Epidemiology of Plasmodium falciparum infection and drug resistance markers in Ota Area, Southwestern Nigeria.

Purpose: Effective routine monitoring and surveillance of parasite genes is a necessary strategy in the control of parasites' resistance to antimalarial drugs, according to the WHO's recommendation. This cross-sectional study therefore aimed at carrying out an epidemiological analysis on malaria incidence in Ado-Odo/Ota, Ogun State. Patients and methods: Blood and corresponding saliva samples were collected from 1,243 subjects of all ages and sex presenting with fever and a parasitemia level ≥2,000 between September 2016 and March 2018. Samples were collected from selected health facilities in the study area of Ogun state to establish the prevalence of falciparum malaria and determine resistance genes harbored by the parasites. The overall prevalence of falciparum malaria in the study site by microscopic examination was 45.86%. The highest incidence of 57.42% was recorded among male subjects. Point mutations of K76T and N86Y in the Pfcrt and pfmdr-1 genes, as well as non-synonymous mutations in Pfk13 genes, were screened for and sequenced for further analysis. Results: Pfcrt was detectable in 57.42% of blood and 51.02% of saliva samples, respectively. About 34.78% of the subjects that were confirmed microscopically harbored the Pfmdr-1 mutated gene while 26.67% of the saliva samples revealed Pfmdr-1. Epidemiological studies identified the presence of wild-type Pfk13 genes in 21.84% of blood and 44.44% of saliva samples correspondingly. For each of the genes evaluated, saliva portrayed great diagnostic performance when compared with blood. Conclusion: Findings from this study have established the prevalence of malaria and the resistance pattern of P. falciparum in the study area. The findings may help in formulating drug policies and suggest the use of saliva as a noninvasive point-of-care method of diagnosing malaria potentially deployable to rural endemic areas.

Proteinuria and perinatal lethality in mice lacking NEPH1, a novel protein with homology to NEPHRIN.

A high-throughput, retrovirus-mediated mutagenesis method based on gene trapping in embryonic stem cells was used to identify a novel mouse gene. The human ortholog encodes a transmembrane protein containing five extracellular immunoglobulin-like domains that is structurally related to human NEPHRIN, a protein associated with congenital nephrotic syndrome. Northern analysis revealed wide expression in humans and mice, with highest expression in kidney. Based on similarity to NEPHRIN and abundant expression in kidney, this protein was designated NEPH1 and embryonic stem cells containing the retroviral insertion in the Neph1 locus were used to generate mutant mice. Analysis of kidney RNA from Neph1(-/-) mice showed that the retroviral insertion disrupted expression of Neph1 transcripts. Neph1(-/-) pups were represented at the expected normal Mendelian ratios at 1 to 3 days of age but at only 10% of the expected frequency at 10 to 12 days after birth, suggesting an early postnatal lethality. The Neph1(-/-) animals that survived beyond the first week of life were sickly and small but without edema, and all died between 3 and 8 weeks of age. Proteinuria ranging from 300 to 2,000 mg/dl was present in all Neph1(-/-) mice. Electron microscopy demonstrated NEPH1 expression in glomerular podocytes and revealed effacement of podocyte foot processes in Neph1(-/-) mice. These findings suggest that NEPH1, like NEPHRIN, may play an important role in maintaining the structure of the filtration barrier that prevents proteins from freely entering the glomerular urinary space.

Thrombomodulin overexpression to limit neointima formation.

BACKGROUND-These studies were initiated to confirm that high-level thrombomodulin overexpression is sufficient to limit neointima formation after mechanical overdilation injury. METHODS AND RESULTS-An adenoviral construct expressing thrombomodulin (Adv/RSV-THM) was created and functionally characterized in vitro and in vivo. The impact of local overexpression of thrombomodulin on neointima formation 28 days after mechanical overdilation injury was evaluated. New Zealand White rabbit common femoral arteries were treated with buffer, viral control, or Adv/RSV-THM and subjected to mechanical overdilation injury. The treated vessels (n=4 per treatment) were harvested after 28 days and evaluated to determine intima-to-media (I/M) ratios. Additional experiments were performed to determine early (7-day) changes in extracellular elastin and collagen content; local macrophage, T-cell, and neutrophil infiltration; and local thrombus formation as potential contributors to the observed impact on 28-day neointima formation. The construct significantly decreased neointima formation after mechanical dilation injury in this model. By histological analysis, buffer controls exhibited mean I/M ratios of 0.76+/-0.06%, whereas viral controls reached 0.77+/-0.08%; in contrast, Adv/RSV-THM reduced I/M ratios to 0.47+/-0.06%. Local inflammatory infiltrate decreased in the Adv/RSV-THM group relative to controls, whereas matrix remained relatively preserved. Rates of early thrombus formation also decreased in Adv/RSV-THM animals. CONCLUSIONS-This construct thus offers a viable technique for promoting a locally neointima-resistant small-caliber artery via decreased thrombus bulk, normal matrix preservation, and decreased local inflammation without the inflammatory damage that has limited many other adenoviral applications.

