Effect of octreotide on oxidative stress in the erythrocyte and kidney tissue in adriamycin-induced experimental nephrotic syndrome model

INTRODUCTION

Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model.

METHODS

Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated.

RESULTS

There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group.

CONCLUSIONS

Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option.

Comparison of Grip Strength Measurements by Widely Used Three Dynamometers in Outpatients Aged 60 Years and Over

Grip strength (GS) is widely used in various fields such as sports, rehabilitation, and geriatrics to assess muscle strength, and to diagnose sarcopenia and frailty in older adults. There is a potential for measurement differences among different dynamometers available, and studies comparing GS measurements by variable tools have conflicting results. The two most frequently used dynamometers are the Jamar hydraulic (Jamar) and spring-type hand grip dynamometers, and Jamar has not been compared to Jamar PLUS+ Digital (Jamar+) dynamometer in older adults. So, we aimed to assess GS measurements with the Jamar as the reference standard against Jamar+, and spring-type Takei T.KK. 5401 (Takei) digital dynamometers. One hundred and ten outpatients aged >60 years were included. Inter-instrumental reliability was determined. The differences between dynamometers were evaluated by Bland-Altman plots and measurement error. The measurements with Jamar+, and Takei dynamometers were reliable and valid regarding the Jamar dynamometer. Takei and Jamar+ dynamometers overestimated GS over the Jamar dynamometer. Though the differences in the measured values might be disregarded in clinical practice, individuals defined to have low GS varied by the use of different dynamometers. Grip strength better be measured by the same dynamometer in serial measurements of older individuals.

A Core Outcome Set for nutritional intervention studies in older adults with malnutrition and those at risk: a study protocol

BACKGROUND

Malnutrition (i.e., protein-energy malnutrition) in older adults has severe negative clinical consequences, emphasizing the need for effective treatments. Many, often small, randomized controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and a need for meta-analyses and data pooling has been expressed. However, evidence synthesis is hampered by the wide variety of outcomes and their method of assessment in previous RCTs. This paper describes the protocol for developing a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk.

METHODS

The project consists of five phases. The first phase consists of a scoping review to identify frequently used outcomes in published RCTs and select additional patient-reported outcomes. The second phase includes a modified Delphi Survey involving experienced researchers and health care professionals working in the field of malnutrition in older adults, followed by the third phase consisting of a consensus meeting to discuss and agree what critical outcomes need to be included in the COS. The fourth phase will determine how each COS outcome should be measured based on a systematic literature review and a second consensus meeting. This will be followed by a dissemination and implementation phase. Patient and Public Involvement (PPI) representatives will contribute to study design, oversight, consensus, and dissemination.

CONCLUSIONS

The result of this project is a COS that should be included in any RCT evaluating the effect of nutritional interventions in older adults with malnutrition and those at risk. This COS will facilitate comparison of RCT results, will increase efficient use of research resources and will reduce bias due to measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.

1322 DEVELOPMENT OF A CORE OUTCOME SET FOR NUTRITIONAL INTERVENTION STUDIES IN OLDER ADULTS WITH MALNUTRITION AND THOSE AT RISK

Background

Malnutrition (i.e., protein-energy malnutrition) in older adults is associated with significant complications and increased mortality, highlighting the need for effective treatments. Many randomised controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and there is a need for meta-analyses. However, evidence synthesis is hampered by the wide variety of outcomes and assessment methods in RCTs. This project, led by EuGMS Special Interest Group Nutrition, aims to develop a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk.

Methods

The project consists of five phases: 1) a scoping review (completed) to identify frequently used outcomes in published RCTs and select additional patient-reported outcome measures (PROMs). Patient and Public Involvement (PPI) representatives have been involved to provide feedback on the proposed list of outcomes resulting from the review and PROMs; 2) a modified Delphi Survey whereby experienced researchers and health care professionals working in the field of malnutrition in older adults will be invited to rate the importance of the proposed outcomes; 3) a consensus meeting to discuss and agree what critical outcomes need to be included in the COS; 4) a systematic review to determine how each COS outcome should be measured and a second consensus meeting; 5) a dissemination and implementation phase.

