Objective To study the efficacy of low-dose daytime ambulatory peritoneal dialysis (DAPD) and low-dose CAPD in diabetic end-stage renal disease (ESRD) patients with better residual renal function (RRF). Methods Forty stable diabetic ESRD patients with better RRF (rGFR ≥ 5 ml/min and urine volume ≥ 750 ml/d) were enrolled. They were randomly divided into two groups: low-dose DAPD group (n=20) and low-dose CAPD group (n=20). DAPD group received three 1.5 L to 2 L daily exchanges with a nocturnal empty belly, dwelling for 3 to 4 hours. CAPD group received three 1.5 L to 2 L daily exchange or four 1.5 L daily exchange regimens and dwelled during the night. At the beginning of the study and 6 months later, total weekly Kt/V and Ccr (peritoneal+renal), rGFR were calculated. Meanwhile 24-hour urinary protein,serum albumin (Alb), hemoglobin (Hb), fasting plasma glucose, glycosylated hemoglobin and insulin dosage were measured. Nutritional status was assessed by SGA. Results Thirty-five patients fulfilled the study. There were no significant differences between two groups in age, gender, BMI,PD time, D/Pcr, etc. At the end of the 6th month, the insulin dose[(33.6±10.9) U/d] and 24-hour dialysate protein [(11.13t4.95) g] in CAPD group were significantly higher as compared to DAPD group [(20.6±6.2) U/d, P＜0.05 and (5.66±2.88) g, P＜0.01 respectively]. Alb in CAPD group [(29.7±4.2) g/L] was significantly lower than that in DAPD group [(36.5 ±3.9) g/L, P＜0.05].While the net ultrafiltration [(554±187) ml vs (309±177) ml], 24-hour urine volume [(1090±361)ml vs (750±258) ml] and rGFR [(8.21±2.40) ml/min vs (4.88±2.11) ml/min] in DAPD group were all significantly higher than those in CAPD group (all P＜0.05). Conclusion For the diabetic ESRD patients with better RRF, the low-dose DAPD regimen is more effective to control plasma glucose, improve nutritional status and protect RRF than the low-dose CAPD.

Objective To investigate the situation of prevalence,treatment and control of hypertension in patients with chronic kidney disease(CKD)by CROSS-sectional study. Methods Nine hundred out-patients with CKD in our department from November 2006 to March 2007 were enrolled in the study,including 480 male and 420 female.Among 900 CKD cases,354 patients underwent maintenance dialysis,including 228 on hemodialysis and 126 on peritoneal dialysis.Results The prevalence of hypertension in CKD patients was 80.2%(nude 83.5%vs female 76.4%,P<0.01).The prevalence of hypertension in patients on dialysis was significantly higher than that in non-dialysis patients(90.1%vs 73.8%,P<0.01),but there was no significant difference between hemodialysis and peritoneal dialysis cases.Antihypertensive treatment rate was 92.4%in CKD patients with hypertension.and was significantly higher in patients on dialysis than that in non-dialysis patients(95.6%vs 89.8%.P<0.01).The control rate according to current recommendations for CKD patients (BP<130/80 mm Hg) was very low. Control of both SBP and DBP was only achieved in 20.4% of non- dialysis patients. The control rate of hypertension (BP< 125/75 mm Hg) in patients with proteinuria >1 g/24 h was 8.4%. The proportion of dialysis patients with BP<140/90 mm Hg was significantly lower than that of non-dialysis patients (45.2% vs 55.5%, P<0.01). The percentage of hemodialysis patients with BP < 140/90 mm Hg was significantly higher than that of peritoneal dialysis patients (49.8% vs 36.5%, P<0.05). The prevalence of hypertension was associated with the decrease of renal function and the increase of age. The prevalence of hypertension in diabetic nephropathy was higher than that in primary glomerular diseases. Patients received 1, 2, 3 and 4 or more kinds of antihypertensive drugs accounted for 37.2%, 37.5%, 19.3% and 5.9% respectively. The combination of calcium channel blocker (CCB) and renin-angiotensin-aldosterone system (RAAS) inhibitors was more frequently used in CKD patients. The CCB was the most frequently prescribed drug (74.1% ), followed by angiotensin Ⅱ receptor blockers (ARB) (48.4%), angiotensin-converting enzyme inhibitors (ACEI) (25.6%) and alpha, beta-blockers (24.7%). Conclusions The prevalence of hypertension in CKD patients is quite high, which is associated with the progression of renal function, increase of age, the type of underlying kidney disease, obesity and diabetes mellitus. The control of hypertension is unsatisfied in CKD patients, especially in dialysis patients and those with overt proteinuria.

