Spontaneous Tumor Lysis Syndrome Secondary to Iatrogenic Acute Kidney Injury: A Case Report

Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing cells lead to increased cell turnover which exceeds the kidneys’ ability to adequately filtrate by-products of cellular breakdown (i.e., phosphate, potassium, anduric acid), leading to end organ damage. It has been reported in the past that kidney failure is a sequelae of Tumor Lysis Syndrome (TLS), but there have been no reports that demonstrate acute kidney injury (AKI) preceding TLS. The case presented here demonstrates TLS in a patient with no formal cancer diagnosis, who had received no chemotherapy or radiation that was precipitated by an iatrogenic AKI with chlorthalidone and ibuprofen. This unusual pattern of AKI preceding STLS may provide insight into the pathophysiology of the condition and could possibly lead to greater understanding of this phenomenon.

Purification of total DNA extracted from activated sludge

Purification of the total DNA extracted from activated sludge samples was studied. The effects of extraction buffers and lysis treatments （lysozyme, sodium dodecyl sulfate （SDS）, sonication, mechanical mill and thermal shock） on yield and purity of the total DNA extracted from activated sludge were investigated. It was found that SDS and mechanical mill were the most effective ways for cell lysis, and both gave the highest DNA yields, while by SDS and thermal shock, the purest DNA extract could be obtained. The combination of SDS with other lysis treatment, such as sonication and thermal shock, could apparently increase the DNA yields but also result in severe shearing. For the purification of the crude DNA extract, polyvinyl polypyrrolidone was used for the removal of humic contaminants. Cetyltrimethyl ammonium bromide, potassium acetate and phenol/chloroform were used to remove proteins and polysaccharides from crude DNA. Crude DNA was further purified by isopropanol precipitation. Thus, a suitable protocol was proposed for DNA extraction, yielding about 49.9 mg （total DNA）/g volatile suspended solids, and the DNA extracts were successfully used in PCR amplifications for 16S rDNA and 16S rDNA V3 region. The PCR products of 16S rDNA V3 region allowed the DGGE analysis （denatured gradient gel electrophoresis） to be possible.

Tumor lysis syndrome after transarterial chemoembolization of hepatocellular carcinoma: Case reports and literature review

Tumor lysis syndrome (TLS) is a potentially lethal complication in cancer therapy. It may occur in highly sensitive tumors, especially in childhood cancer and leukemia, whereas, it is rare in the treatment of solid tumors in adults. TLS results from a sudden and rapid release of nuclear and cytoplasmic degradation products of malignant cells. The release of these can lead to severe alterations in the metabolic prof ile. Here, we present two cases of large hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE) that resulted in TLS. Although TLS rarely happens in the treatment of adult hepatic tumor, only a few cases have been reported. We should keep in mind that all patients with HCC, particularly those with large and rapidly growing tumors, must be closely watched for evidence of TLS after TACE.

Sorafenib induced tumor lysis syndrome in an advanced hepatocellular carcinoma patient

A 55-year-old male patient with hepatitis B-related liver cirrhosis was found to have advanced hepatocellular carcinoma.His AFP was initially 9828μg/L and rapidly dropped to 5597μg/L in ten days after oral sorafenib treatment.However,he developed acute renal failure, hyperkalemia,and hyperuricemia 30 d after receiving the sorafenib treatment.Tumor lysis syndrome was suspected and intensive hemodialysis was performed. Despite intensive hemodialysis and other supportive therapy,he developed multiple organ failure(liver, renal,and respiratory failure)and metabolic acidosis. The patient expired 13 d after admission.

