Difficulties in diagnosis and treatment of pyogenic liver abscess / 中华肝胆外科杂志

Klebsiella pneumoniae liver abscess accompanied by metastatic infectious complications was firstly reported in 1986. The pathogen was defined as Hypervirulent K. pneumoniae (hvKp) after a series of studies, which is an evolving pathotype and more virulent than classical K. pneumoniae (cKp). At present, it is difficult to distinguish hvKp and cKp in the clinical microbiology lab, which results in delay in early diagnosis and treatment on hvKp-related infections. Biliary tract diseases after cholangiojejunostomy, biliary interventional therapy and liver transplantation have become common causes of recurrent acute cholangitis. The incidence of bacterial liver abscess is on the rise, especially the infection caused by multidrug-resistant bacteria. This article reviews difficulties in the diagnosis and treatment of bacterial liver abscess.

Modified en-bloc kidney transplantation from deceased infant donor to adult recipients: a report of 4 cases / 中华器官移植杂志

Objective:To introduce a newly modified surgical approach and explore the clinical efficacy of en bloc kidney transplantation from deceased infant donors to adults.Methods:Four cases of en bloc kidney transplantation from deceased infant donor to adult were performed with a new modified surgical approach in renal transplantation and dialysis center of the Second People's Hospital of Shanxi Province from January 2017 to September 2019. All 4 cases were cardiac death donors. There were 3 males and 1 female donors, aged (54 ± 22.69) d and weighing (5.6 ± 0.79) kg. There were 1 male and 3 female recipients, aged (41.5 ± 5.97) years and weighing (45 ± 3.56) kg. For lowering operative difficulties and preventing hemodynamic disturbances, bilateral kidneys were sutured and fixed during trimming. Then end-to-side anastomosis was performed between donor kidney abdominal aortic valve and recipient external iliac artery and between donor renal inferior vena cava valve and recipient external iliac vein.Results:All operations were successful without vascular or urinary complication. The average duration of donor kidney repair was 20 min and the average duration of transplantation 68.75 min. The functions of transplanted kidney recovered well during a follow-up period of 12 months. The long-term survivals of recipient and transplanted kidney were satisfactory.Conclusions:The newly modified surgical approach of en bloc kidney transplantation from deceased infant donor to adult has optimized operative handling. With a higher success rate, vascular complications are lowered. A wider popularization is recommended.

Diagnosis and treatment of giant hypertrophy of gastric mucosa / 中华消化外科杂志

Giant hypertrophy of gastric mucosa is rare and lack of typical clinical manifestations. The main treatment measures were minimally invasive surgery and drug intervention. Clinicians should pay attention to it's imaging features, in order to make early diagnosis and treatment, and obtain a good prognosis. The authors introduce the results of gastro-enterography and computed tomography in a case with giant hypertrophy of gastric mucosa, and differentiate the imaging results from gastric cancer, lymphoma and gastric stromal tumor, so as to provide references for the clinical diagnosis of the disease.

Preliminary results of multicenter studies on ABO-incompatible kidney transplantation / 中华器官移植杂志

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

A report of 9 cases of living donor kidney transplantation from ABO-incompatible relatives / 中华器官移植杂志

Objective:To summarize the clinical experiences of 9 ABO-incompatible kidney transplantation at our center and explore its clinical application value.Methods:Methods From April 2016 to December 2019, there were 9 living kidney transplants of ABO incompatible relatives, including type A to type B (n=3), type B to type O (n=3), type B to type A (n=1) and type AB to type B (n=2). Immunosuppressant plus single membrane plasmapheresis (PE) and/or double filtration plasmapheresis (DFPP) and rituximab were employed for pretreating recipients. Adverse reactions of recipients were observed during and after pretreatment. Blood group antibody titer, complications and other related parameters were recorded before and after transplantation before and after monitoring pretreatment.Results:After pretreatment, IgM, IgG and total titer of blood group antibodies were ≤1: 4 on the day of transplantation and the titer of non-blood group antibodies rebounded within 2 weeks (≤1: 8). During preconditioning, 2 patients experienced oral numbness and involuntary dithering during plasmapheresis and there was 1 case of infusion reaction after rituximab dosing. The early recovery of renal function was all excellent. Renal biopsy was performed in 4 patients with slow elevation of serum creatinine and 1 case developed acute antibody-mediated rejection. The survival rate of all recipients at the last follow-up was 100%.Conclusions:Live kidney transplantation of ABO-incompatible relatives is both safe and feasible so that it may help alleviate some shortage of donor kidney.