Conclusions

The result of this project will be a COS that should be included in any RCT testing the effectiveness of interventions to tackle malnutrition in older people as a minimum. This COS will facilitate comparison of RCT results, will promote efficient use of research resources and might reduce bias in measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.

The extension of the 2-D finite element/boundary element hybrid method to general multigroup neutron diffusion theory

The finite element-boundary element hybrid method developed previously for reflected systems and restricted to one or two group neutron diffusion theory has been extended to the general multigroup neutron diffusion theory by using the boundary integral equation of multigroup neutron diffusion theory. A linear or bilinear 2-D FEM formulation in the core combined with a 2-D linear BEM formulation in the reflector constitute the basic discretization procedure. Use of the boundary integral equation of multigroup diffusion theory transforms all group-to-group scattering domain integrals into surface integrals in the reflector. Hence the need for a reflector domain mesh is completely eliminated. Via comparisons with pure FEM and BEM solutions of the reflected systems within the context of three and four group diffusion theories, the present formulation is validated and assessed.

A reminder of the anatomy of the recurrent artery of heubner

Previous accounts of the recurrent artery of Heubner show serious inconsistencies concerning the origins, dimensions and numbers of the artery. In the present study, based on 54 (38 male, 16 female) human autopsy brains the common type of the recurrent artery of Heubner was present bilaterally in 46 cases (85.2%), while in 6 (11.1%) cases it was present only on one side (4 on the right, 2 on the left). Unilateral vessels were seen only in the male autopsy brains. The recurrent artery of Heubner could not be identified in 2 brains (3.7%). Multiple Heubner arteries were not observed in the present study. No gender differences were observed regarding the origin and dimensions of the recurrent artery of Heubner. 76 recurrent arteries of Heubner arising from the junction of the anterior cerebral artery (ACA) and anterior communicating artery (ACoA) (79.2%) had a mean diameter of 0.66+/-0.11 mm. In 14 arteries the artery derived from the A2 segment of the ACA (14.6%) and the mean diameter was 0.66+/-0.17 mm; in 6 arteries it originated from the A1 segment of the ACA (6.2%) and the mean diameter was 0.47+/-0.15 mm. The average diameter was calculated as 0.67+/-0.12 mm and ranged between 0.40 and 0.90 mm, irrespective of sex or side. A detailed anatomical knowledge of the recurrent artery of Heubner is important when considering vascular surgery in this area.

Morphometric measurements of the caudal cranial nerves in the petroclival region

OBJECTIVE

The dural zone of entry or exit of the caudal cranial nerves in the petroclival region does not have a constant localization. The present study aimed to measure the clival length, the distances between cranial nerve dural openings and the distance of cranial nerves from the mid-clival line in 30 human autopsy cases.

MATERIAL AND METHODS

Thirty autopsy specimens (8 female, 22 male) from persons aged between 20-76 years (mean age 38.9 years) were studied. Autopsies with intracranial lesions were not included in the study.

RESULTS

The average distances between the right and left dural openings of caudal cranial nerves in the petroclival region were as follows (mean+/-sd): trigeminal, 32.17+/-5.41 mm; abducent, 20.04+/-3.23 mm; facial and vestibulocochlear, 50.97+/-5.86 mm; glossopharyngeal, vagus, accessory, 41.59+/-6.46 mm and hypoglossal 26.8+/-4.33 mm. The measurements of the distances of the cranial nerve exits to the mid-clival line showed considerable asymmetries for the left and right trigeminal nerves. Furthermore, the distances between the trigeminal and the abducent nerves on the right and left differed significantly (p<0.029). The average distance between these two cranial nerves on the left was 8.44+/-3.66 mm and on the right was 7.31+/-2.41 mm. In addition, the average clival length was 56.96+/-5.91 mm (range: 42-71 mm).