Tumor lysis syndrome: A clinical review

Tumor lysis syndrome is an oncometabolic emergency resulting from rapid cell death. Tumor lysis syndrome can occur as a consequence of tumor targeted therapy or spontaneously. Clinicians should stratify every hospitalized cancer patient and especially those receiving chemotherapy for the risk of tumor lysis syndrome. Several aspects of prevention include adequate hydration, use of uric acid lowering therapies, use of phosphate binders and minimization of potassium intake. Patients at high risk for the development of tumor lysis syndrome should be monitored in the intensive care unit. Established tumor lysis syndrome should be treated in the intensive care unit by aggressive hydration, possible use of loop diuretics, possible use of phosphate binders,use of uric acid lowering agents and dialysis in refractory cases.

Bottleneck Analysis for Data Acquisition in High-Speed Network Traffic Monitoring

The increasing network throughput challenges the current network traffic monitor systems to have compatible high-performance data processing.The design of packet processing systems is guided by the requirements of high packet processing throughput.In this paper,we depict an in-depth research on the related techniques and an implementation of a high-performance data acquisition mechanism.Through the bottleneck analysis with the aid of queuing network model,several performance optimising methods,such as service rate increasing,queue removing and model simplification,are integrated.The experiment results indicate that this approach is capable of reducing the CPU utilization ratio while improving the efficiency of data acquisition in high-speed networks.

Endoscopic lysis of bladder scar associated with Hunner’s lesions:A new technique

Objective:Five to ten percent of interstitial cystitis/bladder pain syndrome(IC/BPS)patients have Hunner’s lesions(HL),areas of non-specific inflammation and scarring.The poor quality of life of patients with HL is entwined in associated pain and loss of bladder capacity.Although the decrease in bladder capacity is usually dependent on pain,it may also be dependent upon scarring and associated compliance changes produced by the inflammatory process.This report reviews the potential role of endoscopic scar lysis using the holmium laser in the management of these patients whose only other therapeutic option is urinary diversion.Methods:Two patients with HL and“end stage”bladders who underwent holmium laser division of bladder wall scar/tethering were identified.Clinical data were reviewed with emphasis on safety and efficacy.Results:Both patients selected for this procedure underwent holmium laser lysis of known scar tissue in an effort to increase bladder capacity and improve symptoms of urinary frequency and pain with bladder filling.The median age of patients who underwent the procedure was 63(59-67)years.Incisions were made with the holmium laser at frequencies of 3e10 Hz of 300e700 J along the region of scarring.All procedures were performed by the same practitioner.There was an increase in bladder capacity by 58.3%(50.0%-66.7%).During a mean follow-up of 4.2 years,there appeared to be a significant improvement with an increase in interval time between voids and a decrease in pain with bladder filling.Conclusion:Patients with IC/BPS may be severely debilitated by a clinically significant decrease in their bladder capacity,especially in the face of HL.The use of the holmium laser to incise regions of scar and bladder wall tethering may produce a clinically significant and durable increase in bladder capacity.The use of this technique as a means of treating bladder scarring poses an excellent adjunct to existing treatment strategies.

Improved Detection of Sleeping Sickness Cases by LED Fluorescence Microscopy: Evidence from a Prospective Multi-Centric Study in the Democratic Republic of the Congo

Background: Confirmatory diagnosis of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) is based on demonstration of parasites by microscopy. However, the sensitivity of routine microscopy methods is very low, and many cases are missed and left untreated. A clinical study was conducted in the Democratic Republic of the Congo to evaluate the accuracy of improved microscopy methods in diagnosis of HAT. These included examination by fluorescence microscopy (FM) of acridine orange (AO) stained smears of whole blood and smears made following a new procedure for concentrating trypanosomes by selective lysis of red blood cells (RBC). Methodology/Principal Findings: Venous blood was collected from 213 HAT cases, 101 HAT suspects and 95 controls and used to determine the accuracy of four microscopy methods: bright field microscopy of Giemsa-stained thick blood smears, FM of AO-stained thick blood smears, FM of AO-stained thick blood smears prepared after RBC lysis and concentration, and FM of AO-stained thin blood smears prepared after RBC lysis and concentration. The sensitivity of FM using thick blood smears stained with AO was 3 times higher than bright field microscopy using Giemsa-stained thick blood smears [19.7% (95% CI: 14.9% - 25.6%) versus 6.1% (95% CI: 3.6% - 10.2%)]. When the RBC lysis and concentration procedure was included, sensitivity of the test was further enhanced to 23.0% (95% CI: 17.9% - 29.1%) with thick blood smears and 34.3% (95% CI: 28.2% - 40.9%) with thin blood smears. Specificity of all four microscopy methods was 100% (95% CI: 96.1% - 100.0%). However, the miniature anion exchange chromatography technique (mAECT) and capillary tube centrifugation (CTC) method remained more sensitive. Conclusions: These new methods have practical advantages, including shorter staining time, ease of demonstration of parasites, and the possibility of archiving slides. They could, therefore, be alternative methods to improve case detection where concentration procedures such as mAECT or CTC are not performed.