Conversion therapy ofsirolimus in expanded standard renal transplant recipients / 中华器官移植杂志

Objective To evaluate the efficacy and safety of converting traditional triple immunosuppressive regimen into quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid plus hormone in expanded criteria donor (ECD) renal transplant recipients .Methods A retrospective analysis was conducted for 39 patients undergoing extended standard kidney transplantation with conversion therapy from January 2015 to June 2018 .Renal function ,liver function ,blood lipid ,bone marrow suppression ,positive rate of urinary protein ,positive rate of urinary BK virus and other adverse reactions were analyzed .Results A total of 39 recipients fulfilled the inclusion criteria ,including 28 boys and 11 girls with an average age of (37 .69 ± 11 .07) years and a median postoperative conversion time of 6 months .As compared with pre-conversion therapy ,renal function and estimated glomerular filtration rate improved significantly at 1 month ,3 months ,6 months and 1 year (P<0 .05) .No significant difference existed in the level of blood lipid ,whole blood leukocyte or hemoglobin at pre and post-conversion ( P>0 .05) .No significant difference existed between AST and ALT at pre and post-conversion (P< 0 .05) . After conversion , the positive rates of urinary protein and BK virus urine declined . Subacute rejection occurred in 1 case after conversion .Addition of sirolimus was curative .No severe adverse reactions such as infection and diarrhea occurred in the remaining cases .Conclusions T he quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid and hormone is both safe and effective for ECD recipients of renal transplantation .

Genomic analysis of Sheldrake origin goose hemorrhagic polyomavirus, China

Goose hemorrhagic polyomavirus (GHPV) is not a naturally occurring infection in geese in China; however, GHPV infection has been identified in Pekin ducks, a domestic duck species. Herein, we investigated the prevalence of GHPV in five domestic duck species (Liancheng white ducks, Putian black ducks, Shan Sheldrake, Shaoxing duck, and Jinyun Sheldrake) in China. We determined that the Jinyun Sheldrake duck species could be infected by GHPV with no clinical signs, whereas no infection was identified in the other four duck species. We sequenced the complete genome of the Jinyun Sheldrake origin GHPV. Genomic data comparison suggested that GHPVs share a conserved genomic structure, regardless of the host (duck or geese) or region (Asia or Europe). Jinyun Sheldrake origin GHPV genomic characterization and epidemiological studies will increase our understanding of potential heterologous reservoirs of GHPV.

Mycobacterium vaccae induces a strong Th1 response that subsequently declines in C57BL/6 mice

Mycobacterium (M.) vaccae is a fast-growing species of saprophytic bacteria that is widely distributed. To understand the host immune responses induced by M. vaccae isolated from bovine submaxillary lymph nodes, C57BL/6 mice were infected with reference strain M. vaccae Bacillus Calmette-Guérin (BCG) and isolated M. vaccae using intraperitoneal injections. Comparison of the bacterial replication and organ pathology between M. vaccae and M. vaccae BCG revealed that M. vaccae was more malignant than M. vaccae in mice. We also demonstrated that serum from the M. vaccae-infected mice contained a higher expression level of gamma-interferon (IFN-γ), tumor necrosis factor alpha, monocyte chemoattractant protein-1, interleukin (IL)-4, IL-12, IL-10 and transforming growth factor beta than did the other groups, especially after week 4. Furthermore, when the numbers of CD3⁺CD4⁺IFN-γ⁺ and CD3⁺CD4⁺IL4⁺ cells in the infected mice were observed by flow cytometry, we found that a powerful T helper 1 (Th1) response was induced by M. vaccae infection, which was associated with the emergence of CD3⁺CD4⁺IFN-γ⁺ cells. However, the Th1 response declined over time, which was associated with appearance of the CD4⁺CD25⁺FoxP3⁺ and CD4⁺CD25⁺CD152⁺Treg cell reaction. In addition, a strong Th2 response was found. Finally, we found that M. vaccae infection increased the production of type I IFNs, which was associated with a reduced Th1 response.

