Captopril related kidney damage: renal afferent arteriolar responses to angiotensin II and inflammatory signaling / 生理学报

Captopril can have nephrotoxic effects, which are largely attributed to accumulated renin and "escaped" angiotensin II (Ang II). Here we test whether angiotensin converting enzyme-1 (ACE1) inhibition damages kidneys via alteration of renal afferent arteriolar responses to Ang II and inflammatory signaling. C57Bl/6 mice were given vehicle or captopril (60 mg/kg per day) for four weeks. Hypertension was obtained by minipump supplying Ang II (400 ng/kg per min) during the second 2 weeks. We assessed kidney histology by periodic acid-Schiff (PAS) and Masson staining, glomerular filtration rate (GFR) by FITC-labeled inulin clearance, and responses to Ang II assessed in afferent arterioles in vitro. Moreover, arteriolar H2O2 and catalase, plasma renin were assayed by commercial kits, and mRNAs of renin receptor, transforming growth factor-β (TGF-β) and cyclooxygenase-2 (COX-2) in the renal cortex, mRNAs of angiotensin receptor-1 (AT1R) and AT2R in the preglomerular arterioles were detected by RT-qPCR. The results showed that, compared to vehicle, mice given captopril showed lowered blood pressure, reduced GFR, increased plasma renin, renal interstitial fibrosis and tubular epithelial vacuolar degeneration, increased expression of mRNAs of renal TGF-β and COX-2, decreased production of H2O2 and increased catalase activity in preglomerular arterioles and enhanced afferent arteriolar Ang II contractions. The latter were blunted by incubation with H2O2. The mRNAs of renal microvascular AT1R and AT2R remained unaffected by captopril. Ang II-infused mice showed increased blood pressure and reduced afferent arteriolar Ang II responses. Administration of captopril to the Ang II-infused mice normalized blood pressure, but not arteriolar Ang II responses. We conclude that inhibition of ACE1 enhances renal microvascular reactivity to Ang II and may enhance important inflammatory pathways.

Clinical evaluation of protein-amino acid metabolic disorders / 中国实用内科杂志

Proteins are macro-molecules crucial for cell life, which are made up of amino acids(AAs). The biochemical consequence of hyper-catabolism is protein disarrangement, clinically evident with signs such as sarcopenia, hypalbuminemia,anaemia, infection, and altered fluid compartmentation, etc. Therefore, identification and treatment of proteins' metabolic impairment with appropriate measurements and therapy is a clinical strategy that can improve the prognosis of patients with acute/chronic hypercatabolic inflammatory disease. Here, we describe the role metabolism of protein and AAs in hypercatabolic syndrome, illustrating the clinical impact of protein disarrangement and also illustrate simple, cheap, repeatable, and worldwide available measurements to identify these conditions in order to provide scientific evidence for HPD nutritional treatment.

Study on the expression of antiphospholipid antibody subtypes in primary glomerulopathy / 中国实用内科杂志

OBJECTIVE: To discuss expression of antiphospholipid antibody subtypes in primary glomerular diseases. METHODS: All1021 cases who were admitted to our center between June 2015 and July 2017 in Kidney Disease Center, First Affiliated Hospital,College of Medicine, Zhejiang Universityhad renal biopsy in our center and they were praved to have primary glomerular diseases(303 cases of membranous nephropathy, 483 cases of IgA nephropathy, 76 cases of mesangial proliferative glomerulonephritis, 119 cases of minimal change nephropathy and 40 cases of focal segmental glomerulosclerosis). The levels of anti-cardiolipin(ACL) antibody subtypes(IgG, IgM and IgA)and anti-β2 glycoprotein 1(β2 GP1) antibody subtypes(IgG, IgM and IgA) were measured and compared.RESULTS: The positive rate of APA in membranous nephropathy group was highest(17.5%) and in minimal change nephropathy was lowest group(11.8%), but there were no significant differences among the groups. The positive rates of ACL in IgA nephropathy and mesangial proliferative glomerulonephritis were 11.4% and 14.5% respectively, which were significantly higher than those of anti-β2 GP1 antibody(P< 0.001, P = 0.009 respectively). The positive rate of anti-β2 GP1 antibody in membranous nephropathy group was 11.2%,significantly higher than that in the other four groups. The positive rate of ACL-IgM in mesangial proliferative glomerulonephritis group was 13.2%, which was significantly higher than that in the other four groups(P< 0.05). The positive rate of ACL-IgA in IgA nephropathy group was 5.8%, which was significantly higher than the other four groups, and there was no statistical difference(P<0.05).CONCLUSION: Antiphospholipid antibody is positive in patients with primary glomerular diseases, and the positive rate of its subtypes varies among the different pathological types of glomerulonephritis, which can be helpful to differential diagnosis and treatment of the disease.