CONCLUSIONS

Most of the surgical procedures performed in this area are to remove tumors which significantly modify the local anatomy. Knowledge of morphometric variations can increase the success of cranial nerve preservation during surgical procedures of the posterior cranial fossa.

The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery

The carotico-clinoid foramen is the result of ossification either of the carotico-clinoid ligament or of a dural fold extending between the anterior and middle clinoid processes of the sphenoid bone. It is anatomically important due to its relations with the cavernous sinus and its content, sphenoid sinus and pituitary gland. In this study the ossification state of the carotico-clinoid ligament, the diameter of the internal carotid artery and the carotico-clinoid foramen has been studied on 50 autopsy cases. Of the 100 carotico-clinoid foramina examined, in 27 sides (15 right, 12 left) the carotico-clinoid ligament was completely ossified, in 18 sides (9 right, 9 left) the carotico-clinoid ligament was incompletely ossified and in 55 sides (26 right, 29 left) it was a ligamentous structure. The correlation of the dimensions of the carotico-clinoid foramen and the internal carotid artery showed no statistical significance, except between the carotico-clinoid foramen with a fibrous carotico-clinoid ligament and the internal carotid artery on the right side (p=0.007, r=0.51). The existence of a bony carotico-clinoid foramen may cause compression, tightening or stretching of the internal carotid artery. Further, removing the anterior clinoid process is an important step in regional surgery; the presence of a bony carotico-clinoid foramen may have high risk. Therefore, detailed knowledge of the type of ossification between the anterior and middle clinoid processes can be necessary to increase the success of regional surgery.

The afferent connections of the posterior hypothalamic nucleus in the rat using horseradish peroxidase

The posterior hypothalamic nucleus has been implicated as an area controlling autonomic activity. The afferent input to the nucleus will provide evidence as to its role in autonomic function. In the present study, we aimed to identify the detailed anatomical projections to the posterior hypothalamic nucleus from cortical, subcortical and brainstem structures, using the horseradish peroxidase (HRP) retrograde axonal transport technique in the rat. Subsequent to the injection of HRP into the posterior hypothalamic nucleus, extensive cell labelling was observed bilaterally in various areas of the cerebral cortex including the cingulate, frontal, parietal and insular cortices. At subcortical levels, labelled cells were observed in the medial and lateral septal nuclei, the bed nucleus of stria terminalis, and various thalamic and amygdaloid nuclei. Also axons of the vertical and horizontal limbs of the diagonal band were labelled and labelled cells were localised at the CA1 and CA3 fields of the hippocampus and the dentate gyrus. The brainstem projections were from the medial, lateral and parasolitary nuclei, the intercalated nucleus of the medulla, the sensory nuclei of the trigeminal nerve, and various reticular, vestibular, raphe and central grey nuclei. The posterior hypothalamic nucleus also received projections from the lateral and medial cerebellar nuclei and from upper cervical spinal levels. The results are discussed in relation to the involvement of the posterior hypothalamic nucleus in autonomic function and allows a better understanding of how the brain controls visceral function.

Trifurcation of the left common carotid artery: a case report

During dissection of the carotid triangle, a carotid trifurcation was encountered. The left common carotid artery gave off three terminal branches: external carotid, internal carotid, and occipital arteries. The level of trifurcation was 35 mm above the superior margin of the thyroid cartilage. Further, the superior thyroid artery arose from the common carotid artery instead of the external carotid. Herein, we describe the detailed anatomical features of the variant branching pattern of the left common carotid artery and its clinical implications.

Celiacomesenteric trunk

The celiac trunk is the widest ventral branch of the abdominal aorta. The unusual embryological development of the ventral splanchnic arteries can lead to considerable variations. During the dissection of a 54-year-old male cadaver as a rare variation, a celiacomesenteric trunk was observed. The rare occurrence of this variation is stated to be 1%-2.7%. As in the other case, the celiac trunk and the superior mesenteric arteries arose from a common trunk at the level of L1. This case of celiacomesenteric trunk is described in detail, which can be of value in the operative procedures of the upper abdomen.