Dexamethasone enhancement of hyperoxic lung inflammation in rats independent of adhesion molecule expression.

Infants and adults on oxygen often are treated with glucocorticoids in an attempt to reduce lung inflammatory injury. However, glucocorticoids hasten the development of hyperoxic lung injury in some animal models. The purpose of this study was to test the hypothesis that dexamethasone alters the lung inflammatory responses to hyperoxia exposure. We studied male Sprague-Dawley rats, placing them in >95% oxygen immediately after administration of 0, 0.1, 1, or 10 mg/kg of dexamethasone. At 0, 24, or 48 hr of exposure to hyperoxia, extravascular lung water contents were measured, and lung inflammatory responses were assessed by lung myeloperoxidase activities, lung neutrophil counts, and lung expression of E-Selectin and intercellular adhesions molecule-1 (ICAM-1). Dexamethasone, independent of exposure to hyperoxia, led to marked increases in lung neutrophil counts, without increases in lung myeloperoxidase activities or increases in the expression of the adhesion molecules. Hyperoxia exposure also enhanced lung neutrophil accumulation, and extravascular lung water increased earlier in animals exposed to hyperoxia and dexamethasone than in those exposed to hyperoxia alone. In conclusion, the increase in lung neutrophils in dexamethasone-treated rats without enhanced expression of E-Selectin or intracellular adhesions molecule-1 suggests that dexamethasone leads to lung neutrophil accumulation by its effect on neutrophils. The more rapid development of hyperoxic lung injury associated with earlier lung neutrophil accumulation suggests that dexamethasone-induced lung neutrophil sequestration primes the lung for the development of hyperoxic lung injury and supports further the conclusion that lung inflammation contributes significantly to the development of hyperoxic lung injury.

Sex differences in diquat-induced hepatic necrosis and DNA fragmentation in Fischer 344 rats.

Redox cycling metabolism of diquat catalyzes generation of reactive oxygen species, and diquat-induced acute hepatic necrosis in male Fischer 344 (F344) rats has been studied as a model of oxidant mechanisms of cell killing in vivo. At equal doses of diquat, female F344 rats sustained less hepatic damage than did male rats, as estimated by plasma alanine aminotransferase (ALT) activities after 6 h. Biliary efflux of glutathione disulfide (GSSG) was greater in male than in female rats at each dose of diquat, but even comparable rates of GSSG excretion were associated with less hepatic injury in female rats. Hepatic activities of superoxide dismutase (SOD) and glutathione peroxidase (GPX) were similar in the two genders, and activities of glutathione reductase (GR) and glutathione S-transferase-alpha (GST-alpha) activities were higher in the male rats. Previous studies in male rats have implicated formation of 2,4-dinitrophenylhydrazine (DNPH)-reactive "protein carbonyls" and related iron chelate-catalyzed redox reactions as mechanisms critical to diquat-induced acute cell death in vivo. However, diquat-treated female rats showed higher levels of DNPH-reactive proteins in livers and in bile than did males, both at identical doses of diquat and at doses that produced similar elevations in plasma ALT activities. In female rats, fragmentation of hepatic deoxyribonucleic acids (DNA) was increased by doses of diquat that did not increase plasma ALT activities, and increased fragmentation was observed prior to elevation of plasma ALT activities. In the present studies, hepatic necrosis was most closely associated with DNA fragmentation, although additional studies are needed to determine the mechanisms responsible for and the pathophysiological consequences of the fragmentation.

Increased soluble E-Selectin is associated with lung inflammation, and lung injury in hyperoxia-exposed rats.