Protective effect of 5-amino salicylic acid against acute lung injury caused by paraquat poisoning / 医学研究生学报

ObjectiveThe mechanism of paraquat poisoning (PQP) inducing acute lung injury is not clear. Nuclear factor erythroid 2-related factor 2 (Nrf2 )-antioxidant response element (ARE) is found to be a most important endogenous antioxidant defense pathway. This study aimed to explore the protective effect of 5- amino salicylic acid (5-ASA) against PQP-induced acute lung injury by activating the Nrf2-ARE pathway.MethodsEighty healthy adult male SD rats were randomly divided into four groups: blank control, 5-ASA control, PQP, and 5-ASA treatment. The animals in the PQP and 5-ASA treatment groups were injected with paraquat at 20 mg/kg into the left abdominal cavity for construction of the PQP model and those in the blank and 5-ASA control groups with isotonic saline at 1 mL. At 2 hours after modeling, the rats in the 5-ASA control and 5-ASA treatment groups received gavage of 5-ASA 75 at mg/kg for 3 successive days. At 1 and 3 days after observation, all the rats were sacrificed and the lower lobe of the right lung harvested for HE staining and observation of pathologic changes in the lung tissue. Meanwhile the left lung tissue was collected for determination of the expressions of Nrf2 and HO-1 proteins by Western blot.ResultsBehavioral changes were observed in the rats of the PQP and 5-ASA treatment groups, but less obvious in the latter. The alveolar wall capillaries of the rats in the PQP group were expanded and congested significantly, with widened alveolar septa and infiltration of a large number of inflammatory cells at 1 and 3 days, even severer at 3 days. The rats of the 5-ASA treatment group showed obviously reduced edema and the inflammatory cell infiltration at the corresponding time points as compared the PQP group. The lung tissue pathology scores were significantly higher in the 5-ASA treatment and PQP groups than in the blank control at 1 day (0.66±0.10 and 0.61±0.04 vs 0.18±0.05, P<0.05) and at 3 days (0.74±0.08 and 0.49±0.08 vs 0.16±0.02, P<0.05), but markedly lower in the 5-ASA treatment than in the PQP group (P<0.05). Both the expressions of Nrf2 and HO-1 proteins were remarkably higher in the 5-ASA control, PQP and 5-ASA treatment groups than in the blank control at 1 and 3 days (P<0.05), and so were they in the 5-ASA treatment than in the PQP group (P<0.05).Conclusion5-ASA can effectively reduce PQP-induced acute lung injury, which may be related to its up-regulation of the Nrf2 expression.