Comparison of Economically Favourable and Further Development Friendly DNA Isolation Methods from Microbial Cultures

Microorganisms, regardless of whether pathogenic or not, may cause enormous economic losses due to adverse effects on human and animal health, or by damaging the quality of the agricultural and food products. Based on these effects, the development of prompt molecular methods and their involvement in the practical pathogen diagnostic diagnostics is more than actual. This paper is focused on the evaluation of easy-to-perform and highly budget-friendly, PCR-related DNA purification protocols for diagnostic purposes especially in water or similar simple matrices. The slight modifications of earlier described DNA isolation methods, which rely on chelate exchange resin and/or ethanol-sodium-based heat lysis, we reevaluated in comparison with a widely used commercial kit. The efficiency of DNA purification techniques was assessed from Gramnegative as well as Gram-positive bacteria and yeast using quantitative PCR. The effectivity of different methods tested may vary depending on the bacterial or yeast species in question. Nevertheless, in our hands, the chelate exchange resin-based methods were found to be the most robust and/or satisfying at least by an acceptable reproducibility rate. Our presented results support the potential of low-cost but still sensitive molecular microbe detection procedures consisting of only a few pipetting steps resulting in good reproducibility and the least possible environmental burden, serving as a good starting point for developments of matrix-specific processes and methods.

Maintainability Analysis Visualization System and Its Development in AutoCAD Environment

Maintainability is an important design characterist ic , and also is a design parameter. The essence of maintainability design is to ex pect and solve possible maintenance problems at early stage during product devel opment, maintainability must be designed into product simultaneously. But curren t maintainability methods do not support concurrent engineering. This paper anal yzes the deficiencies of existing maintainability technologies, and introduces t he concept of maintainability analysis visualization. The two major deficiencies are that maintainability analysis time lags behind product design, and the main tainability techniques do not accommodate modern product design concepts. After this, the infrastructure of maintainability analysis visualization system is dis cussed. The system are composed of four subsystems, they are product modeling, d isassembly process modeling, simulation and analysis, and user interface. Produc t modeling is accomplished with the capability of CAD system, disassembly proces s modeling is mainly a reason process based on assembly information. The system is integrated into AutoCAD so that designer can timely analyze their product des ign from the viewpoint of easy maintenance. Human model generation function, hum an task analysis function, tool analysis function, visibility analysis function is implemented, disassembly process planning function is still under developing.

Thrombolytic activity of cheonggukjang kinase in recovery from brain damage in a rat cerebral embolic stroke model