The pulmonary damage caused by prolonged exposure to high oxygen concentrations is accompanied by lung inflammation, which may contribute to the expression of hyperoxic lung injury. In turn, adhesion molecules are crucial for initiating inflammatory responses. The goal of the present study was to investigate the association of contents of soluble adhesion molecules in plasma or alveolar fluids of hyperoxic rats with lung expression of adhesion molecules, lung inflammation and lung injury. We exposed adult Sprague-Dawley rats to > 95% oxygen for up to 60 h and measured the contents of intercellular adhesion molecule-I (ICAM-I) and E-Selectin in plasma and lung tissue expression of the same molecules, and we assessed lung myeloperoxidase (MPO) activties and lung water contents as indices of lung inflammation and injury, respectively. We also assessed ICAM-I content in lavage samples, because ICAM-I may be shed from the alveolar epithelium. Lung water was elevated at 60 h of hyperoxia-exposure, and this effect was preceded by increases in lung MPO activities. Lung ICAM-I expression was more than doubled at 48 h, although soluble ICAM-I contents were not elevated in plasma or lavage. Soluble E-Selectin was increased by more than 50% at 24 h of hyperoxia-exposure, while lung expressions of E-Selectin were not increased until 48 h. The sequence of the events observed in the present studies suggests that E-Selectin contributes to lung inflammation in hyperoxia and the acceleration of lung injury immediately following the inflammatory response suggests a pivotal role for inflammation in this injury.

[A new method of determining the oxygen consumption of ventilated patients]. / Eine neue Methode zur Bestimmung des Sauerstoffverbrauchs beatmeter Patienten.

A new method to determine the oxygen consumption in ventilated patients is described. The principle is based on application of the linear pressure slope from breathing pressure during lung closure (15 s with a maximum airway pressure of 10-15 mbar). This technique was compared with a modified spirographic method. In 11 patients and 18 observations we found the following results VO2SP = 36.573 ml/min + 0.887.VO2P1 (VO2SP: oxygen consumption with spirography, VO2P1: oxygen consumption with lung closure). The correlation coefficient was r = 0.9148.

[The spirographic determination of O2 consumption during mechanical ventilation]. / Die spirografische Bestimmung des O2-Verbrauchs unter maschineller Beatmung.

A spirographic method to determine the oxygen consumption during artificial ventilation is described. In comparison with experimentally quoted VO2-values the mean relative error was less than 5%. The accuracy is more exact in higher inspiratory oxygen fractions. Therefore this method can be used for reference measurements.

[A new method of non-invasive determination of the cardiac minute volume in ventilated patients]. / Eine neue Methode zur nichtinvasiven Bestimmung des Herzminuten-volumens am beatmeten Patienten.

A method for the determination of stroke volume and cardiac output from pulse-synchronized variations of pressure in mechanically ventilated patients is described. A comparison with 20 readings obtained by thermodilution showed good correlation (r = 0.9866).

[Injector units for special use areas during normal and high frequency jet ventilation--flow technic studies]. / Injektoreinheiten für spezielle Anwendungsgebiete während Normo- und Hochfrequenzjetventilation--Strömungstechnische Untersuchungen.

Two injector units for special use during normo- and high-frequency jet ventilation are presented. Their pressure-volume-characteristics were analysed and theoretically consolidated. There is a good correlation between measurements and theory. Hence the jet ventilation is easier and dangerous incidents are avoidable.

[Not Available]. / Die Höhe des Liquorflusses über dem Aquädukt MR-Liquorflussquantifizierung an 107 Patienten ohne klinische und bildmorphologische Hinweise auf eine Liquorzirkulationsstörung : MR-Liquorflussquantifizierung an 107 Patienten ohne klinische und bildmorphologische Hinweise auf eine Liquorzirkulationsstörung.