Research Progress of Study on Function of T Cell Immunity against Influenza Virus / 病毒学报

The influenza A virus (IAV) belongs to the family Influenza Virus and subfamily Orthomyxoviridae. The IAV can cause acute infections of the lower respiratory in human and animals. Recently, many studies have been performed to reveal the lung CD4+ T cells, CD8+ T cells and Tregs via multiple effector and regulatory mechanisms to against IAV. In this paper, we review the state of progress with regards to various strategies of IAV escape from T cell responses, T cells and innate T cells immunity against influenza virus, which will provide a useful reference tool for future related reseach.

The blood homocysteine level and distribution analysis of Ganzhou city people / 重庆医学

Objective We analysed the homocysteine level and distribution of ganzhou city crowd ,learned about its elevatory sit‐uation ,and provided theory basis for the intervention of high homocysteine level crowd and the prevention of heart and head blood vessel disease .Methods We detected the blood homocysteine level of 6419 adults who had physical examination in our hospital dur‐ing 2012 by enzymatic methods ,and analyzed the diagnose rate of HHcy and the distributions of Hcy in different age and gender . Results The total detection rate of high homocysteine level in 6419 adults was 39 .11% ,among which 47 .30% in male and 22 .49% in female ,the comparison was statistically significant (χ2 = 424 .28 ,P< 0 .05) ;the detection rate of male was higher than female .In different ages ,the detection rates were statistically significant comparatively (P< 0 .05) .The detection rate of homocys‐teine level in both gender rises with age .At the same time ,homocysteine levels in males of 25 - 34 years old age group and 35 - 44 years old age group ,45 - 54 years old age group and 55 - 64 yeas old age group were not statistically significant ;while there were statistical differences of Hcy level in the rest age groups of male ,different age groups of female and same age different gender groups (P< 0 .05) .Conclusion The HHcy detection rate and the blood Hcy distribution of Ganzhou city crowd has its regional characteristics compared with other regions ,and it may be associated with the main population distribution of hakka people and oth‐er geological factors .The detection rate of HHcy was relatively high ,and it′s advisable to take early prevention to lower the risk of heart and head blood vessel disease .

Imaging features of Alport syndrome combined with huge esophageal and gastric leiomyoma / 中华消化外科杂志

Alport syndrome is a hereditary glomerular basement membrane disease.Hematuria,sensorineural deafness and progressive renal function impairment is the main clinical symptoms.Alport syndrome can be associated with ocular abnormalities,and a few of patients were complicated with diffuse leiomyoma.The incidence of Alport syndrome with diffuse leiomyoma is low,and it mainly invades esophagus,the trachea and female genital tract,et al.Patients with Alport syndrome and diffuse leiomyoma have difficulty in swallowing and postprandial vomiting,recurrent bronchitis symptoms and dyspnea.Diffuse leiomyoma is commonly seen in the esophagus.Alport syndrome with huge esophageal and gastric leiomyoma is rarely seen in clinical practice.In this article,the imaging manifestations of Alport syndrome combined with huge esophageal and gastric leiomyoma is summarized to improve the understanding and diagnostic accuracy of this disease.