Cheonggukjang is a soybean paste made by fermenting whole cooked soybeans with Bacillus subtilis. Cheonggukjang contains a fibrinolytic enzyme that could provide clinical applications for removing blood clots. In the present study, the term ＂cheonggukjang kinase＂ （CGK） was used to refer to this fibrinolytic enzyme. The thrombolytic effects of CGK were analyzed in a rat model of cerebral embolic stroke produced by middle cerebral artery occlusion （MCAO）. Results from fibrin and platelet-rich clot lysis assays demonstrated that thrombolytic activity was greatest in CGKs, which were cultured for 40 hours. In addition, T50, the time needed to decompose 50% of the clot, did not change with plasminogen treatment, indicating that CGK was not a plasminogen activator, but was rather presumed to act as a plasmin-like protein. An intravenous infusion of CGK （1 U plasmin-like activity/100 μg CGK/kg） at 1 hour after MCAO resulted in removal of clots in a rat model of cerebral embolic stroke. CGK-treated groups exhibited a significant dose-dependent reduction in infarct volume. CGK treatment also improved functional recovery, as assessed by neurological deficit scores. Decreased infarct volume and improved functional recovery following CGK treatment was greater compared with recombinant tissue plasminogen activator （10 mg/kg）. These results suggested that CGK effectively reduced infarct volume and improved functional recovery following ischemic brain injury. CGK exhibits a number of potential clinical applications ir the treatment of cerebral embolic stroke.

Novel rapid tissue lysis method to evaluate cancer proteins: Correlation between elevated Bcl-X_L expression and colorectal cancer cell proliferation

AIM： We optimized a rapid and efficient tissue lysis method using the MagNA Lyser （Roche, Germany）. Using this novel method combined with immunoblot analysis, we investigated the correlation between abnormal Bcl-XL expression and clinicopathological characteristics in colorectal cancer. METHODS： Tissue samples from Sprague-Dawley rats were tested to determine optimal lysis conditions for use with MagNA Lyser. We next used the new method to extract tissue proteins from the tumor tissue of a colorectal cancer patient. The availability of extractable tissue proteins for proteomic study was demonstrated by two-dimensional （2D） gel electrophoresis and subsequent matrix-assisted laser desorption/ionization time-of-flight （MALDI-TOF） mass spectrometry. In addition, we prepared tissue lysates from paired tumor tissues and adjacent nontumor tissues of 50 colorectal carcinoma patients. Ensuing immunoblot analyses were performed to detect the level of Bcl-X, expression. RESULTS： The optimal sample sizes processed were found to be around 200 mg, with oscillation frequency of 6 500 r/rain for 80 s. Test of the first human tissue lysate confirmed that the MagNA Lyser method was adequate for protein extraction and subsequent identification by current proteomic protocols. The method was also applicable to immunoblot analysis. Thirty of 50 （60%） colorectal patients exhibited higher level of Bcl-XL expression in their tumor tissues. Raised level of Bcl-XL expression correlated with patients＇ gender and tumor cell proliferation index （P= 0.037 and P〈0.001, respectively）, but was independent of clinicopathological characteristics and overall survival. CONCLUSION： We report a novel tissue lysis method applicable to proteomic and immunoblot analyses, which can facilitate the discovery and detection of cancer protein alterations.

Entropy Production Rate Changes in Lysogeny/Lysis Switch Regulation of Bacteriophage Lambda

According to the chemical kinetic model of lysogeny/lysis switch in Escherichia coli （E. coil） infected by bacteriophage A, the entropy production rates of steady states are calculated. The resuits show that the lysogenic state has lower entropy production rate than lyric state, which provides an explanation on why the lysogenic state of A phage is so stable. We a/so notice that the entropy production rates of both lysogenic state and lyric state are lower than that of saddle-point and bifurcation state, which is consistent with the principle of minimum entropy production for living organism in nonequilibrium stationary state. Subsequently, the relations between CI and Cro degradation rates at two bifurcations and the changes of entropy production rate with CI and Cro degradation are deduced. The theory and method can be used to calculate entropy change in other molecular network.

The bacteriophage mu lysis system–A new mechanism of host lysis?

