Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 6 Articles
Introduction: Extragonadal germ cell tumors (EGCT) account for approximately 3%–7% of all germ cell tumors. Metachronous testicular tumors develop in 5%–7% of patients after EGCT treatment; however, bilateral testicular tumors have not been reported. Case Presentation: A 30- year- old man underwent retroperitoneal tumor resection and was diagnosed as teratoma. A cystic lesion in the right testis without malignant features was managed by surveillance. Five years later, he presented with left testicular discomfort. Imaging revealed bilateral testicular tumors, and serum hCG was elevated (11.9 mIU/mL). Bilateral radical orchiectomy revealed pure seminoma (pT1) in the left testis and mixed germ cell tumor with seminoma and teratoma components (pT1) in the right testis. Conclusions: This is the first reported case of bilateral testicular tumors developing after EGCT treatment. In patients with EGCT, the potential presence of testicular germ cell neoplasia in situ should be considered, and long- term follow- up is recommended....
Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent and debilitating condition with unclear etiology. Increasing evidence implicates immune dysregulation, yet the molecular mechanisms underlying impaired immune regulation remain poorly defined. This study investigated the role of altered immune responses within PBMC populations and DNA methylation in CP/CPPS pathogenesis. Methods: Post‐prostatic massage urine samples designated as Voided Bladder 3 (VB3) urine from CP/CPPS patients and healthy controls were analyzed for CD4+ T cell markers and lineage‐defining transcription factors. DNA methylation profiling of peripheral blood mononuclear cells (PBMCs) and purified CD4+ T cells was performed using targeted methylation arrays. Functional assays evaluated IL10 production following lipopolysaccharide (LPS) stimulation, with or without azacitidine (AZA), a DNA methyltransferase inhibitor that reverses methylation‐dependent gene silencing. In vivo relevance was assessed using the experimental autoimmune prostatitis (EAP) mouse model. Results: VB3 samples from CP/CPPS patients demonstrated elevated CD4‐associated transcripts and increased expression of immune‐related transcription factors including RORγT. DNA methylation analysis identified differences in methylation across immune‐regulatory loci including IL10, FOXP3, CD274, ITGAL, and TNF‐α. PBMCs from patients exhibited diminished IL10 secretion in response to LPS, which was restored by AZA treatment. In the EAP model, recombinant IL10 administration failed to attenuate pelvic allodynia, whereas AZA significantly reduced pain sensitivity. Conclusions: CP/CPPS is associated with epigenetic alterations in immune regulatory genes that may influence inflammatory responses. Pharmacologic inhibition of DNA methylation enhanced IL10 responses in vitro and reduced pain behaviors in vivo, supporting demethylation therapy as a potential strategy for treating chronic prostatic inflammation and pelvic pain....
Background: Chronic kidney disease and its terminal stage represent a growing global health burden, particularly in sub-Saharan Africa where access to optimal renal replacement therapy remains limited. Among hemodialysis patients, chronic inflammation and protein-energy wasting are major determinants of poor outcomes and are closely interrelated within the Malnutrition- Inflammation-Atherosclerosis (MIA) syndrome. However, data from Central Africa remain scarce. Objective: To assess the prevalence of hypoalbuminemia and inflammatory syndrome, and to identify factors independently associated with hypoalbuminemia in chronic hemodialysis patients in Brazzaville. Methods: We conducted a cross-sectional analytical study including adult patients undergoing chronic hemodialysis in two public dialysis centers in Brazzaville between March and December 2025. Hypoalbuminemia was defined as serum albumin < 35 g/L and inflammatory syndrome as C-reactive protein (CRP) > 6 mg/L. Multivariate logistic regression was performed to identify factors independently associated with hypoalbuminemia. Results: A total of 60 patients were included (mean age: 53.0 ± 12.1 years; 70% male). The prevalence of hypoalbuminemia was 26.7%, while inflammatory syndrome was observed in 56.7% of patients. Hypoalbuminemia was associated with longer dialysis duration (p = 0.013), elevated CRP levels (p = 0.049), and inflammatory syndrome (p = 0.007). In multivariate analysis, inflammatory syn-drome (adjusted OR = 9.97; 95% CI: 1.75 - 56.75; p = 0.010) and diabetes mellitus (adjusted OR = 4.81; 95% CI: 1.05 - 21.95; p = 0.043) were independently associated with hypoalbuminemia. Conclusion: Hypoalbuminemia is frequent among chronic hemodialysis patients in Brazzaville and is strongly associated with persistent systemic inflammation. These findings highlight the central role of the MIA syndrome and the need for integrated management strategies targeting both inflammation and nutritional status to improve patient outcomes....