Influence of peritoneal transport characteristics on nutritional status and clinical outcome in Chinese diabetic nephropathy patients on peritoneal dialysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>High peritoneal transport status was previously thought to be a poor prognostic factor in peritoneal dialysis (PD) patients. However, its effect on diabetic nephropathy PD patients is unclear in consideration of the adverse impact of diabetes itself. The purpose of this study was to investigate the influence of peritoneal transport characteristics on nutritional status and clinical outcome in diabetic nephropathy patients on PD.</p><p><b>METHODS</b>One hundred and two diabetic nephropathy patients on PD were enrolled in this observational cohort study. According to the initial peritoneal equilibration test result, patients were divided into two groups: Higher transport group (HT, including high and high average transport) and lower transport group (LT, including low and low-average transport). Demographic characteristics, biochemical data, dialysis adequacy, and nutritional status were evaluated. Clinical outcomes were compared. Risk factors for death-censored technique failure and mortality were analyzed.</p><p><b>RESULTS</b>Compared with LT group (n = 37), serum albumin was significantly lower and the incidence of malnutrition by subjective global assessment was significantly higher in HT group (n = 65) (P < 0.05). Kaplan-Meier analyses showed that death-censored technique failure and mortality were significantly increased in HT group compared with that in LT group. On multivariate Cox analyses, higher peritoneal transport status and lower residual renal function (RRF) were independent predictors of death-censored technique failure when adjusted for serum albumin and total weekly urea clearance (Kt/V). Independent predictors of mortality were advanced age, anemia, hypoalbuminemia, and lower RRF, but not higher peritoneal transport status.</p><p><b>CONCLUSIONS</b>Higher peritoneal transport status has an adverse influence on nutrition for diabetic nephropathy patients on PD. Higher peritoneal transport status is a significant independent risk factor for death-censored technique failure, but not for mortality in diabetic nephropathy patients on PD.</p>

Progress on pathogenesis and treatment of paraquat-induced pulmonary fibrosis / 浙江大学学报·医学版

Paraquat (PQ) is a highly effective herbicide with contact toxicity. PQ mainly accumulates in the lungs after absorption into the blood circulation. The respiratory function failure caused by PQ-induced lung injury, especially the irreversible pulmonary fibrosis in late phase, is the leading cause of death in patients with PQ poisoning. The mechanism of PQ poisoning is still unclear. Now it is speculated that oxidative stress and inflammation injury are the main pathogenic mechanisms, and abnormal gene expression, mitochondrial damage, loss of pulmonary surfactant, cytokine network and unbalanced matrix metalloproteinases/tissue inhibitors may be also involved in the pathogenesis. In addition to reducing poison absorption and increasing its removal, the current clinical treatment is mainly composed of antioxidant and anti-immune response, but has poor therapeutic effects. Although many novel methods of treatment have been proposed, most of them are still in the experimental stage. It is a hot spot to clarify the mechanism of PQ poisoning and to seek safe and effective treatment of pulmonary fibrosis. This article reviews the research progress on pathogenesis and treatment of PQ-induced pulmonary fibrosis.

Efficacy and safety of Changfu peritoneal dialysis solution: a multi-center prospective randomized controlled trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis (PD) solutions. Some researchers believe that 6 L/d is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution (Changfu) and its difference between 6 L and 8 L dosage.</p><p><b>METHODS</b>Adult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices.</p><p><b>RESULTS</b>Changes of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate (Ccr). Normalized protein catabolic rate (nPCR) from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume (nUF) and estimated glomerular filtration rate (eGFR). Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L×1.73 m(-2)×w(-1). More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that.</p><p><b>CONCLUSIONS</b>The domestic PD solution (Changfu) was proven to be as effective as Baxter dialysis solution. During 48-week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.</p>

Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of hypertension in the non-dialysis CKD patients through a nationwide, multicenter study in China.</p><p><b>METHODS</b>The survey was performed in 61 tertiary hospitals in 31 provinces, municipalities, and autonomous regions in China (except Hong Kong, Macao, and Taiwan). Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or use of antihypertensive medications. BP < 140/90 mmHg and < 130/80 mmHg were used as the 2 thresholds of hypertension control. In multivariate logistic regression with adjustment for sex and age, we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.</p><p><b>RESULTS</b>The analysis included 8927 non-dialysis CKD patients. The prevalence, awareness, and treatment of hypertension in non-dialysis CKD patients were 67.3%, 85.8%, and 81.0%, respectively. Of hypertensive CKD patients, 33.1% and 14.1% had controlled BP to < 140/90 mmHg and < 130/80 mmHg, respectively. With successive CKD stages, the prevalence of hypertension in non-dialysis CKD patients increased, but the control of hypertension decreased (P < 0.001). When the threshold of BP < 130/80 mmHg was considered, the risk of uncontrolled hypertension in CKD 2, 3a, 3b, 4, and 5 stages increased 1.3, 1.4, 1.4, 2.5, and 4.0 times compared with CKD 1 stage, respectively (P < 0.05). Using the threshold of < 140/90 mmHg, the risk of uncontrolled hypertension increased in advanced stages (P < 0.05).</p><p><b>CONCLUSIONS</b>The prevalence of hypertension Chinese non-dialysis CKD patients was high, and the hypertension control was suboptimal. With successive CKD stages, the risk of uncontrolled hypertension increased.</p>