Bacteriophages are viruses that infect bacteria and can choose any one of the two alternative pathways for infection,i.e.,lysis or lysogeny.Phage lysis is one of the conventional biological processes required to spread infection from one bacterium to another.Our analysis suggests that in the paradigm bacteriophage Mu,six proteins might be involved in host cell lysis.Mu has a broad host range,and Mu-like phages were found in both Gram-negative and Gram-positive bacteria.An analysis of the genomes of Mu and Mu-like phages could be useful in elucidating the lysis mechanism in this group of phages.A detailed review of the various mechanisms of phage lysis and different proteins associated with the process will help researchers understand the phage biology and their life cycle in different bacteria.The recent increase in the number of multidrug-resistant(MDR)strains of bacteria and the usual long-term nature of new drug development has encouraged scientists to look for alternative strategies like phage therapy and the discovery of new lysis mechanisms.Understanding the lysis mechanism in the Mu-like phages could be exploited to develop alternative therapeutics to kill drug-resistant pathogenic bacteria.In this review article,we have analyzed the phage Mu-mediated host lysis system,which is unknown till now,and our analysis indicates a possibility of the existence of a new lysis mechanism operating in Mu.

Study on Genetic Inactivation Bacterial Ghosts of Pasteurella multocida based PhiX174 Gene E Lysis Cassette Mediated

[Objective] To study on genetic inactivation bacterial ghosts of Pasteurella multocida based PhiX174 gene E lysis cassette mediated. [ Method ] Recombinant pPBA1100-e was constructed by which the gene E of bacteriophage Phix174 and temperature sensitivity expressing control system hybridized with plasmid pPBA1100 by genetic engineering method. Recombinant was transformed to Pasteurella multocida and lysis gene E expressed by temperature induction. Recombinant was detected by restriction endonuclease. Cell morphology of bacterial ghost of Pasteurella mul- tocida was observed by scanning electron microscopy and inactivation ratio was estimated by CFU analysis. I Result~ The results indicated that the recombination plasmid presented three bands by restriction endonuclease and agarose electrophoresis and that molecular weight of every band ac- corded with theoretical value. The result of SEM observing showed that recombination plasmid expressed successfully in P. multocida and produced bacterial ghost. The result of CFU detecting demonstrated that inactivation ratio of P. multocida reached 99 per cent. ~Conclusion~ This study pro- vided technical bases for the preparation of antigen vaccine of natural bacterial outer membrane protein.

Tumour lysis syndrome:A rare acute presentation of locally advanced testicular cancer--Case report and review of literature

Tumour lysis syndrome(TLS)is a potentially fatal complication of malignancy or its treatment.This uncommon syndrome comprises laboratory findings of hyperuricaemia,hypocalcaemia,hyperkalaemia and hyperphosphataemia.A literature search revealed a total of eight patients,with testicular cancer,who had TLS.All these patients had metastatic disease.We present a unique case of a 47-year-old gentleman we saw in clinic,who presented with a rapidly growing right groin mass and acute breathlessness,and discuss the diagnosis and management of TLS.TLS is extremely rare in testicular cancer but necessitates the awareness of urologists.TLS can occur spontaneously in testicular malignancy.Cell lysis in a rapidly proliferating germ cell tumour is a possible mechanism.The prompt identification and institution of management for TLS is crucial to improve clinical outcomes.

Complicated Tumor Lysis Syndrome after CWH Treatment in a Renal Transplantation Patient: One Case Report and Literature Review

IntroductionTumor lysis syndrome （TLS） is a potentially lethal emergency caused by lysed tumor cells, and it frequently occurs in tumors of hematologic origin. Up until now, there has been only one known report published overseas about TLS resulting from post-transplant lymphoproliferative disorder （PTLD）. In 2008, a PTLD patient who had previously undergone renal transplantation was treated in the renal transplantation center of our hospital, and TLS occurred during treatment for PTLD. At the time, no further literature regarding the treatment of post-transplant renal inadequacy complicating TLS was available. So, continuous veno-venous hemofiltration （CVVH） was used to effectively control the progression of TLS. In this article, the experiences gained from our management of this complex case and our analysis, supported by relevant literature, are described.

