diffusion and thermal diffusion in ternary fluid mixtures following a suggestion of Haugen and Firoozabadi [J. Phys. Chem. B 110, 17678 (2006)]. Simultaneous detection of two laser beams with different wavelengths makes it possible to determine the time dependent concentration profiles of all three components. By comparing the measured beam deflection signals to a numerical solution of the coupled heat and mass transport equations, the diffusion matrix, the thermal diffusion, and the Soret coefficients are obtained by a numerical model combined with a nonlinear least-squares fitting routine. The results can be improved by additional thermal diffusion forced Rayleigh scattering experiments, which yield a contrast-weighted average thermal diffusion coefficient. The three Soret coefficients can be obtained independently from the stationary beam deflection amplitudes. Measurements have been performed on the symmetric (equal weight fractions) ternary mixtures dodecane/isobutylbenzene/1,2,3,4-tetrahydronaphthalene and 1-methylnaphthalene/octane/decane. There is only partial agreement between our results and literature data.

Downsizing a tumor thrombus of advanced renal cell carcinoma with neoadjuvant systemic therapy and resulting histopathological effects.

BACKGROUND: We report a treatment option in surgical therapy of locally advanced renal cell carcinoma (RCC). METHOD: A 63-year-old patient with locally advanced RCC including an atrial thrombus underwent 2 cycles of neoadjuvant therapy (Sutent 50 mg daily for 4 weeks followed by 2 weeks off) and then tumor surgery. Primary surgical therapy had to be delayed because of suspected bronchial carcinoma and additional diagnostics. After neoadjuvant therapy to downsize the tumor thrombus and exclusion of any additional malignant tumors, operation was done via abdominal access; no sternotomy was necessary. RESULTS: Histopathological examinations of the primary tumor after tyrosine kinase inhibitor therapy were evaluated and compared to tumor biopsy material taken before therapy. CONCLUSION: Neoadjuvant therapy with Sutent may represent a favorable treatment option in cases of locally advanced clear-cell RCC with extended tumor thrombus.

[Sexuality after kidney transplantation]. / Sexualität nach Nierentransplantation.

The quality of life of patients after kidney transplantation is of increasing interest. In this connection, issues of sexuality are meaningful too. Many patients with end-stage kidney disease suffer from sexual disorders. More than 50% of the male patients on dialysis and even more females are affected by disturbances such as erectile dysfunction and loss of libido or abnormal menstrual cycles. After successful kidney transplantation most symptoms in women are improved, whereas in men disturbances in erectile function often persist or even deteriorate. In these patients treatment with inhibitors of phosphodiesterase type 5 is a valid option with an effective response. In women with stable graft function pregnancy can be achieved successfully. Nevertheless, pregnant kidney allograft recipients should be considered as high-risk patients needing special care under the supervision of a team of obstetricians and nephrologists.

[Laser-supported partial nephrectomy for renal cell carcinoma]. / Lasergestützte partielle Nephrektomie beim Nierenzellkarzinom.

To decrease the disadvantages of vascular hilar clamping, we tested the use of a laser for partial nephrectomy. We conclude that laser-supported partial nephrectomy without clamping of the renal vessels, particularly in carefully selected patients, is a safe alternative to classic partial nephrectomy.

[The German Renal Cell Tumor Network]. / Deutsches Netzwerk Nierenzelltumoren.

To provide complex experimental and clinical analysis of renal cell tumors, it is necessary to investigate this tumor entity interdisciplinarily. The aim of the German Renal Cell Tumor Network is to answer current problems through interdisciplinary cooperation among clinicians and basic researchers from different fields. It is thus now possible to analyze more than 500 well-characterized tumor samples using different techniques.

[Molecular characterization of metastatic renal cell carcinomas. Differentiation of prognosis and therapy]. / Molekulare Charakterisierung der metastasierten Nierenzellkarzinome. Individuelle Prognosebewertung und Therapiewahl.

Molecular biological tumor markers and prognostic parameters are necessary for differential diagnosis, individual prognosis, and therapy in patients with renal cell tumors. By using high throughput technologies for DNA, RNA, and protein analysis, it is possible to comprehensively characterize tumor samples. We identified specific molecular patterns of metastatic tumors, allowing the determination of metastatic potential of the primary tumor. Different therapeutic options are now available for patients with metastatic renal cell carcinoma. Therefore, it is necessary to select the best therapy for each patient and to detect therapy resistance very early. Biomarkers in tumor tissue and serum were found correlating with therapy response.