Current pattern of Chinese dialysis units: a cohort study in a representative sample of units / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Understanding the characteristics of Chinese dialysis patients and the current practice trends is the first step to evaluate the association between practice pattern and outcome in these populations. In the present study, we evaluated the status of medical treatment and characteristic features of chronic dialysis patients in China.</p><p><b>METHODS</b>Through a clustering sampling, we selected 9 centers from the largest dialysis facilities in 6 cities around China. All adult undergoing dialysis in the selected units were screened. A total of 2388 (1775 on hemodialysis (HD) and 613 on peritoneal dialysis (PD)) patients were finally enrolled. All data were collected at enrollment on the bases of review of medical records.</p><p><b>RESULTS</b>In this cohort, 1313 (55.0%) were male. The mean age was 54 years old. The median time for dialysis was 26 months (12 - 51 months). Seventy-five percent of patients were on HD and 25.0% on PD. Among PD patients, about 21% patients did not receive dialysis adequacy. For HD patients, about 14.0% of them did not achieve dialysis adequacy when the target of kt/V was set as 1.2. Only 44.7% of patients achieved blood pressure target of 140/90 mmHg. About 60% of patients did not reach the hemoglobin target of 110 g/L even though 85.0% of them were treated with erythropoietin. In addition, 48.5% of the patients had uncontrolled mineral metabolism revealed by the high calcium-phosphate product. Compared with HD patients, higher level of serum glucose, triglyceride, and total and low density lipoprotein cholesterol were more common in PD patients.</p><p><b>CONCLUSIONS</b>This observational study suggests that many Chinese dialysis patients did not achieve the therapeutic target, particularly in blood pressure control, anemia correction, and mineral balance. PD patients were more likely to suffer metabolic disturbance.</p>

Effect of donor bone marrow transfusion on renal allograft function in kidney transplant patients / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effect of donor bone marrow transfusion on kidney function in renal allograft recipients.</p><p><b>METHODS</b>From May 1999 through May 2004, 74 cadaver renal transplant patients received postoperative donor bone marrow transfusion (DBMT group), the clinical outcomes were compared with 74 non-infused renal transplant recipients (control group). Both groups received the renal allograft from the same donor and were given equivalent immunosuppressant. The immunosuppressive regimen included tacrolimus/CiclosporinA, mycophenolate mofetil, and prednisolone maintenance. Patients were followed up for 24 to 108 months (mean 69.5 months).</p><p><b>RESULT</b>The serum creatinine concentrations of DBMT group at 1,2 and 3 y after operation were (105 + or - 23.9)micromol/L,(107.5 + or - 32.4) micromol/L and (115 + or - 26.6)micromol/L; those of control group were (114.7 + or - 28)micromol/L,(116.5 + or - 27.6)micromol/L and (125 + or - 32.6)micromol/L,respectively. Glomerular filtration rate (GFR) of DBMT group at 1,2 and 3 y after operation were (70.2 + or - 24.4)ml/min, (74.3 + or - 24.1)ml/min and (73.5 + or - 22.4)ml/min; those of control group were (62.4 + or - 15.8)ml/min, (63.9 + or - 18.7)ml/min and (61.9 + or - 20.3)ml/min. After 5 year-follow-up,the prevalence of proteinuria in DBMT group was 50% (37/74),that was 77% (57/74) in control group (P<0.01). Only 3/74 DBMT recipients had biopsy-proven chronic rejection, whereas 12/74 showed chronic rejection in the controls (P<0.05).</p><p><b>CONCLUSION</b>In kidney transplant recipients DBMC infusions may improve the long-term graft survival.</p>