With the 2D-phase-contrast technique the volume flow of the CSF via the cerebral aqueduct can be quantified by MRI-means. In this study the stroke volume of CSF via the aqueduct per cardiac cycle (SVcc) is used to measure the extent of the volume flow. Normative values for the SVcc are not yet defined, however, they are indispensable for the clinical utility of this non-invasive method.The aim of the presented investigation is to evaluate, if the interthalamic width of the third ventricle is useful as a reference system for the extent of the SVcc via the aqueduct and if a normal CSF-flow can be defined.Hundred and seven patients (56 female, 51 male; age distribution 8 to 89 years) without clinical or imaging findings of a CSF-flow disturbance were examined on a standard 0.5 T MRI-scanner (Gyroscan, Philips). The measurements of the SVcc via the aqueduct were performed in a single slice perpendicular to the aqueduct in the level of its median third with a retrospective cardial-gated quantitative 2D-phase-contrast sequence. The interthalamic width of the third ventricle was measured in a transversal slice (bicommissural orientation, standard T1-weighted spin-echo sequence) in the level of the upper margin of the tectorial membrane.In 83 patients with a normal heart rate and without any further abnormalities in their imaging studies the SVcc is essentially dependent (r = 0.822) on the interthalamic width of the third ventricle (between 1 and 16 mm). Eleven patients with either a subcortical atrophy without leucencephalopathy, megacisterna magna, Dandy-Walker variant or bradycardia showed a significant increase of the SVcc (p < 0.05). On the other hand a significant decrease of the SVcc (p < 0.05) is seen in 13 patients with either tachycardia, Arnold-Chiari Type-1 malformation, relative aqueductal stenosis and/or severe periventricular leucencephalopathy. These results are in good agreement with the current conceptions on the physiology of the CSF-flow. As the above mentioned criterias of influence have ho pathological significance concerning a CSF-flow disturbance requiring therapy, we used the linear regression with y = B1*× +b0 (b1 = 22.2 ± 2.9; b0 = 43,5 ± 21.1) in all 107 patients to evaluate the extent of the SVcc (y) versus the interthalamic width of the third ventricle (x).This correlation offers the possibility to differentiate a hyperdynamic (above +3 standard error SE), a hypodynamic (below -3 SE) and a normodynamic (between ± 3 SE) CSF-flow via the cerebral aqueduct for the first time. Additional imaging findings and the heart rate must find their influence in the evaluation.

[A simple formula for calculating the CO2 flow in controlled hyperventilation of patients with solvent poisoning]. / Eine einfache Formel zur Berechnung der CO2-Einspeisung bei kontrollierter Hyperventilation an Patienten mit Lösungsmittelintoxikation.

Controlled hyperventilation is a therapeutic measure for the treatment of intoxications with solvents. To avoid the occurrence of respiratory alkalosis, carbon dioxide must be added to the inspiratory gas flow. Up to now the addition of carbon dioxide was performed empirically and was adapted to the needs by repeated blood gas analyses. We developed a formula enabling us to calculate the necessary carbon dioxide flow. A case report explains the procedure.

Targeted disruption of the c-src proto-oncogene leads to osteopetrosis in mice.

To understand the normal, physiological role of the c-src proto-oncogene, a null mutation was introduced into the gene by homologous recombination in mouse embryonic stem cells. Two independent targeted clones were used to generate chimeras that transmitted the mutated allele to their offspring. Intercrossing of heterozygotes gave rise to live born homozygotes, but most of these mice died within the first few weeks of birth. Histological and hematological examination of the homozygous mutants did not reveal detectable abnormalities in the brain or platelets, where src is most highly expressed. However, these mutants were deficient in bone remodeling, indicating impaired osteoclast function, and developed osteopetrosis. These results demonstrate that src is not required for general cell viability (possibly because of functional overlap with other tyrosine kinases related to src) and uncover an essential role for src in bone formation.

[Secretolysis using high frequency jet ventilation (HFJV) in ventilation obligatory status asthmaticus]. / Sekretolyse durch Hochfrequenz-Jet-Ventilation (HFJV) beim beatmungspflichtigen Status asthmaticus.

With high frequency jet-ventilation superimposed on intermittent positive pressure ventilation a good secretolysis was obtained. Preliminary results in patients with mechanical ventilation during status asthmaticus are presented.

[1st experiences with a urethral endothesis in bladder neck adenoma]. / Erste Erfahrungen mit einer Harnröhrenendothese beim Blasenhalsadenom.