Spontaneous Tumor Lysis Syndrome and Secondary Thrombotic Thrombocytopenic Purpura in Early Stage Colorectal Cancer

Introduction Acute tumor lysis syndrome （ATLS） is a well-described oncological emergency that is usually associated with hematological malignancies complicated by treatment. It is typically related to a high tumor burden, rapidly growing and chemosensitive malignancies. ATLS is characterized by the presence of hyperphosphatemia, hyperuricemia, hyperkalemia, hypocalcemia and acute renal failure. The administration of cytotoxic chemotherapy causes tumor death and tissue necrosis which leads to release of inflammatory mediators precipitating this syndrome. However, it has been rarely reported in hematological malignancies without administration of chemotherapy, and has been referred to as spontaneous tumor lysis syndrome （STLS）. STLS is even more infrequent in solid tumors.

Successful prevention of tumor lysis syndrome using recombinant urate oxidase in patient with metastasic and bulky prostate rhabdomyosarcoma

Tumor lysis syndrome (TLS) is a life-threatening oncological emergency that frequently occurs in patients with hematological malignancies. It is becoming more common in patients with solid tumors because of advances in molecular targeted therapies. Recombinant urate oxidase (rUO) is effective at preventing and treating hyperuricemia, but clinicians who treat adult patients with solid tumors are generally not aware of this. In addition, the treatment guidelines for TLS do not include indications for rUO treatment for chemosensitive sarcoma. We report an adolescent case of metastatic rhabdomyosarcoma (RMS), in which clinical TLS was successfully prevented using rUO. A 16-year-old Japanese male suffered from urinary retention and bone pain and was diagnosed with prostate RMS combined with multiple bone metastases and bone marrow involvement. He was judged to be at high risk of clinical TLS because his prostate tumor was bulky and he displayed laboratory TLS. rUO was administered during chemotherapy. Soon after the initiation of chemotherapy, his disseminated intravascular coagulation (DIC) got worse, and his lactate dehydrogenase (LDH) level was elevated due to tumor lysis. However, his serum uric acid levels remained low, and he was prevented from falling into acute renal failure. The planned regimen was successfully completed without life-threatening complications, and the patient achieved a complete response after 2 courses of chemotherapy. The international TLS consensus panel developed recommendations for TLS prophylaxis, but did not define the TLS risk classification of RMS. We recommend that RMS should be treated like neuroblastoma because it grows rapidly and is highly chemosensitive. Our patient was considered to be indicated for rUO because he displayed urinary retention, DIC, and laboratory TLS before chemotherapy. These features might be useful as indications for rUO therapy, which can safely support chemotherapy.

Tumor Lysis Syndrome in the Course of Burkitt Lymphoma Revealed by Medullar Compression

Background: Tumor lysis syndrome is unknown to many neurosurgical teams. A dreaded complication, especially in the course of hematological malignancies, like it was the case in two of our patients operated for spinal cord compression by Burkitt’s lymphoma. Objectives: To describe the clinical and biological presentation of this potentially fatal complication, which can be improved by early preventive or curative treatments. Case Reports: Patient 1: A 49-year-old woman was admitted for vertebral and intercostal pain and paraparesis. Myelography revealed epidural medullary compression at the 7th thoracic vertebrae (Th7) level. Patient 2: A 67-year-old woman was admitted for cervico-thoracic pain and paraparesis. MRI showed posterior epidural medullary compression between the 1st thoracic vertebrae (Th1) and 5th thoracic vertebrae (Th5). In both cases, an urgent decompressive laminectomy was performed. They had also received postoperative corticosteroid therapy. The multi-visceral failure occurred on the 1st day (D1) and 3rd day (D3) postoperatively, respectively. In the absence of adequate management, the outcome was fatal for the two patients respectively at D3 and D5 postoperatively. This syndrome was retained in the presence of glucocorticoid (triggering factor) and the histological result in favor of Burkitt lymphoma (target disease). Conclusion: Malignant hemopathies is a common cause of spinal cord compressions. From these two cases, the importance of biological and clinical surveillance emerges, with patients requiring urgent management for radiculo-medullar tumor compression.