Renal transplantation in gigantism: A case report

BACKGROUND Gigantism,characterized by excessive growth and height is due to increased secretion of growth hormone,most commonly from a pituitary adenoma.In addition to the surgical and anesthetic complexity,the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single or dual kidney transplantation.The lack of relevant literature further adds to the dilemma.CASE SUMMARY A 45-year-old patient with untreated gigantism and end stage renal failure on renal replacement therapy was waitlisted for a deceased donor dual kidney transplantation due to the extreme physical stature(Height-247 cm and weight-200 kg).He was offered 2 kidneys from a 1-0-1 HLA mismatched 24-year-old DCD donor(Height-179 cm and weight-75 kg),and was planned for a bilateral retroperitoneal implantation into the recipient external iliac vessels.The immunosuppression consisted of alemtuzumab induction(50 mg)and steroidfree maintenance with tacrolimus.The donor’s right kidney was uneventfully implanted extra-peritoneally into the right external iliac vessels.On contralateral exposure,the left common and external iliac arteries were ectatic and frail.A complex vascular reconstruction was not preferred in order to preserve the arterial supply to the left lower limb,to minimise the cold ischemia time and prevent additional warm ischemic insult to the second kidney.Hence,it was decided not to proceed with dual transplantation.Amidst concerns of nephron mass insufficiency,the graft function was remarkable with a serum creatinine of 120μmol/L within a month from transplantation and 94μmol/L at 1-year post transplantation,and without proteinuria.CONCLUSION To our knowledge,this is the first case report on kidney transplantation in gigantism.Although it is believed that dual kidney transplantation is ideal,a single kidney transplantation from an appropriately selected donor can provide sufficient functioning nephron mass in patients with gigantism.

The Interpretation of the Gigantic Insect in Metamorphosis

Kafka shows people the image of the gigantic insect according to the description of characteristics of its figure,action,language,food,etc and psychology.It seems to be absurd,but this phenomena discloses the reality of people's alienation in that society.The protagonist Gregor is similar to the gigantic insect in weakness,loneliness and the tragedy of the two is just an epitome of that times.Gregor,like the gigantic insect,cannot control his own fate and can just be trapped in the disaster caused by the cruel society of intense industrialization,which leads to his tragic end.

Perioperative nursing of a newborn with Beckwith-Wiedemann syndrome

Objective:To explore the perioperative nursing of a newborn with Beckwith-Wiedemann syndrome.Methods:We observed the blood glucose of the child and prevent infection of omphalocele before transpor tation and before the operation;after the operation,we performed airway nursing,blood glucose monitoring,urination observation,and tumor marker monitoring;finally,at the time of discharge from the hospital,we provided health education.Results:After a series of perioperative nursing measures,the child was discharged smoothly from hospital 34 d after operation.Conclusions:Beckwith-Wiedemann syndrome is a rare congenital malformation.Timely and accurate observation and evaluation of the child during perioperative period and targeted nursing measures can effectively reduce or avoid the occurrence of postoperative complications.

The intriguing giant deer from the Bate cave (Crete): could paleohistological evidence question its taxonomy and nomenclature?

The research describes for the first time a possible case of pituitary gigantism in fossil mammals,precisely in deer.The pathology was detected in 2 long bones(tibia and metatarsus)belonging to an individual of an unusual large size found at the Bate cave(Rethymnon,Northern Crete).It formed the basis of Candiacervus major,the largest among the endemic deer species recorded in the Pleistocene-Early Holocene of Crete.Radiological and histomorphological examinations highlighted a reduction in cortical bone thickness and the presence of wide lacunae inside of the bone tissue.The pathological conditions suggest a pituitary gigantism diagnosis also supported by some morphological evidence,such as the extremely elongated distal part of the metatarsal diaphysis,the proportionally small proximal epiphysis,and some bone gracility.The diagnosis of a case of pituitary gigantism as presumed responsible for the extraordinary elongation of the tibia and the metatarsal bone is intriguing as they are,respectively,the paratype and the holotype of the C.major.The species represents a case of a deviation from the“island rule”in Pleistocene large mammals.The new evidence recommends a taxonomic and nomenclatural revision of this species.The main outcomes of this research are as follows:(i)a case of pituitary gigantism is described for the first time in an extinct mammal;(ii)it is underlined that paleohistology may provide interesting clues for disentangling taxonomic and nomenclatural issues;(iii)one of the very few cases of gigantism in insular mammals is being questioned.

A giant crocodile in the Dubois Collection from the Pleistocene of Kali Gedeh(Java)

The fauna of the Pleistocene Homo-bearing sites of Java has been well known for more than a century.A recent revision of the crocodylian remains confirmed both the validity of Gavialis bengawanicus and the synonymiza-tion of Crocodylus ossifragus with C.siamensis.Here we report on a still unpublished crocodylian specimen collected by Eugene Dubois in the latest Early Pleistocene of Kali Gedeh that can be tentatively referred to the genus Crocodylus.The size of the specimen,the approximately 1 m long lower jaw in particular,indicat-ed that this crocodile attained a total length of approximately 6 or 7 m.Along with specimens from the Plio-Pleistocene of Africa,this material provides evidence for gigantism in Crocodylus.It is not clear whether or not the‘temperature-size rule’applies to fossil crocodylians,but due to the growing interest in predicting future temperature-related size changes of the extant organisms,it would be interesting to study in detail the past reac-tion to temperature changes of crocodylians and other terrestrial ectothermic animals.

Optically actuating ultra-stable radicals in a large π-conjugated ligand constructed photochromic complex

Producing ultra-stabilized radicals via light irradiation has raised considerable concern but remains a tremendous challenge in functional materials. Herein, optically actuating ultra-stable radicals are discovered in a sterically encumbered and large π-conjugated tri(4-pyridyl)-1,3,5-triazine(TPT) ligands constructed photochromic compound Cu_(3)(H-HEDP)_(2)TPT_(2)·2H_(2)O(QDU-12;HEDP=hydroxyethylidene diphosphonate). The photogeneration of TPT· radicals is the photoactive behavior of electron transfer from HEDP motifs to TPT units. The ultra-long-lived radicals are contributed from strong interchain π-π interactions between the large π-conjugated TPT components, with the radical lifetime maintained for about 18 months under ambient conditions. Moreover, the antiferromagnetic couplings between TPT· radicals and Cu^(2+)ions plummeted the demagnetization to 35% of its original state after light irradiation, showing the largest room temperature photodemagnetization in the current radicalbased photochromic materials.

A mixed-ligand approach for a gigantic and hollow heterometallic cage {Ni_(64)Gd_(96)} for gas separation and magnetic cooling applications

Subject Code:E01With the support of the National Natural Science Foundation of China,the research team led by Prof.Zheng Yanzhan(郑彦臻)at the Frontier Institute of Science and Technology,Xi'an Jiaotong University,recently reported a gigantic rare-earth transition metal cuboidal hollow cluster {Ni_(64)Gd_(96)}that exhibits high selectivity for absorbing CO_2over CH_4or N_2at room temperature and large magnetocaloric effects at