Our examinations hitherto performed allow the following conclusions: 1. The placed before endothesis for the pars prostatica urethrae allows a spontaneous miction which is nearly free of residual urine. Here the endothesis cannot render possible the physiologic funnel-shaping of the vesical neck. This is theoretically not possible and was confirmed by means of fluoroscopic control of the act of miction in lying endothesis. By the endothesis the pars prostatics urethrae is passively kept open. The continence takes place by the so-called sphincter externus and the diaphragma urogenitale (5). The voluntary relaxation of the diaphragma urogenitale and the contraction of the detrusor render possible the depletion of the urinary bladder. By reason of the lacking funnelling the residual urine proved in several patients can be explained as well as the relatively low maximum value of the urinary flow of about 15 ml/s despite a miction which was subjectively regarded as good. 2. The disadvantages of the permanent catheter mentioned at the beginning as well as the usual care of the catheter and bladder irrigations are unnecessary. 3. Incrustations were not observed up to the 78th day.

Molecular mechanisms of lipopolysaccharide induced ICAM-1 expression in A549 cells.

OBJECTIVE AND DESIGN: Lung intercellular adhesion molecule-1 (ICAM-1) expression is increased by LPS or hyperoxia on type II cells in vivo. The goals of the present study were to determine the mechanisms of ICAM-1 expression in a lung alveolar epithelial cell line (A549) exposed to lipopolysaccharide (LPS). MATERIALS: A549 cells, a transformed human cell line with characteristics of alveolar epithelial cells, were used. TREATMENT: Cells were exposed to LPS, TNF-alpha, IL-1beta, or media alone for up to 12 h. METHODS: Northern blot analyses were done to determine mRNA expression of ICAM-1 after exposures. Protein binding to NF-kappaB sequences were determined by gel mobility shift assays and super-shift analysis. RESULTS: ICAM-1 mRNA expression was induced in A549 cells with exposure to LPS for 1 to 4 h, and was diminished to baseline at 8 h, and the inductions were independent of TNF-alpha and IL-1beta expression. Nuclear protein extracts from LPS-exposed cells bound to a NF-kappaB sequence and the timing of increased binding correlated closely with ICAM-1 mRNA induction. Super-shift studies indicated that p65 was involved in the binding to the NF-kappaB sequence and p50 was not. CONCLUSION: LPS inducibility of ICAM-1 mRNA in A549 cells is independent of TNF- and IL-1 in A549 cells, and the similar time course of mRNA induction and NF-kappaB activation suggest the induction of ICAM-1 is mediated, in part, by NF-kappaB.

Golgi targeting of the GLUT1 glucose transporter in lactating mouse mammary gland.

Lactose, the major carbohydrate of human milk, is synthesized in the Golgi from glucose and UDP-galactose. The lactating mammary gland is unique in its requirement for the transport of glucose into Golgi. Glucose transporter-1 (GLUT1) is the only isoform of the glucose transporter family expressed in mammary gland. In most cells, GLUT1 is localized to the plasma membrane and is responsible for basal glucose uptake; in no other cell type is GLUT1 a Golgi resident. To test the hypothesis that GLUT1 is targeted to Golgi during lactation, the amount and subcellular distribution of GLUT1 were examined in mouse mammary gland at different developmental stages. Methods including immunohistochemistry, immunofluorescence, subcellular fractionation, density gradient centrifugation, and Western blotting yielded consistent results. In virgins, GLUT1 expression was limited to plasma membrane of epithelial cells. In late pregnant mice, GLUT1 expression was increased with targeting primarily to basolateral plasma membrane but also with some intracellular signal. During lactation, GLUT expression was further increased, and targeting to Golgi, demonstrated by colocalization with the 110-kD coatomer-associated protein beta-COP, predominated. Removal of pups 18 d after delivery resulted in retargeting of GLUT1 from Golgi to plasma membrane and a decline in total cellular GLUT1 within 3 h. In mice undergoing natural weaning, GLUT1 expression declined. Changes in the amount and targeting of GLUT1 during mammary gland development are consistent with a key role for GLUT1 in supplying substrate for lactose synthesis and milk production.

Direct in vivo gene transfer into porcine myocardium using replication-deficient adenoviral vectors.

