Rutin ameliorates renal fibrosis and proteinuria in 5/6-nephrectomized rats by anti-oxidation and inhibiting activation of TGFß1-smad signaling.

OBJECTIVES: Rutin, a polyphenolic flavonoid, was reported to have beneficial effect on drug induced nephropathy. The present study aimed to introduce 5/6 nephrectomized rat model to further evaluate its renal protective effect. METHODS: Adult Wistar rats were induced to develop chronic renal failure through 5/6 nephrectomy (5/6 Nx). After that, animals were treated orally with saline, rutin at 15 and 45 mg/kg, and losartan (10 mg/kg) daily for 20 weeks; sham-operated animals were also involved as control. After treatment for 8 and 20 weeks, blood and urine samples were collected for biochemical examination; all the kidney remnants were collected for histological examination. The protein levels of TGF-ß1, smad2 and phosphorylated-smad2 (p-smad2) in kidney were measured. Immunohistochemistry was used to analyze the expression of TGF-ß1, fibronectin and collagen IV in kidney tissues. RESULTS: Results suggested that rutin could reduce the proteinurea, blood urine nitrogen and blood creatinine in 5/6 Nx animals significantly, as well as oxidation stress in the kidney. By histological examination, rutin administration alleviated glomerular sclerosis scores and tubulointerstitial injuries in a dose-dependent manner (P<0.01). Immunohistochemistry also suggested rutin could reduce the expression of TGF-ß1, fibronectin and collagen IV in kidney tissues. By western blot, we found the rutin could reduce the TGF-ß1, p-smad2 expression in the kidney tissues of rats. CONCLUSIONS: This study suggests that the rutin can improve renal function in 5/6 Nx rats effectively. Its effect may be due to its anti-oxidation and inhibiting TGFß1-Smad signaling.

Medial arcuate ligament: a new anatomic landmark facilitates the location of the renal artery in retroperitoneal laparoscopic renal surgery.

PURPOSE: The purpose of this study was to introduce a new method for locating the renal artery during retroperitoneal laparoscopic renal surgery. PATIENTS AND METHODS: The medial arcuate ligament (MAL) is a tendinous arch in the fascia under the diaphragm that arches across the psoas major muscle and is attached medially to the side of the first or the second lumbar vertebra. The renal artery arises at the level of the intervertebral disc between the L1 and L2 vertebrae. We evaluate the role of the MAL that serves as an anatomic landmark for locating the renal artery during retroperitoneal laparoscopic renal surgery. RESULTS: There is a reproducible consistent anatomic relationship between MAL and the renal artery in 210 cases of retroperitoneal laparoscopic renal surgery. Two main types of the MAL, the "narrow arch" and the "fascial band" types, can be observed. CONCLUSION: MAL can serve as an accurate and reproducible anatomic landmark for the identification of the renal artery during retroperitoneal laparoscopic renal surgery.

[Frequency and linkage disequilibrium of specific HLA-DR and HLA-DQ genes in Chinese Han population].

This study was aimed to investigate the distribution feature of HLA-DR/DQ gene linkage disequilibrium in Chinese Han population and to improve the accuracy of HLA matching results. Genotyping of HLA-DR and HLA-DQ gene locus was performed using PCR-SSP typing in Chinese Han population receiving kidney transplantation. The results showed that there were 29 new linkage combinations in 1799 patients, in which DR13-DQ5, DR11-DQ8 and DR8-DQ8 were discovered for 11, 8 and 7 times respectively while DR9-DQ8, DR12-DQ6 and DR14-DQ4 were both discovered for 6 times. The linkage disequilibrium parameters of these haplotypes were negative, showing that these linkages were uncommon. It is concluded that this study not only enriches the classical HLA-DR/DQ linkage combinations, but also indicates the national relevance of combination distribution, and it has great importance in improving the accuracy of HLA matching experiments and reducing unnecessary repeated work.

[Transurethral partial cystectomy with a 2 micron laser in diagnosis and treatment for bladder submucosal lesions in adults].