ObjectiveTo compare the efficacy and safety of intermittent patient-initiated single-dose antibiotic prophylaxis and continuous antibiotic prophylaxis for the prevention of recurrent urinary tract infection (UTI) in postmenopausal women. MethodsA randomized controlled clinical trial was conducted for the prevention of recurrent urinary tract infection. Single dose of antibiotic was given every night in continuous antibiotic prophylaxis group and every time after exposure to conditions predisposed to UTI in intermittent antibiotic prophylaxis group. The duration of prevention was 12 months in both groups. ResultsThe effective rates of intermittent antibiotic prophylaxis and continuous antibiotic prophylaxis were 71.0% and 81.8% respectively (P＞0.05). The incidence of gastrointestinal adverse reaction in intermittent antibiotic prophylaxis group was significantly lower than that in continuous antibiotic prophylaxis group (7.7% vs 28.6%,P＜0.05). ConclusionsCompared with continuous antibiotic prophylaxis, intermittent patient-initiated single-dose antibiotic prophylaxis is a better prophylaxis with less gastrointestinal adverse reactions for the prevention of recurrent urinary tract infection in postmenopausal women.

Objective To explore the potential risk factors for aortic and mitral valve calcification in maintenance hemodialysis(MHD)patients. Methods Patients on MHD for at least 6 months.aged≥1 8 years without history of surgery or catheter for heart valve disease were enrolled in the study.Echocardiographic examination was performed to detect the calcification.The risk factors for aortic and mitral valve calcification were analyzed by Logistic regression. Results One hundred and eighty-one MHD patients(98 men and 83 women)were enrolled in the study.Of all the patients,aortic or mitral valve calcification was found in 94 patients(5 1.9%),aortic valve calcification in 90 patients(49.7%),mitral valve calcification in 30 patients(16.6%),aortic and valve calcification in 26 patients(14.4%).Multivariate Logistic regression showed that age(β=5.52,P=0.007),dialysis duration(β=6.99,P=0.039)and pre-albumin(β=-12.616,P=0.004)were independently correlated with aortic valve calcification.Mitral valve calcification was independently correlated with dialysis duration(β=6.057,P=0.002),history of primary hypertension(β=3.054,P=0.008),hemoglobin(β=-0.061,P=0.035)and β2 microglobulin(β=7.63,P=0.01).While the correlation between mitral valve calcification and age was borderline significant(β=0.085,P=0.05).Conclusions Valve calcification is prevalent in MHD patients,and aortic valve calcification is more common than mitral valve calcification.Age,dialysis duration and low serum pre-albumin are independent risk factors for aortic valve calcification.The risk factors for mitral valve calcification include age,dialysis duration,history of primary hypertension,anemia and high serum β2 microglobulin.

Objective To explore the relationship between receptor of advanced glycaton end products(RAGE)gene Gly82Ser polymorphism and patients with transient ischemia attack(TIA).Methods The Gly82Ser gene at the position of RAGE gene exon 3 was identified by a polymerase chain reaction- restriction fragment length polymorphism(PCR-RFLP)method in 70 cases of TIA & Diabetes(DM), 60 of simply TIA and 66 healthy control subjects.Results The genotypes of RAGE gene Gly82Ser identified were GG, GS and SS.The frequencies of RAGE gene Gly82Ser GS heterozygous genotype of TIA & DM and control were respectively 62.9% and 43.9%, significantly higher in TIA & DM patients than in control subjects(OR 2.036, 95% CI 1.021--4.062, P=0.042), however no significant difference was found between simply TIA and control(53.3% vs 43.9%, OR 1.299,95% CI O.644--2.618, P=0.465). Significant difference of the frequency of S allele was found neither between TIA & control and control(being 34.3% and 26.5%, respectively, OR 1.446,95% CI 0.859--2.434, P=0.164), nor between simple TIA and control(28.3% vs 26.5%, OR 1.096,95%CI 0.630--1.907, P=0.746).Conclusions RAGE gene Gly82Ser GS heterozygous genotype may be associated with TIA & DM patients.RAGE gene Gly82Ser polymorphism is a risky factor for TIA & DM patients, but not for TIA patients.