Preparation of a novel targeted MR contrast agent Gd-DTPA-Granzyme B monoclonal antibody / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To prepare a novel MRI targeted contrast agent Gd-DTPA-Granzyme B monoclonal antibody (mAb) and to test its reaction conditions.</p><p><b>METHODS</b>The Granzyme B mAb was coupled with DTPA,and then conjugated with Gd. The Gd-DTPA antibody was characterized using MALDI-TOF-MS. Cytotoxicity test was performed with MTT assay, and immune activation was examined with immunohistochemistry.</p><p><b>RESULT</b>MALDI-TOF-MS demonstrated that the molecular weight shifted from granzyme B mAb (133986) to Gd-DTPA-GB mAb (139736), which indicated the conjugation of the antibody with Gd-DTPA. The molar ratio of Gd per IgG molecule was about 20. MTT assay showed that Gd, DTPA, Gd-DTPA and Gd-DTPA-GB mAb groups did not make an impact on cell viability, and there were no significant differences among 4 groups (P>0.05). Immunohistochemistry results showed that compared with the positive control group the targeted contrast agent had a high immune activity.</p><p><b>CONCLUSION</b>The novel contrast agent Gd-DTPA-Granzyme B mAb prepared in this study keeps a good immune activity and has no significant cytotoxicity.</p>

Efficacy and safety of induction therapy with alemtuzumab in kidney transplantation: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Alemtuzumab, a humanized CD52 monoclonal antibody, with its profound lymphocyte depletion property, was expected to be a promising induction therapy agent for kidney transplantation (KTx). However, currently no consensus is available about its efficacy and safety. The aim of this meta-analysis was to make a profound review and an objective appraisal of this issue.</p><p><b>METHODS</b>Relevant papers were searched, essentially in the PubMed database and the Cochrane library. After a thorough review, randomized controlled trials (RCTs) comparing the outcome of KTx using alemtuzumab induction therapy (test group) with a control group were collected according to the inclusion criteria. Data of general characteristic of studies and major outcomes of Ktx were extracted and meta-analyses were performed with RevMan 4.2 software. The odds ratio (OR) with a 95% confidence intervals (CI) was the principle measurement of effect.</p><p><b>RESULTS</b>Five RCTs were included. The chi square test showed no significant between-study heterogeneity, thus fixed effect model was employed. Sub-group analysis with studies including alemtuzumab induction followed by a tacrolimus-based immunosuppressive regimen showed that the acute rejection rate (ARR) was lower relative to the control (OR = 0.59, 95% CI 0.34 - 1.01, P = 0.05). However, meta-analysis with all included studies revealed that neither ARR nor patient/graft survival rates differ significantly between the test and the control group, but the cytomegalovirus (CMV) infection rate was higher in the test group (OR 2.50, 95% CI 1.22 - 5.12, P = 0.01). A great number of the test group recipients safely remained on a regimen that was steroid-free and with a reduced dose of conventional immunosuppressive drugs.</p><p><b>CONCLUSIONS</b>Alemtuzumab induction therapy for KTx was an effective and safe protocol in the tested follow-up period. Steroid avoidance and a dose reduction of conventional immunosuppressive drugs after alemtuzumab induction therapy may have clinical importance. However, high quality RCTs with larger population and longer follow-up are needed for a more accurate and objective appraisal of this novel protocol.</p>