OBJECTIVE: To investigate the characteristics of transurethral partial cystectomy with a 2 µm laser in diagnosis and treatment for the bladder submucosal lesions in adults. METHODS: Nine patients with suspected pathological diagnosed bladder submucosal lesions in out-patient department were diagnosed and treated transurethral with a 2 µm laser under sacral block between August 2009 and December 2010. The diameters of tumors were 1.5 - 2.5 cm. A 2 µm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with bladder wall at the base were removed together and sent for pathological examination. The surgical procedures, intraoperative hemorrhage, intraoperative and postoperative complications were observed, pathological diagnosis and postoperative follow-up were performed. RESULTS: All operations were successful. Mean operative time was 36.4 minutes (range 25 to 47 minutes), perioperative blood loss was minimal. There was no obturator nerve reflection and no hemorrhage detected after surgery. Postoperative pathological diagnosis included leiomyoma in 3 cases, pheochromocytoma in 3 cases, endometriosis in 1 case and metastatic bladder cancer in 2 cases. CONCLUSIONS: Transurethral partial cystectomy with a 2 µm laser can diagnose and treat bladder submucosal lesions. The procedures are effective and safe. Patients could get accurate pathological diagnosis without further painful and some bladder tumors can be treated by minimally invasive surgery.

Transurethral partial cystectomy with 2 µm thulium continuous wave laser in the treatment of bladder pheochromocytoma.

PURPOSE: To introduce transurethal partial cystectomy with a 2013 nm thulium laser as a treatment for paraganglioma of the urinary bladder in adults. PATIENTS AND METHODS: Three patients with pheochromocytomas were treated transurethrally with a 2013 nm thulium laser under general anesthesia. A 2013 nm thulium laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together. Intraoperative fluctuation of blood pressure, preoperative values of 24-hour urine catecholamine (CA) and vanillylmandelic acid (VMA), and postoperative complications were observed, and postoperative followtwoups were performed. RESULTS: All operations were successful. Operative time was 25 to 32 minutes. Perioperative blood pressure was stable in two cases while blood pressure fluctuated in the third case. When the entire tumor and the full-thickness bladder wall at the base were freed, blood pressure reverted to stability. All values of 24-hour urine CA and VMA were within normal limits postoperatively. Patients were followed for 7 to 9 months postoperatively with no recurrence. This series included highly selected patients who were treated by a single senior surgeon who is rich in experience in performing 2013 nm thulium laser procedures. CONCLUSIONS: To our knowledge, this is the first report of a 2013 nm thulium laser used to treat bladder pheochromocytoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and cut down the blood supply of the tumor, then peel it while blood pressure remains stable, thus completing partial cystectomy for bladder pheochromocytoma safely.

Anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy.

OBJECTIVES: To increase awareness of the anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy. METHODS: A total of 61 cases of retroperitoneoscopic left living donor nephrectomy were carried out from March 2008 to June 2010. The anatomical variations of the posterior lumbar tributaries of the left renal vein in these patients were noted. RESULTS: According to the variation of posterior lumbar tributaries, there were seven types in total, including five main types (accounts for 95.1%, 58/61 cases) and the type of reno-hemi-azygo-lumbar trunk (AZV; accounts for 16.4%, 10/61 cases). According to the number of posterior lumbar tributaries, no lumbar vein covers accounted for 16.4% (10/61 cases), one lumbar vein accounted for 47.5% (29/61 cases), two lumbar veins accounted for 32.8% (20/61 cases) and three lumbar veins accounted 3.3% (2/61 cases). According to the operation time during the process of managing posterior lumbar veins, it was type 4 (AZV) on which the surgeon spent the most time (P<0.05), and type 5 (no lumbar vein) on which the surgeon spent the least time (P<0.05). CONCLUSIONS: This is the first report of the anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneal laparoscopic left living donor nephrectomy. Detailed knowledge of these anatomical variations will undoubtedly help surgeons to avoid the potential risk of vein damage during nephrectomy and to obtain a longer renal artery for the following renal transplantation.

[Analysis of the 1000 Hz tympanometry in normal hearing neonates].