Assessment of the performance of the Ames II assay: a collaborative study with 19 coded compounds.

Nineteen coded chemicals were tested in an international collaborative study for their mutagenic activity. The assay system employed was the Ames II Mutagenicity Assay, using the tester strains TA98 and TAMix (TA7001-7006). The test compounds were selected from a published study with a large data set from the standard Ames plate-incorporation test. The following test compounds including matched pairs were investigated: cyclophoshamide, 2-naphthylamine, benzo(a)pyrene, pyrene, 2-acetylaminofluorene, 4,4'-methylene-bis(2-chloroaniline), 9,10-dimethylanthracene, anthracene, 4-nitroquinoline-N-oxide, diphenylnitrosamine, urethane, isopropyl-N(3-chlorophenyl)carbamate, benzidine, 3,3'-5,5'-tetramethylbenzidine, azoxybenzene, 3-aminotriazole, diethylstilbestrol, sucrose and methionine. The results of both assay systems were compared, and the inter-laboratory consistency of the Ames II test was assessed. Of the eight mutagens selected, six were correctly identified with the Ames II assay by all laboratories, one compound was judged positive by five of six investigators and one by four of six laboratories. All seven non-mutagenic samples were consistently negative in the Ames II assay. Of the four chemicals that gave inconsistent results in the traditional Ames test, three were uniformly classified as either positive or negative in the present study, whereas one compound gave equivocal results. A comparison of the test outcome of the different investigators resulted in an inter-laboratory consistency of 89.5%. Owing to the high concordance between the two test systems, and the low inter-laboratory variability in the Ames II assay results, the Ames II is an effective screening alternative to the standard Ames test, requiring less test material and labor.

New cut-off point between T1 and T2 renal cell carcinoma - necessary for a better discriminatory power of the TNM classification.

PURPOSE: We evaluated the pathological features of tumor size, lymph node and distant metastases, cell type, growth pattern, infiltration pattern, histological grade, local invasion and venous involvement of organ-confined renal carcinomas. The aim of this study was the re-evaluation of the TNM classification and the tumor cut-off point between T1 and T2 for renal cell carcinomas from the 1987 to the 1997 versions. MATERIALS AND METHODS: (1) Patients with renal cell carcinoma who had been operated between October 1992 and August 2001 were evaluated. 437 of 691 patients showed T1 and T2 tumors. These organ-confined tumors have been divided into five groups: group 1: tumor-size of 20 mm or less (n = 16), group 2: 21-30 mm (n = 79); group 3: 31-40 mm (n = 83; group 4: 41-70 mm (n = 184), and group 5: more than 70 mm in diameter (only T2, n = 75). Follow-up ranged from 0 to 100 months (average 28.63 months). (2) Of 15,347 autopsies performed in Jena between 1985 and 1996, 272 renal cell carcinomas were revealed. In 145 of these 272 cases renal cell carcinomas were limited to the kidney. These 145 tumors were divided accordingly into 5 groups: group 1: 20 mm or less (n = 33), group 2: 21- 30 mm (n = 31); group 3: 31-40 mm (n = 29); group 4: 41-70 mm (n = 42), and group 5: T2 (n = 10). Clinicopathological criteria examined were lymph node and distant metastases, cell type, growth pattern, infiltration pattern, histological grade, local invasion and venous involvement. To identify the optimal cut-off point between T1 and T2 disease the chi2 test was used. RESULTS: (1) In the clinical series only 1.8% (n = 8) of all cases showed lymph node metastases. Distant metastases were shown in 57 cases (13.04%); within group 1: 0%, group 2: 7.59%, group 3: 1.20%, group 4: 15.76%, group 5: 28%. The tumor grading was statistically correlated with tumor size. (2) In the pathological series 94 of the evaluated 145 patients were downstaged from T2(1987) to T1(1997). Lymph node and distant metastases were well correlated with tumor size. Lymph node metastases were seen in 0, 12.9, 31, 29.3 and 40% (group 1 to group 5) and distant metastases in 12.1, 25.8, 41.4, 47.7 and 60%. There were no statistically significant differences between T2(1997) and T1(3-7 cm). The tumor grading was statistically correlated with tumor size (grade 1: in 66.7, 25.8, 17.2, 9.5 and 0%). CONCLUSION: Our data suggest that the current cut-off diameter between T1 and T2 renal cell carcinomas (7 cm) is too high. Lowering the cut-off level will result in better discriminatory power of the TNM classification. From our data, we conclude that the cut-off diameter should be lowered to 3.5 cm (p < 0.001).