Clinical observation on treatment of chronic allograft nephropathy with bailing capsule / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of Bailing Capsule (BLC, a dry powder-formed preparation of Cordyceps sinensis mycelia) on chronic allograft nephropathy (CAN).</p><p><b>METHODS</b>A comparative synchronous study was conducted between 36 CAN patients treated with BLC 9.0 g/d (treated group) for 12 weeks and 15 CAN patients treated without BLC (control group). The changes of renal function, endogenous creatinine clearance rate, volume of urinary protein and urinary protein components, including immune globulin (Ig) and albumin (Alb), urinary retinol binding protein (RBP) and beta2-microglobulin (beta2-MG), as well as the incidence rate of leucopenia before and after treatment in the two groups were compared.</p><p><b>RESULTS</b>Compared with the control group, BLC showed more significant effects in lowering urinary protein (0.89 +/- 0.53 g/d in the treated group vs 1.31 +/- 0.59 g/d in the control group after treatment, the same below), serum creatinine (206.48 +/- 30.61 micromol/L vs 240.17 +/- 29.55 micromol/L), relieving glomerular and tubular proteinuria represented by levels of Ig, Al, RBP and beta2-MG in urine, increasing endogenous creatine clearance rate (37.33 +/- 9.91 ml/min vs. 31.92 +/- 10.95 ml/min), and reducing the incidence rate of leucopenia (2.8% vs 13.3%) in CAN patients.</p><p><b>CONCLUSION</b>BLC has certain therapeutical effect on CAN. It could relieve injury in glomerulus and tubular interstitium and has preventive and therapeutical effect on leucopenia.</p>

Testicular tumor in Mongolian men (report of 35 cases) / 中华男科学杂志

<p><b>OBJECTIVE</b>To improve the diagnosis, therapy and prognosis of testicular tumor in Mongolian men.</p><p><b>METHODS</b>A retrospective review of 35 cases of testicular tumors in Mongolian men from seven medical centers dated from 1990 to 2004 was performed.</p><p><b>RESULTS</b>The usual presentation of a testicular tumor was a nodular or painless swelling of one gonad. The mean delay in diagnosis was 40.03 +/- 53.45 weeks. For 16 patients, delay in diagnosis was more than or equal to six months. The histologic composition of this series was 21 (60%) seminoma, 10 (28.6%) nonseminoma, 2 (5.7%) lymphoma, 1 (2.35%) fibroneuroma and 1 (2.35%) leiomyoma. Regarding stage, 22, 2, and 5 of 29 germ cell tumors were seen initially as stage I, II, and III, respectively. Combined therapy, including radical orchiectomy, radiotherapy and chemotherapy, were taken. 29 cases have been followed for 2 months to 10 years, 4 out of them died of distant metastasis, one died of other disease, one lives with tumor, the others live without relapse and metastasis. Three and 5-year survival rates for Mongolian patients with seminoma and nonseminoma were 95.0%, 95.0%, 57.1% and 42.8%, respectively.</p><p><b>CONCLUSION</b>In this article, the rate of seminoma to germ cell tumors is higher than that of general population. There is an increased mean delay in diagnosis for Mongolian patients. Three and 5-year survival rates for nonseminoma are lower than that for seminoma. Better public awareness regarding testicular tumor in this population, advances in diagnosis and therapy will help to improve therapeutic effectiveness and prognosis.</p>

Changes of gap junction in penile cavernous smooth muscle cells of hypertensive rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the changes of the intercellular conjunction in penile cavernous tissues between spontaneously hypertensive rats (SHR) and normotensive ones, and to study the relation of blood pressure with erectile function.</p><p><b>METHODS</b>After apomorphine (APO) injection, we observed penile erections in SHR (SHR group, n=5) and Wistar-Kyoto rats (WKY group, n=5), studied the ultrastructure of the cell-to-cell conjunction between the penile cavernous smooth muscle cells with a transmission electrical microscope, and examined the expression of mRNA and Connexin 43 protein by RT-PCR and immunohistochemistry.</p><p><b>RESULTS</b>The erectile frequency in the SHR group was significantly lower than in the WKY group. The smooth muscle cells were decreased and the collagen fibers between the smooth muscle cells were increased in the SHR group. The expression of mRNA and Connexin 43 protein in the cavernous tissues was significantly lower in the SHR group than in the WKY group (P < 0.05).</p><p><b>CONCLUSION</b>Hypertension affects penile erection, and the pathological changes of the cell-to-cell conjunction between the penile cavernous smooth muscle cells may be one of the important mechanisms of erectile dysfunction associated with hypertension.</p>