OBJECTIVE: To analysis the clinical characteristics of 1000 Hz probe tone tympanometry obtained from normal neonates who passed the OAE screening. To calculate the normal range of the variances of the tympanometry, which may serve as the guide for newborn hearing screening and detect middle ear function in neonates. METHODS: OAE screening were performed to screen the hearing with GSI-70 Automated OAE. The 1000 Hz probe tone tympanograms were obtained from 650 neonates who passed the TEOAE screening in both ears and were on the normal physiological conditions after birth with GSI Tympstar Version II Middle Ear Analyzer. The means, the standard deviation, the 95% confidence interval were analyzed. RESULTS: The 1000 Hz tympanometric data showed the 1Y1B1G tympanogram in 732 ears (56.3%), the 1Y3B1G tympanogram in 145 ears (11.2%), the 0Y0B0G tympanogram in 269 ears (20.7%), other shapes in 154 ears (11.8%) according to the Vanhuyse model. The 1000 Hz tympanometric datas showed the single-peaked tympanogram in 967 ears, the 95% confidence interval of the tympanometric data were as follows: tympanometric peak pressure (Tpp) was from -55.0 to 180.0 daPa, peak compensated static acoustic admittance (Peak Ytm) was 0.03-1.18 mmHo, tympanometric width (TW) was 70.0-230.0 daPa. CONCLUSIONS: The majority of 1000 Hz tympanograms from this study show the single-peaked in normal neonates. The 95% confidence interval of the tympanometric data may serve as a guide for hearing screening and detecting middle ear function in neonates.

[Retroperitoneal laparoscopic living donor nephrectomy: report of 58 cases].

OBJECTIVE: To review a single-institution experience with retroperitoneal laparoscopic living donor nephrectomy (RLDN). METHODS: Fifty-eight donors underwent RLDN at our institution (including 32 male and 26 female donors aged 20-61 years, mean 42 years). Left nephrectomy was performed in 56 cases. The first 35 patients underwent total RLDN, and the latter 23 received modified RLDN. RESULTS: RLDN was performed successfully in all the patients without conversion to open surgery. The mean surgical time was 93 min (range 70-130 min), and the mean blood loss was 20 ml (range 10-50 ml), with a mean warm ischemia time of 2.8 min (1.3-6 min). Retroperitoneal hematoma occurred postoperatively in one case. The mean hospital stay of the donors was 6.4 days (5-10 days). Two recipients showed delayed graft function, and one graft was lost because of acute rejection. The other recipients had normal renal function in two weeks except for 3 having normal renal function in 4 weeks. CONCLUSION: RLDN is a safe procedure with minimal invasiveness, and the modified RLDN lowers the learning curve of the surgery.

Laparoscopic-assisted partial nephrectomy combined with open procedure for posteromedial renal tumors.

OBJECTIVE: To describe the technique of laparoscopic-assisted partial nephrectomy melded with open procedure in resection of postero-medial renal tumors. METHODS: Six patients with postero-medial renal tumors were admitted between July 2008 and March 2009. They included 4 diagnosed renal cell carcinomas and 2 renal angiomyolipomas on preoperative imaging, and their tumors ranged from 2.5-4.3 cm in diameter. They underwent laparoscopic-assisted nephron-sparing surgery combined with a small-incision procedure. RESULTS: All 6 patients underwent successful resection. The mean operating time was 124 minutes and the average duration of pneumoperitoneum was 25 minutes. The duration of renal arterial blockage ranged from 19-36 minutes, with an average of 23 minutes. The intraoperative hemorrhage volume averaged 160 mL. Postoperative pathology revealed negative margins in all resected specimens. No urinary fistula or secondary hemorrhage occurred postoperatively, and renal function showed no impairment. The patients were followed for 1-8 months. Ultrasonographic or computed tomography examination revealed no recurrence. CONCLUSIONS: The laparoscopic-assisted partial nephrectomy combined with an open procedure is a novel technique for the resection of posterior medial renal tumors. The technique is safe and effective.

[Necessity and safety of conversion from mycophenolate mofetil to AzA thioprine after renal transplantation].

OBJECTIVE: To investigate the necessity and safety of conversion from mycophenolate mofetil (MMF) to Azathioprine (AzA) in stable renal transplant patients. METHODS: In a randomised open clinical trial, A total of 87 low-risk renal allograft recipients on triple immunosuppressive therapy (prednisone/MMF/cyclosporine) 6 months after transplantation was randomised into two groups: converted (switching MMF to AzA treatment 6 months after transplantation, n = 42) and control (continued MMF treatment, n = 45). Renal function, acute rejection episodes, side effects and related complications were analysed in each group. RESULTS: The outcome (such as event-free graft survival rate and incidence of acute rejection) of treatment after a 12-months follow-up of patients in two groups was similar. Liver lesion and leukocytopenia, most of which was reversible, occurred more frequently in the converted than in the control group. CONCLUSION: Under the special economic atmosphere and medical insurance system of our country, the conversion from MMF to AzA in some renal transplant patients was necessary and safe. Further study is needed to evaluate the long-term outcome of this conversion.