Rare variation of the axillary artery

The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery). The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery. It continues its course in the arm lateral to the median nerve and terminates by giving a minute twig to the radial artery. The superficial brachial artery is larger in caliber than the deep brachial artery and gives no branches in the arm region. In the cubital fossa it gives the ulnar and the radial arteries. This case is a variant of the axillary artery that has been rarely (0.12-3.2%) documented in the literature. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures in this region. Clin. Anat. 13: 66-68, 2000.

The effects of cold-restraint stress on urinary bladder wall compared with interstitial cystitis morphology

Stress is associated with many diseases of unknown aetiology. This study demonstrates the effects of cold-restraint stress on the morphology of the urinary bladder. Additionally, it compares the results obtained with the morphology of the interstitial cystitis. The animals were subjected to three hours of cold-restraint stress and then starved for 48 h. The morphology and histochemistry of the urinary bladder was investigated with light and electron microscopy. The proliferative activity was analysed via flow cytometry. Increased and degranulated mast cells in the mucosa, leucocyte infiltration in the lamina propria, vacuole formation in the urothelial cells, loose tight junction, dilated intercellular spaces and altered proliferative activity were observed in the stress group when compared with the control. The increase in the number of mast cells and especially degranulated mast cells and vacuole formation and the loose tight junction of the urothelium correlated with the histopathological findings of interstitial cystitis.

An unusual flexor hallucis longus muscle

During the dissection of the posterior compartment of the left leg, an unusual flexor hallucis longus muscle of a fifty two years-old male cadaver was observed. On the medial side of the flexor hallucis longus, on its lower distal half, a prominent aponeurotic structure was observed. A small unusual muscle mass was attached to this aponeurotic structure. The muscular fibres of the unusual mass were arranged in form of bipennate muscle. It originated via a broad tendon from the muscular fibres of the tibialis posterior and the deep transverse fascia covering the same muscle. It inserted on the aponeurosis of the lower medial half of the flexor hallucis longus muscle. Having in mind the very different pathology in the region of the ankle and the foot, the significance of such a muscle mass could be of practical importance.

A variation of coeliac trunk

The anatomical variations of the coeliac trunk are due to developmental changes in the ventral splanchnic arteries. This report describes a case in which the left inferior phrenic artery and left gastric artery arose from the long coeliac trunk (4.3 cm.) via a common trunk. The arterial variations, like other anatomical variations, cannot be ignored during the operative procedures in abdomen. Therefore the different forms of variations concerning the coeliac trunk should be kept in mind during both surgical and non-surgical evaluations.

An unusual variation of extensor digitorum brevis manus: a case report and literature review

An unusual variation of the extensor digitorum brevis manus in a male cadaver is presented. The band-shaped muscle was located at the ulnar side of the hand between the fourth and fifth extensors. It originated from the deep carpal fascia and inserted to the extensor tendons of the fourth and fifth fingers with a tendon and a slip, respectively. The origin, insertion, and location of the muscle differ from those previously reported; with these anatomic features, the muscle variation cannot be placed into the current classifications. The phylogenetic and ontogenetic implications of the muscle are reviewed.

Celiacomesenteric trunk

The celiac trunk is the widest ventral branch of the abdominal aorta. The unusual embryological development of the ventral splanchnic arteries can lead to considerable variations. During the dissection of a 54-year-old male cadaver as a rare variation, a celiacomesenteric trunk was observed. The rare occurrence of this variation is stated to be 1%-2.7%. As in the other case, the celiac trunk and the superior mesenteric arteries arose from a common trunk at the level of L1. This case of celiacomesenteric trunk is described in detail, which can be of value in the operative procedures of the upper abdomen.