Background and Objectives: Ultrasound-guided placement of tunneled hemodialysis catheters may be useful when fluoroscopy is unavailable or radiation exposure should be avoided. This study describes a technique based on direct ultrasound visualization of the metallic guidewire within the right atrium and evaluates one-year clinical and functional outcomes. Materials and Methods: We conducted a single-center retrospective observational study of 319 adult hemodialysis patients undergoing tunneled catheter placement. The technique combined intravascular guidewire length measurement with subcostal ultrasound visualization of the guidewire tip in the right atrium. Baseline characteristics, insertion site, immediate complications, blood flow rate, Kt/V, and extracorporeal circuit pressures were analyzed. Results: Mean age was 55.9 ± 14.5 years, and 58.6% were women. The main causes of chronic kidney disease were diabetes mellitus and arterial hypertension. Mean blood flow rate was 349 mL/min at 3 months and 357 mL/min at 12 months. Mean Kt/V at 12 months was 1.57. No catheter malpositions requiring immediate repositioning were documented. Procedure-related complications were infrequent and mainly local. Conclusions: Ultrasound-guided tunneled catheter placement using direct visualization of the guidewire within the right atrium was technically feasible and associated with favorable functional parameters and few immediate complications. Given the retrospective design and lack of a comparative group, these findings should be interpreted with caution. Prospective comparative studies are needed to confirm safety, reproducibility, and clinical utility....
Background: Post-transplant immune heterogeneity may influence kidney allograft outcomes, yet the clinical relevance of circulating T-cell phenotypes remains incompletely defined. We aimed to identify 12-month post-transplant data-driven T-cell clusters and examine their relation to graft-function patterns during the first post-transplant year. Methods: Peripheral blood T-cell subpopulations were analyzed in 112 kidney transplant recipients at 12 months post-transplantation using flow cytometry. Standardized subpopulation frequencies underwent unsupervised hierarchical clustering, with principal component analysis used for visualization. Longitudinal graft function trajectories (eGFR and serum creatinine at 1, 3, 6, and 12 months) were analyzed using generalized estimating equation models, including time-by-cluster interactions. Results: Three recipient clusters were identified: a CD8-skewed cytotoxic/senescent cluster, an innate-like cytotoxic cluster, and a CD4-dominant cluster. Cluster robustness was supported by complementary k-means analysis. Older recipient age and baseline cytomegalovirus seropositivity were associated with the CD8-skewed cluster. Recipients assigned to different T12 clusters showed differences in serum creatinine levels and graft function trajectories, although some associations were attenuated after additional adjustment for transplant-related factors. Conclusions: In this cohort, unsupervised clustering identified distinct post-transplant T-cell profiles associated with early graft function patterns. These findings are hypothesis-generating and require longitudinal and external validation....
Background/Objectives: Recently, a 6.3 Fr single-use flexible ureteroscope (f-URS) was introduced to the market. The purpose of this pilot study is to present our experience with it during Endoscopic Combined Intrarenal Surgery (ECIRS) and to compare its performance with the conventional 7.5 Fr scope. Methods: For percutaneous access, renal puncture was performed in a nonpapillary approach. Regarding retrograde access, for the first group, a 7.5 Fr single-use f-URS was used, while for the second group, a 6.3 Fr single-use f-URS was utilized. Lithotripsy was primarily performed in an antegrade manner, using the Lithoclast Trilogy®. In cases where stones could not be reached with a nephroscope, retrograde lithotripsy was performed with either a Holmium:YAG laser or a Thulium Fiber Laser. Results: In total, 45 patients were included. Of these, 23 patients underwent ECIRS with the 6.3 Fr f-URS and 22 with the 7.5 Fr f-URS. The mean operative time, fluoroscopy time and lasing time were 59.5 ± 5.6 min, 139.7 ± 14.2 s and 18.4 ± 2.7 min in the 6.3 Fr group and 57.1 ± 3.9 min, 133.8 ± 29.7 s and 18.6 ± 1.9 min in the 7.5 Fr group, respectively. Two patients in the 6.3 Fr group and three patients in the 7.5 Fr group experienced Grade II complications. Stone-free rates were 91.3% in the 6.3 Fr group versus 86.4% in the 7.5 Fr group. Conclusions: The use of a 6.3 Fr f-URS during ECIRS is potentially a feasible, safe and efficient approach. Both the 6.3 Fr and 7.5 Fr scopes were associated with comparable outcomes during ECIRS. Additional studies are needed so as to draw safer conclusions....
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