Objective： The aim of this study was to evaluate the expression of E-cadherin,α -catenin,β -catenin,and γ -catenin in gastric carcinoma and dysplasia and to determine the relationship with tumorigenesis and biological behavior of gastric cancer. Methods： The expression of E-cadherin, α -catenin, β -catenin, and γ -catenin in 43 patients with gastric carcinoma and gastric biopsy specimens from 22 patients with dysplasia and 10 healthy controls were determined using immunohistochemistry. Results： Membranous staining was observed in control biopsy specimens for all components of the complex. Abnormal expressive rates of E-cadherin,α -catenin,β -catenin in gastric carcinomas (53.5％ ,55.8％ ,51.2％ ,respectively) were significantly higher than that in gastric mucosal dysplasials （ 22.7％ ,22.7％ , 18.2％ , respectively P<0.05） ,and the rates in advanced gastric carcinomas were also significantly higher than that in early gastric carcinoma（ P< 0.01, P< 0.05, P< 0.01,respectively） . Tumors with a decrease in E cadherin occurred significantly more frequently in undifferentiated gastric carcinoma (P< 0.05). There were higher abnormal expressive rates of E-cadherin and β  catenin in the patients with tumor infiltrating out of serosa and with lymph nodes metastasis （ P<0.01 or P< 0.05） . Up to 50.0％ of gastric dysplasials and 76.7％ of tumors stained abnormally for one or more components of the cadherin catenin complex (P< 0.05), and the lymph nodes metastasis rates for one or more components of the E cadherin complex was significantly higher than that for no one components of the E cadherin complex (P< 0.01). Conclusion： The decreased expression of E cadherin and part of the catenins correlate with tumor stage, poor differentiation, infiltrative tumor growth, and lymph nodes metastasis, which suggests that E cadherin complex play a critical role in the course of chang from gastric mucosal dysplasials to gastric carcinoma. Thus, study of all the components of E cadherin catenin complex may be more valuable than single component of the complex for the detection of patients with gastric carcinoma.

Objective To clarify the relationship between clinical manifestation and pathological features of IgA nephropathy (IgAN) patients with mild proteinuria and/or hematuria.Methods Clinicopathological data from 316 biopsy-proven IgAN cases (proteinuria＜1 g/24 h and/or hematuria, and Scr＜133 μmol/L) from our hospital between January 1993 and October 2009 were studied retrospectively. The renal histopathology was quantified according to Lee's grading and Katafuchi's semi-quantitative standard, and the risk factors for renal pathological lesions were evaluated using multifactor logistic regression analysis. Results Among these 316 patients, 123 were male and 193 patients were female. The mean age at the time of renal biopsy was (33.10±10.69) years old. Clinical features were found as follows: hematuria with proteinuria was found in 267 patients (84.5%), isolated hematuria in 24 patients (7.6%), and isolated proteinuria in 25 patients (7.9%). 16.5% of patients had hypertension. The percentages of CKD stage Ⅰ, Ⅱ, Ⅲ were 76.9%, 20.9% and 2.2%, respectively. 31.3% of patients presented Lee's grade Ⅲ or more severe.52.8% of patients had various degrees of glomerulosclerosis. Crescent formation was observed in 20.3% of patients. 22.5% of patients showed tubular atrophy;16.8% showed interstitial fibrosis and 24.7% also had renal vascular lesions. The extent of glomerulosclerosis was negatively correlated with eGFR levels, but positively correlated with the amount of proteinuria and mean arterial pressure (MAP) level (P＜0.05). The score of tubulointerstitial lesion was positively correlated with the amount of proteinuria and negatively correlated with eGFR and hemoglobin (Hb)level (P＜0.05). The degree of renal vascular lesion was also correlated to MAP level positively and eGFR level negatively (P＜0.05). Multifactor logistic regression analysis revealed that proteinuria, Scr and Hb at the time of renal biopsy were independent risk factors for severe renal pathological lesions (Lee's grade Ⅲ or more severe) with odds ratio of 8.564, 1.031 and 0.975 respectively (all P＜0.01). Conclusions Severe renal histological lesions and decrease of renal function may be seen in some IgAN patients with mild proteinuria and/or hematuria. The levels of proteinuria,Scr and Hb are the independent risk factors for severe renal pathological lesions. Renal biopsy is important in these patients in order to make diagnosis and individual treatment.

Protein-protein interactions (PPI) are involved in a variety of biological processes, including cell-to-cell interactions, metabolism and development control. The misregulation, post-translational modification and interference of PPI are related to a variety of human diseases, making the regulation of these interactions a very attractive field of drug discovery. In recent years, the interaction between MDM2 and p53 has become a research hotspot, which plays an important role in the treatment of tumors. But unfortunately there are no such inhibitors approved all over the world. In this view, recent advances of MDM2-p53 inhibitors were briefly described and its inhibitors with potential therapeutic activities in clinical studies were introduced.