Celiacomesenteric trunk

The celiac trunk is the widest ventral branch of the abdominal aorta. The unusual embryological development of the ventral splanchnic arteries can lead to considerable variations. During the dissection of a 54-year-old male cadaver as a rare variation, a celiacomesenteric trunk was observed. The rare occurrence of this variation is stated to be 1%-2.7%. As in the other case, the celiac trunk and the superior mesenteric arteries arose from a common trunk at the level of L1. This case of celiacomesenteric trunk is described in detail, which can be of value in the operative procedures of the upper abdomen.

A morphological study on the V2 segment of the vertebral artery

Morphometric investigations on the V2 segment of the vertebral artery, showed that, it did not have a constant calibre during its course within the foramina transversaria. The vertebral artery, entering the foramina transversaria reduced its calibre and further continued to reduce until C3 level, above C3 it began to reincrease its calibre and at C1 level reached its largest calibre. Measurements on the muscular thickness, showed an increase as ascending through the foramina transversaria. The widening and narrowing of the vertebral artery within the foramina transversaria was attributed as tortious artery or congenital anomaly. This study showed that it was the normal anatomy of the artery within the foramina transversaria.

The accessory tendon of the extensor indicis muscle

The extensor indicis and the extensor pollicis longus muscles differentiates from the extensor digitorum profundus muscle. The extensor indicis muscle is an unstable muscle concerning its variations. Kosugi (1989) found the frequency of variations of this muscle to be 20% and described 18 different types of variations of this muscle. This study describes a rare case of the extensor indicis muscle. The extensor indicis muscle develops an accessory tendon in between the extensor indicis and extensor pollicis longus muscle. It passes under the extensor retinaculum. At the level of 2nd metacarpal bone, the accessory extensor indicis tendon is connected to the tendon of the extensor pollicis longus muscle by a intertendinous connection.

The anatomy of lamina pretrachealis fasciae cervicalis

The definitions concerning the fascia pretrachealis is either contradictory or insufficient in anatomy textbooks. The fascia pretracheatis is clinically important in the procedure of tracheostomy, mediastinascopy and also in tracheal and bronchial trauma. The anatomy of the fascia pretrachealis (extension, relation and the attachments) was reexamined using cadaveric preparations and the clinical value of the fascia is reinforced. The fascia pretrachealis is attached to the upper brim and to the oblique line of the thyroid cartilage and continued its course on the anterior surface of the trachea and fused with the advantitia of arch of the aorta, posterior aspect of pulmonary artery and the pericardium. Laterally it is attached to the cartilagenous part of the trachea. Also contraversial literature concerning description of the fascia pretrachealis has been evaluated.

An accessory mylohyoid muscle

During dissection of the submandibular region of a forty year old male a unilateral left accessory mylohyoid muscle was revealed. This muscle was located between the left anterior belly of the digastric and left mylohyoid muscles. It arose from the left mylohyoid line of the mandible and was inserted into the lower portion of the mylohyoid raphe and hyoid bone. This unilateral accessory mylohyoid muscle is a rare anomaly, which is thought to contribute to the functional support of the floor of the mouth.

Vascularization of the long flexor tendon

The arterial supply of the long flexor tendon of the index and ring fingers were studied morphologically on 36 cadaver hands. Our studies, showed that the long flexor tendons were supplied by two main sources. Primarily by small arteries which ran in the vinculum longum and vinculum brevis and reached the dorsal surface of the tendon. Also by small intrinsic longitudinal vessels which ran parallel to the collagenous fibers of the tendon and extended from the muscular attachment of the long flexor tendons. No morphological difference on the vascularization of the index and ring fingers were observed.

Variations in the extracranial origin of the human vertebral artery

The aim of this study is to demonstrate a case of a cadaver in which both left and right vertebral arteries had an abnormal origin. On the left, the artery arose directly from the arch of the aorta. On the right, a double-originating vertebral artery was seen. The literature on the variations of the artery is reviewed and a detailed morphometric study of the artery was carried out because of its importance for neurosurgeons.