Pediatric renal transplantation: clinical analysis of 23 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characters and the therapeutic experience of pediatric kidney transplantation.</p><p><b>METHODS</b>Clinical data of 23 pediatric renal transplant recipients (less than 18 years, 14 boys, 9 girls) were analyzed. Recipients were 11 - 17 (mean 15.4 +/- 1.0 years) years old at transplantation. The kidneys were transplanted en bloc extraperitoneally into the recipient's iliac fossa, with the donor renal vein anastomosed to the recipient's external iliac vein. Among 23 transplant procedures, the donor renal artery was anastomosed to the external iliac artery in 14 cases, to the internal iliac artery in 4 cases and to the common iliac artery in 3. The other two allografts were unusual. All the patients were treated with cyclosporine or tacrolimus based immunosuppression, including steroid and azathioprine or mycophenolate mofetil. The initial dose of cyclosporine was 6 - 7 mg per kilogram of body weight per day and that of tacrolimus was 0.15 - 0.20 mg per kilogram of body weight per day. The data of the recovery of renal function, rejection episodes, incidences of side effect and related complication were analyzed respectively.</p><p><b>RESULTS</b>The transplantation operations were performed uneventful in all the 23 recipients. There were no graft losses for technical reasons. The single graft failure was the result from bad compliance. The renal function was improved 5.5 days in average after transplantation in 22 cases. Main complications were arterial hypertension (57%), pulmonary infection (13%), drug-induced hepatic injury (13%) and bone marrow suppression (13%). Acute rejection occurred in 4 persons 1 year post-operatively (17%). The body weight of the recipients increased 2.3 kg in average and height increased 1.0 cm after the first post-operative year. The mean duration for follow-up was 42 month. One-year patient/graft survival rate was 100%/96% and three-year patient/graft survival rate was 90%/80%.</p><p><b>CONCLUSION</b>Kidney transplantation is the preferred treatment for end stage renal failure in children patient. The well procedure, reasonable immunosuppressive regime, prevention and prompt therapy of complication are the keys to get satisfactory survival rate of human/kidney.</p>

Folding and everting distal end of graft flap to reduce orifice stenosis following onlay urethroplasty / 亚洲男科学杂志(英文版)

<p><b>AIM</b>Orifice stenosis remained to be a common complication of hypospadias repair. We had modified the preputial island flap urethroplasty by folding and everting the distal end of the pedicle graft flap to prevent the neo-orifice from stenosis.</p><p><b>METHODS</b>Sixteen patients had undergone hypospadias repair using a modified onlay island flap technique. A urethral catheter was retained for 8 days to 10 days after operation.</p><p><b>RESULTS</b>Satisfactory results were seen in all the patients with a cosmetically fine appearance. One patient had a urinary tract infection and another, urethrocutaneous fistula and both were amply treated. No glanular adhesion or stenosis occurred. A long-term follow up of 6 months to 4 years (mean: 2 years) in 15 patients did not find any complication.</p><p><b>CONCLUSION</b>The modified preputial island flap urethroplasty technique is an easy, reliable and effective approach to reduce orifice stenosis in hypospadias repair.</p>

Male genital schwannoma, review of 5 cases / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To study the clinical features of male genital schwannoma.</p><p><b>METHODS</b>Five male patients with genital schwannoma admitted from 1991 to 2000 were reviewed. The lesions were located in the prostate, spermatic cord, testis or penis. Tumors were simply resected in 3 patients and radically eradicated in 2.</p><p><b>RESULTS</b>The average age of the cohort was 37 years. The most common sign at presentation was a palpable genital mass accidentally discovered by the patient or detected by the physician during a physical check. Diagnosis was made through postoperative pathological examination. Follow-up ranged from 2 years to 6 years (mean 4.5 years). Four cases were cured by simple excision and 1 patient with malignant testis schwannoma died of recurrence 1 year after surgery.</p><p><b>CONCLUSION</b>Owing to the lack of characteristic clinical manifestation, the final diagnosis relies on postoperative pathological examination. S-100 and vimentin are useful markers for the diagnosis of these tumors.</p>