BACKGROUND: Efficient methods of introducing genes into myocardial cells must be developed before local somatic cell gene therapy can be implemented against myocardial disease. Although adenoviral (Ad5) vectors have been used to target rodent hearts and plasmid DNA has been directly injected into the myocardium of rats and dogs, the amounts of recombinant protein produced by these procedures have not been reported, and adenoviral vectors have not been used in large mammalian hearts. METHODS AND RESULTS: Replication-deficient recombinant adenoviral vectors carrying either the luciferase or lacZ reporter genes were injected directly into the ventricular myocardium of adult domestic swine for evaluation of reporter gene expression. This procedure did not affect regional myocardial function as assessed by systolic wall thickening using ultrasonic crystals. Luciferase activity was detected 3 days after injection, increased markedly at 7 days, and then declined progressively at 14 and 21 days. Luciferase production was comparable in the right and left ventricular walls and increased with increasing amounts of virus, reaching 61 +/- 21 ng at the highest dose examined (3.6 x 10(9) plaque-forming units). The injection of 200 micrograms of plasmid DNA (pRSVL) produced levels of luciferase comparable to 1.8 x 10(8) plaque-forming units of recombinant Ad5; however, when normalized to the number of genes injected, the adenovirus was 140,000 times more efficient than plasmid DNA. Histochemical analysis of beta-galactosidase activity produced by a second Ad5 vector demonstrated that nearly all (> 95%) of the stained cells were cardiomyocytes and that the percentage of cardiomyocytes infected by the virus could be quite high in microscopic regions adjacent to the needle track (up to 75% in fields of 60 to 70 cells); however, Ad5-infected cells were rarely observed farther than 5 mm from the injection site. Furthermore, the Ad5 vector induced pronounced leukocytic infiltration that was far in excess of that seen after injection of vehicle alone. CONCLUSIONS: This study demonstrates for the first time that direct intramyocardial injection of replication-deficient adenovirus can program recombinant gene expression in the cardiomyocytes of a large animal species with relevance to human physiology. The efficiency of adenovirus-mediated gene transfer is far superior to that of plasmid DNA injection, and this method appears to be capable of producing more recombinant protein. However, the cell-mediated immune response to the Ad5 vector and the limited distribution of reporter gene expression suggest that less immunogenic recombinant vectors and more homogeneous administration methods will be required before Ad5 vectors can be successfully used for phenotypic modulation.

Endotoxin induces glutathione reductase activity in lungs of mice.

Glutathione reductase catalyzes the NADPH-dependent conversion of glutathione disulfide to glutathione and helps protect the lung from injury by reactive oxygen. In animals allowed to breathe nearly 100% oxygen, the activities of other antioxidants in the lung can be induced by treatment with endotoxin, and this induction is associated with increased tolerance to hyperoxia. The purpose of this study was to see whether glutathione reductase activity in the lungs of mice increased with endotoxin treatment alone. We studied 60 FVB mice (20 males and 40 females). Half received endotoxin (500 micrograms/kg) intraperitoneally at time 0 and 24 h, and the controls received an equal volume of saline. At 48 h we killed the mice and removed their lungs. Treatment of mice with endotoxin increased glutathione reductase activity in the lung 55% (0.035 +/- 0.005 to 0.054 +/- 0.010 mumol NADPH reduced/min/mg protein; mean +/- SD; endotoxin different from control, p < 0.001). The increase in activity was the same for male and female mice. We measured the specific protein for glutathione reductase by Western analysis and mRNA for glutathione reductase using a slot-blot analysis and found that both increased roughly 2-fold with endotoxin treatment. This suggests that endotoxin treatment resulted in either increased rate of transcription of glutathione reductase mRNA or increased mRNA stability. We conclude that endotoxin treatment increases glutathione reductase activity in the lung and that this increase in activity may play a role in subsequent protection from hyperoxia.

Hyperuricemia and urate nephropathy in urate oxidase-deficient mice.

Urate oxidase, or uricase (EC 1.7.3.3), is a purine metabolic enzyme that catalyzes the conversion of uric acid to allantoin in most mammals except humans and certain other primates. The loss of urate oxidase in the human during primate evolution predisposes man to hyperuricemia, a metabolic disturbance that can lead to gouty arthritis and renal stones. To create a mouse model for hyperuricemia and gout, and to address the question of whether urate oxidase is essential in lower mammalian species, we have disrupted the urate oxidase gene in the mouse by homologous recombination in embryonic stem cells. Unlike the human situation, urate oxidase deficiency in mice causes pronounced hyperuricemia and urate nephropathy. More than half of the mutant mice died before 4 weeks of age, indicating that urate oxidase is essential in mice. These mutant mice may also serve as animal models for hyperuricemia and its related nephropathy in humans.