OBJECTIVETo study the influence of Radix aconiti lateralis preparata and Rhizoma zingiberis, two species of Chinese medicinal herbs with hot property, on energy metabolism and gene expression spectrum, and to analyze the possible mechanism of their effects.

METHODSForty-eight specific pathogen free Wistar rats were randomly divided into a Radix aconiti lateralis preparata group, a Rhizoma zingiberis group, and a control group. They were intragastrically treated with concentrated decoction of Radix aconiti lateralis preparata, Rhizoma zingiberis and normal saline respectively for 20 days. Toe temperature (TT), energy intake (EI), digestible energy (DE), and metabolizable energy (ME) were measured. The content of adenosine triphosphate (ATP) and energy charge (EC) in hepatic tissue were measured with high performance liquid chromatography (HPLC). The activity of ATPase and succinate dehydrogenase (SDH) in the liver were detected with chemical colorimetry. The gene expression in the liver was detected with Illumina's rat Ref-12 gene array. The differential expression genes were selected, annotated and classified based on Gene Ontology (GO). Real-time quantitative reverse-transcriptase PCR (Q-RT-PCR) was used to test the accuracy of results.

RESULTSCompared with the control group, the TT on the 10(th) day after the beginning of administration and ATP in the Radix aconiti lateralis preparata and Rhizoma zingiberis groups increased significantly (P<0.05). EI/body mass (BM), DE/BM, ME/BM, the hepatic EC and the activity of Na(+)-K(+)-ATPase, Ca(2+)-Mg(2+)-ATPase and SDH of liver increased significantly only in the Radix aconiti lateralis preparata group (P<0.05). There were 592 differential expression genes in the Radix aconiti lateralis preparata group and 1 159 in the Rhizoma zingiberis group compared with the control group. Among the differential expression genes, genes related to metabolic processes were the most significant based on GO analysis. There were 337 strips of gene differential expression in common in both Radix aconiti lateralis preparata and Rhizoma zingiberis groups compared with the control group.

CONCLUSIONSHerbs with hot property such as Radix aconiti lateralis preparata and Rhizoma zingiberis could improve the energy metabolism in rats, through influencing the metabolic process of sugar, lipid, and amino acid. It could also promote the production, storage, and utilization of energy by regulating the gene expression related to metabolism, which may be the main molecular mechanism of warming yang and dispelling cold for the treatment of the cold syndrome according to Chinese medicine theory.

Aconitum ; chemistry ; Adenosine Triphosphatases ; metabolism ; Adenosine Triphosphate ; metabolism ; Animals ; Body Temperature ; drug effects ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; Energy Intake ; drug effects ; genetics ; Energy Metabolism ; drug effects ; genetics ; Female ; Gene Expression Profiling ; Gene Expression Regulation ; drug effects ; Liver ; drug effects ; metabolism ; Male ; Rats ; Rats, Wistar ; Real-Time Polymerase Chain Reaction ; Reproducibility of Results ; Rhizome ; chemistry ; Succinate Dehydrogenase ; metabolism

OBJECTIVETo study the surgical reconstruction of unilateral Craniofacial Atrophy and Hypoplasia.

METHODSAccording to the etiological factors and severity of the facial deformities, different methods are employed, including bone framework reconstruction, soft tissue transplantation, orthognathic surgery.

RESULTSFrom September 1998 to August 2004, 42 cases were treated, Include: Hemifacial Microsomia 22 cases, Hemifacial Atrophy 16 cases, unilateral facial hypoplasia due to radiation 4 cases. Miniplate and transplants extrusion occurred on 2 post radiation patients due to poor soft tissue coverage, infection occurred on 1 patient after mandibular ramus reconstruction using autogenous rib and contralateral mandibular outer cortex. The leaving patients recovered well and the facial asymmetry were improved greatly.

CONCLUSIONSFacial asymmetry due to unilateral Craniofacial Atrophy or Hypoplasia is a common and complex condition for surgical management, The surgical plan should be delicated made individually according to the severity of the soft tissue and the underlying bone framework.

Adolescent ; Adult ; Craniofacial Abnormalities ; surgery ; Facial Asymmetry ; surgery ; Facial Hemiatrophy ; surgery ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Treatment Outcome ; Young Adult