Diagnosis and therapy of the nutcracker phenomenon: long-term follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis of adult nutcracker phenomenon (NCP) and assess the therapeutic value of endovascular stenting (ES) and superior mesentery artery transposition (SMAT) for the treatment of NCP in long-term follow-up.</p><p><b>METHODS</b>Six patients (6 men) aged 16 and 34 years old (mean age, 22.7 +/- 18.0 years) were diagnosed as having NCP using the examination of the doppler ultrasound and/or magnetic resonance of artery/digital radiography (MRA/DSA). Three patients underwent ES and 3 patients received SMAT for the treatment of the NCP patients associated with recurrent gross hematuria and left flank pain. Doppler ultrasound and urine examination were used at pre- and post-operation.</p><p><b>RESULTS</b>In 3 patients who underwent SMAT, the postoperative complications comprised retroperitoneal hematoma necessitating surgical revision (n = 1). Functional disorder of intestine (n = 1) and paralytic ileus (n = 1) that were resolved by conservative management. In 3 patients who experienced ES, 1 patient received surgical revision because the position of stent was not suitable in left renal vein but no other complication took place. During the follow-up of 6 approximately 50 months (mean 24.7 +/- 18.0 months), except that 1 patient's hematuria disappears at rest and reappears after motion while the other 5 patients remain asymptomatic and free of hematuria. The dopplar ultrasound showed the left renal vein diameters of the angel segment between superior mesentery artery and aorta were (0.18 +/- 0.05) cm preoperation and (0.65 +/- 0.17) cm postoperation, P < 0.001; the left renal vein diameters of the portal segment were (0.89 +/- 0.22) cm preoperation and (0.79 +/- 0.20) cm postoperation, P = 0.003; the left renal vein diameter's ratio between portal and angel segment were (4.99 +/- 0.79) preoperation and (1.23 +/- 0.16) postoperation, P < 0.001.</p><p><b>CONCLUSIONS</b>Dopplar ultrasound plays a very important role in the diagnosis of adult NCP. SMAT is an efficient surgical approach to the treatment of the nutcracker phenomenon and is associated with an acceptable risk of complications. But ES is safer and more efficient than SMAT and may represent a valuable approach to lessening the morbidity of surgical procedures. ES is a new therapeutic method for adult NCP.</p>

Approach of influence factors on infectious complications in patients with primary nephrotic syndrome / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the influence factors on infectious complications in the patients with primary nephrotic syndrome in the course of using glucocorticoid and immune inhibitors.</p><p><b>METHODS</b>571 hospitalized and some outpatients with primary nephrotic syndrome were retrospectively analysed from January,1992 to June,2001 to explore the relationship between the infectious complication and the dose of glucocorticoid,or the curative course of glucocorticoid, or whether glucocorticoid was united with other immune inhibitors,or the course of disease.</p><p><b>RESULTS</b>The infectious incidence increased gradually and the degree became more serious along with the increase of the glucocorticoid dose and the prolonging of the curative course. To the patients who failed in the treatment of prednisone(dose > or = 1 mg/(kg.d), curative course 1 month or so), the dose of the prednisone was reduced to 0.5 mg/(kg.d) or so and multiglycosides tripterygii wilfordii tablets or cyclophosphamide united. The infectious complications was decreased and the degree was alleviated obviously for the patients treated with this method for more than 2 months compared with those who only used prednisone(dose > or = 1 mg/(kg.d), curative course >3 month). There was no obvious difference in the infectious incidence among the groups of different course of disease before using glucocorticoid.</p><p><b>CONCLUSION</b>Glucocorticoid and immune inhibitors must be reasonably applied in order to reduce and alleviate infectious complications for treating primary nephrotic syndromes.</p>