Epidemiological Investigation and Genome Analysis of Duck Circovirus in Southern China / 中国病毒学·英文版

Duck circovirus(DuCV),a potential immunosuppressive virus,was investigated in Southern China from March 2006 to December 2009 by using a polymerase chain reaction(PCR)based method. In this study,a total of 138 sick or dead duck samples from 18 different farms were examined with an average DuCV infection rate of～35%. It was found that ducks between the ages of 40～60 days were more susceptible to DuCV. There was no evidence showing that the DuCV virus was capable of vertical transmission. Farms with positive PCR results exhibited no regularly apparent clinical abnormalities such as feathering disorders,growth retardation or lower-than-average weight. The complete genomes of 9. strains from Fujian Province and 1 from Zhejiang Province were sequenced and analyzed. The 10 DuCV genomes,compared with others genomes downloaded from GenBank,ranged in size from 1988 to 1996 base pairs,with sequence identities ranging from 83.2% to 99.8%. Phylogenetic analysis based on genome sequences demonstrated that DuCVs can be divided into two distinct genetic genotypes,Group I(the Euro-USA lineage)and Group II(the Taiwan lineage),with approximately 10.0% genetic difference between the two types. Molecular epidemiological data suggest there is no obvious difference among DuCV strains isolated from different geographic locations or different species,including Duck,Muscovy duck,Mule duck,Cheery duck,Mulard duck and Pekin duck.

Observation on the optimal brakingtime for ultrasonography of traumatic lipohemarthosis / 中华超声影像学杂志

Objective To investigate the braking time in diagnosis of lipohemarthrosis by ultrasound. Methods Experiment group:After 20 tubes containing fresh blood and pig marrow were uniformly mixed, they were instantly continuously detected by high-frequency linear array transducer in fixed-area at short-interval.Clinical group: Ten walking patients with lipohemarthrosis were examined with continuous detection by ultrasound,CT and MR before operation.Results Experiment group: Cloudy echo and slowly floating up of lipoids were detected at the beginning.After 2.7 to 3.7 minutes (average 3.17 minutes), the liquid was divided into two layers with vague boundary.After 5.3 to 8.0 minutes (average 6.75 minutes) ,the liquid was divided into 3 layers with thickening serum laye.Clinical group: Ultrasound findings: Cloudy medium echo was detected at first.After 2.0 to 4.0 minutes (average 3.08 minutes),the liquid was divided into two layers.After 4.4 to 10.0 minutes (average 6.92 minutes) , the liquid was divided into 3 layers with thickening serum layers.Three knees showed fracture line and 2 knees with occult fracture were diagnosed as lipohemarthrosis.CT and MR findings: Ten knees showed fracture line in CT examination,of which 7 knees showed double liquid-liquid layer and 3 knees showed single liquid-liquid layer in the suprapatellar bursa.Ten knees showed fracture line in MR examination,6 knees showed double liquid-liquid layer and 4 knees showed single liquid-liquid layer in the suprapatellar bursa. Conclusions The best braking time in diagnosing lipohemarthrosis by ultrasound can be shorten to 10 minutes and the necessary braking time is 2 to 4 minutes.

Correlation between ultrasonography and relevant techniques in traumatic lipohemarthrosis / 中国医学影像技术

Objective To explore the correlation between ultrasonographic findings and relevant technical factors in traumatic lipohemarthrosis. Methods Fifty-two patients with traumatic lipohemarthrosis underwent ultrasonic examination in supine position (26 in unbent, 16 in external rotary position, 10 in unbent and 45° rotation) before operation, and 22 of them underwent dynamic examination. Findings of ultrasography were compared with manifestations of MRI and CT regarded as gold standard.Results Fifty-two patients with traumatic lipohemarthrosis were diagnosed correctly. The best effect of ultrasonic examination of lipohemarthrosis was observed on suprapatellar bursa. Superior border of patella were showed well in supine straight position, then turned to the level of patella, and the structure below patella were showed badly. The best posture was in supine genuflex position with 45° rotation when the joint effusion presented, by which thicker layer liquids could be displayed than in straight position. Three layer liquids could not be displayed synchronously in mild external rotary rest position of lower extremity, and the combination of findings at internal and external side were favorable to the diagnosis. Liquids bed changed from one layer to two layers and then to three layers, from fuzzy to clear gradually in dynamic examination.Conclusion Ultrasonic manifestations of traumatic lipohemarthrosis are closely correlated to the position, posture and arresting time during examination.

