Objective To investigate the bacteria spectrum and prognosis of exit-site infection in peritoneal dialysis patients. Methods Perfect exit, equivocal exit, exit-site infection (ESI) and tunnel infection (TI) were classified. Incidence of ESI, bacteria spectrum, treatment effect and prognosis were statistic. Results Sixty-nine patients' exits were examined monthly, twenty-one episodes of ESI were occurred during eighteen months. Main pathogens of exit-site infection were staphylococcus aureus (47. 6% ) and pseudomonas aeruginosa(28. 6% ) . Seventeen episodes of ESI were cured. Four episodes of ESI accompanied with tunnel infections. TI rate diagnosed by clinical observation and ultrasound was 0. 012/patient-year and 0. 036/patient-year respectively. Conclusions The outcome of catheters is associated with the regiment of bacteria. Tunnel infection often occurs in whom with a long time exit-site infection. Ultrasound examination can clarify the diagnosis simply and quickly.

Objective To study the gene and protein expression of matrix metalloproteinase 2 (MMP2) and its inhibitors TIMP1 and TIMP2 in human peritoneal mesothelial cells (HPMC), and the possible role of high glucose in submesothelial extracellular matrix (ECM) degradation during peritoneal dialysis (PD) . Methods Primary HPMC was isolated from spent peritoneal dialysis effluent collected from PD patients. After HPMC confluence, the cells were detached by trypsinization and passaged into 25 cm2 tissue-culture flasks. The effect of high glucose and hyperosmolarity on the gene expression of MMP2, TIMP1 and TIMP2 in HPMC was studied by semi-quantitative RT-PCR. Immunohistochemistry and zymography were used to measure the protein expression of MMP/TIMP in HPMC. Results HPMC expressed MMP2, TIMP1, TIMP2 at both gene and protein levels. 4. 25% glucose significantly up-regulated TIMP1 gene expression in HPMC( P

Objective To investigate the morphological changes of peritoneum during peritoneal dialysis (PD) and elucidate the possible mechanism of its functional deterioration. Methods Peritoneal biopsies were obtained from normal subjects( n = 10), uremic predialysis patients( n = 12) at catheter insertion and PD patients ( n = 10) at the time of catheter remove or reinsertion or renal transplantation, peritoneal morphology was studied by light microscopy, scanning electron microscopy and transmission electron microscopy. Results Normal peritoneal membrane consisted of a monolayer of mesothelial cells on a basement membrane, and a layer of connective tissue containing cells, blood vessels, lymphatic vessels and so on. Mesothelial cells were polygonal, often elongated, and had numerous microvilli on their luminal surface. Sometimes the microvilli ended with roundish formation or resembled a corona. There were lots of oval or roundish pinocytotic vesicles in the cytoplasm of mesothelial cell. Submesothelial connective tissue contained many collagen and elastic fibers. The peritoneal morphology of uremic predialysis patients was similar to that of normal subjects. But significant abnormalities of peritoneal morphology were observed in PD patients and the changes were progressive. Microvilli were the first site of damage, including microvilli shortening, gradual reduction in number and following total disappearance. Then mesolhelial cell detachment from basement membrane and total disappearances were found. Finally the peritoneal membrane only consisted of submesothelial connective tissue denudation of cells. Conclusions PD can modify peritoneal morphology and structure. The morphological change is progressive and might be one of the important causes of peritoneal failure. Peritoneal biopsy can provide lots of valuable informations about the impact of PD, and thus further study on the relationship between peritoneal structure and its function is very useful for understanding of the physiopathology of peritoneum during PD.

Objective To find a procedure for facial rejuvenation w hi ch is simple, safe with lasting aesthetic results and to make it popularized eas ily. Method We performed complete face lifting first by extens ive subcutaneous detatchment. Secondly we plicated the superficial musclo-apon eurofic system (SMAS), including the superficial temporal fascia and the SMAS su perior to the parotid fascia, 1 cm anterior to the incision line by No.1 silk su tures. The distance of plication was about 1-2 cm. Interval of suture was 1 cm. After dissection under the platysma for 1-2 cm, we pulled the posterior edge of platysma postlaterally, and sutured it to the sternocleiodomasoid fascia. The n we suspended the obiculoris oculi and the SMAS lateral to the nasoalar and com issura oris by 4-0 absorbable surtures. If necessary, we plicated the platysma near the anterior border of the detachment. Results We performe d rhytidectomy on 48 patients by extesive subcutaneous detachment and multiple S MAS suspension in the past two years. The results were satisfactory after 3-16 months follow -up. There were no serious complications (including injury of fa cial nerve and skin necrosis and severe bleeding which needed another operation to clean up the hematoma). The aesthetic results were lasting. Complications in cluded temporal hair loss in 3 cases, in which one patient accepted hair transpl antation, and in another two patients alopecia zone were incised and sutured pri marily. Two cases had scar hyperplasia behind the ear, who required revision. Tw o cases had temporary asymmetry which were given no treatment and recovered 3 mo nths after operation. Conclusion This procedure overcomes the s hortcoming caused by simple subcutaneous rhytidectomy, in which improvement is t emporary. The SMAS is well perserved to avoid the facial nerve injury, the most severe complication of rhytidectomy. Therefore, rhytidectomy by extensive subcu taneous detachment and multiple SMAS suspension is a simple and safe procedure w ith lasting aesthetic results.