Inhibitory effect of tea polyphenols on renal cell apoptosis in rat test subjects suffering from cyclosporine-induced chronic nephrotoxicity / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the inhibitory effect of tea polyphenols on renal cell apoptosis in rat test subjects suffering from cyclosporine A (CsA)-induced chronic nephrotoxicity.</p><p><b>METHODS</b>Four groups of rats with CsA-induced chronic nephrotoxicity were respectively treated with vehicle olive oil, tea polyphenols, CsA and tea polyphenols plus CsA. At the end of the 28th day of treatment, 24 hours urine and blood samples were obtained, and the animals were then sacrificed. The serum and urine samples were analysed for creatinine clearance, and kidney tissue was used for pathologic analysis of renal tubular injury and interstitial fibrosis. The TUNEL assay, apoptosis-related enzyme caspase-3 mRNA detected by RT-PCR, and its enzymatic activity were analysed for the possible detections of cell apoptosis.</p><p><b>RESULTS</b>CsA-treated rats displayed increased apoptosis of the tubular and interstitial cells, in comparison with vehicle-treated controls (18.3 +/- 4.6 vs 4.8 +/- 1.3 cells/mm(2), P < 0.05). In comparison with animals treated by CsA, animals treated with CsA plus tea polyphenols demonstrated significantly improved levels of creatinine clearance (0.12 +/- 0.03 vs 0.22 +/- 0.02 ml.min(-1).100 g(-1) body weight, P < 0.05), tubular injury (2.29 +/- 0.43 vs 1.42 +/- 0.26, P < 0.05), and interstitial fibrosis (2.83 +/- 0.20 vs 1.46 +/- 0.19, P < 0.05), and showed a statistically significant decrease in tubular and interstitial cell apoptosis (18.3 +/- 4.6 vs 7.7 +/- 2.1 cells/mm(2), P < 0.05). The expression of caspase-3 mRNA and caspase-3 activity was significantly higher in the CsA-treated group than that of the CsA plus tea polyphenols (TP)-treated group (P < 0.05).</p><p><b>CONCLUSION</b>These results suggested that tea polyphenols significantly inhibits apoptosis of the tubular and interstitial cells in rats with cyclosporine-induced chronic nephrotoxicity, and that tea polyphenols may be useful to prevent CsA-associated kidney toxicity.</p>

The effect of an antioxidant tea polyphenols on cell apoptosis in rat model of cyclosporine-induced chronic nephrotoxicity / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of tea polyphenols on cell apoptosis in rat model of cyclosporine-induced chronic nephrotoxicity.</p><p><b>METHODS</b>Four groups of animals in rat model of cyclosporine-induced chronic nephrotoxicity were respectively treated by olive oil (n = 6), tea polyphenols (TP, n = 6), cyclosporine A (CsA, n = 8) and TP plus CsA (n = 8). At the end of 28th day of treatment, all animals were sacrificed and blood was analyzed for blood serum creatinine and creatinine clearance, kidney tissue for pathologic analysis. The TUNEL assay, caspase-3 mRNA expression detected by reverse transcription-polymerase chain reaction (RT-PCR) and caspase-3 activity were used for the analysis of cell apoptosis.</p><p><b>RESULTS</b>CsA plus TP ameliorated the CsA-induced decrease of renal function and interstitial fibrosis. There was a significant increase in the number of apoptosis-positive cells in the CsA-vs-CsA plus TP-treated group at four weeks (18.9 +/- 3.3 vs. 7.7 +/- 1.4, P < 0.05). The expression of caspase-3 mRNA and caspase-3 activity of CsA-treated group was significantly higher than that of CsA plus TP-treated group (P < 0.05).</p><p><b>CONCLUSION</b>These results indicate that antioxidant tea polyphenols significantly inhibit apoptosis of tubular and interstitial cells in rat model of chronic cyclosporine-induced nephrotoxicity, and suggest that the decrease of cell apoptosis exerted by tea polyphenols may be one of mechanisms to protect renal function and tissue structure.</p>

Effect of combined use of aminoguanidine and cyclosporine A on acute rejection following cardiac allograft in rats / 中华器官移植杂志

Objective　To study the effect of the combined use of aminoguanidine (AG) and cyclosporine A (CsA) on acute rejection following cardiac allograft. Methods　Except the control group, all other three groups were respectively treated by AG 600mg/kg every day subcutaneously 0 to 7 days after transplantation, low-dose CsA 2mg/kg every day i.m 0 to 7 days after transplantation, and low-dose CsA plus AG. Inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production during acute allograft rejection were detected at 4th day after operation, and the graft survival was observed.Results　Compared with the control group, iNOS expression and NO production were significantly inhibited in the AG-treated group (P＜0.05)，the progression of acute rejection was slightly attenuated and allografted heart survival prolonged. The inhibitory effects of iNOS activity and NO production in the recipients receiving the combined treatment of low-dose CsA plus AG were higher than those receiving low-dose CsA alone. Compared with the low-dose CsA group, low-dose CsA plus AG could significantly reduce the histologic grade of acute rejection (P＜0.01) and prolong the graft survival (P＜0.05). Conclusion　The combined use of low-dose CsA and AG could synergistically suppress iNOS activity and NO production, and significantly prolong allografted heart survival.

Intrathymic inoculation of liver specific antigen protects hepatocytes from apoptosis after liver allotransplantation / 中国病理生理杂志

AIM: To study the effects of intrathymic inoculation of liver specific antigen (LSA) on hepatocyte apoptosis after liver allotransplantation. METHODS: Orthotopic liver transplantation was used in this study. Group Ⅰ: syngenic control (Wistar-to-Wistar); Group Ⅱ: acute rejection (SD-to-Wistar); Group Ⅲ: thymus inoculation of SD rat LSA day 7 before transplantation. The observation of general situation and survival time, hepatocyte apoptosis and LAT expression in liver transplants were used to analyze immune state of animals in different groups. RESULTS: The general situation of group Ⅰ was very well after transplantation. Recipients of groupⅡ lost body weight progressively and all died within day 9 to day 13 post transplantation. As for group Ⅲ, the general situation of recipients was remarkably better than that in group Ⅱ. The positive cells of apoptosis in group Ⅲ detected by TUNEL were not significantly different from that in group Ⅰ, but was significantly lower than that in group Ⅱ. LAT was detected at any time in group Ⅱ with peak expression at day 5 and day 7 post transplantation. In contrast, LAT was not detected in any other groups. CONCLUSION: Intrathymic inoculation of LSA protects hepatocytes from apoptosis after liver allotransplantation.

Correlative analysis between renal TGF-?1 expression and cell apoptosis in a rat model of cyclosporine-induced chronic nephrotoxicity, and effect of tea polyphenols on TGF-?1 expression and apoptosis / 中国病理生理杂志

AIM: To investigate the correlation between renal transforming growth factor-?1 (TGF-?1) expression and cellular apoptosis, and effect of tea polyphenols (TP) on TGF-?1 expression and apoptosis. METHODS: Four group animals in a rat model of CsA-induced chronic nephrotoxicity were respectively treated by vehicle (olive oil, 0.1 mL?kg~(-1)?d~(-1), sc), TP (80 mg?kg~(-1)?d~(-1), ig), CsA (15 mg?kg~(-1)?d~(-1), sc) and TP (80 mg?kg~(-1)?d~(-1), ig) plus CsA (15 mg?kg~(-1)?d~(-1), sc). At the end of 28th day of treatment, renal creatinine clearance and tissue pathology were analyzed. The TGF-?1 expression was detected by immunohistochemistry and Western blotting. TUNEL assay, apoptosis-related enzymatic activity caspase-3 were also detected. RESULTS: Compared to CsA-treated rats, the animals treated with CsA plus TP showed a significant increase in the renal creatinine clearance (0.12?0.03 vs 0.22?0.02,P