To investigate the damage on macrophage of the commercial peritoneal dialysis solution(CDS). Methods Macrophages were seperated from peritoneal fluid remained overnight of seven CAPD patients and TNF-a level of supernatant was determined and compared with those macrophages from uremic patients not yet recieving peritoneal dialysis. Results TNF-a levels of different glucose concentration decreased obviously in experimental group compared with control group, especially lower in 2.5% and 4.25% group. Conclusion In vivo experiment confirms that CDS possesses a long time inhibition on macrophage and this inhibition varies with different glucose concentrations.

RT-PCR and in situ hybridization were observed during dialyzer reuse. Results Every plasma cytokine level was decreased during reuse compared with first use dialyzer, but no significant difference was found between them. The levels of gene expression of IL-1?、TNF-? and IL-6 were different from the first use significantly. Conclusion If effective dialysis volumn was maintained, formaldehyde as disinfectant on reprocessing the dialyzer may amilorate membrane bio-compatibility. It would be benificial to decrease appearance of long term hemodialysis -related complications.

Objective To clarify whether the peritoneal equilibration test (PET)-determined solute transport groups defined by Twardowski fits patients in our medical center. Methods 158 initial standardized PET data since 1995 was selected and proportions of four transport groups were calculated according to Twardowski's criterion. Using the mean and standard deviations of 4-hour dialysis/plasma ratio of creatinine (D/Pcr), transport groups of our patients were re-determined. Patients were classified as follow: according to both two criteria, patients whose 4-hour D/Pcr in the range of high transport, low transport and average transport were classified as group H1, group L1 and group A, respectively; several average transport patients who changed to low transport after re-evaluation were classified as group L2; high transport patients who changed to average transport were classified as group H2. Every group was compared with clinical status in order to evaluate which criterion fit our patients. Results The 4-hour D/Pcr was 0. 70 ?0. 14 in our patients. The proportion of high, high-average, low-average and low transport were 21.5%, 44.9%, 17.8% and 5. 7% according to Twardowski's and 14. 6% , 33.5%, 33.5% and 18. 4% after re-evaluation. The ultrafiltration volume in group L2 was significantly higher than that in group A ( P

Objective To assess peritonitis rate in peritoneal dialysis. Methods The peritonitis rate from 1999 Aug. 1st to 2004 Jun 30th in Renji Peritoneal Dialysis Center was analyzed retrospectively. Various methods including cohort-specific peritonitis incidence, negative binomial distribution model, median subject-specific peritonitis incidence and peritonitis-free survival were used for the analysis. Results Cohort-specific peritonitis incidence was 1756. 14 patient-month, the mean peritonitis rate estimated using the negative binomial model was 1/49.58 patient-month, median subject-specific peritonitis rate was 0, mean peritonitis-free survival time was 39. 71 months, the peritonitis-free time was inversely correlated with subject-specific peritonitis rate(P

Objective To investigate if the mechanism of high glucose and losartan in mediating the expression of Smad in human peritoneal mesothelial cells (HPMC) and the possible management of HPMC. Methods Peritoneum was obtained from patients undergoing elective abdominal surgery. HPMCs were incubated in medium containing different concentrations of dextrose, mannitol (1. 5%, 2. 5% , 4. 25% ) and combination with dextrose and losartan. TGF-?1 in supernatant was detected by ELISA and HPMCs were collected to examine Smad family expression with RT-PCR and Western Blot. Results (1) High glucose up-regulated the expression of Smad 2 at both gene and protein levels, especially in 2. 5% and 4. 25% dextrose groups (P

Objective To investigate and compare relative blood volume (RBV) changes in dialysis-symptomatic hypotension and dialysis-refractory hypertension during hemodialysis. Methods Fifteen patients with dialysis-symptomatic hypotension (SH group) and thirteen patients with dialysis refractory hypertension (RH group) on chronic haemodialysis were enrolled in this study. RBV, blood pressure, heart rate and ultrafiltration volume (UV) were measured before hemodialysis and at 1 hour intervals during hemodialysis. Total of 149 and 146 five-hour hemodialysis sessions were performed separately. RBV was assessed using Automatic Blood Volume Monitor. Results RBV changes were significantly higher in SH group than in RH group (P