Renal cell carcinoma is one of the most common malignant tumors of urinary system. The annual incidence rate is approximately 17.9/100 000 populations, and there is a continually rising trend in number of new diagnosis. Metastatic and high-risk renal cell cancer is associated with a poor prognosis and is resistant to traditional chemotherapy and/or radiotherapy. Although cytokine-based therapies (interferon and interleukin-2) have been widely used, their effectiveness remained unsatisfactory due to their low response rates and short survival. Drugs targeting anti-angiogenesis pathways have shown benefits in relapse-free survival. In this review, we introduce the recent advances in the treatment of renal cancer, especially the application of vasculogenic mimicry and mosaic vessels. Although targeted therapies with anti-angiogenic properties have proposed new treatment criteria for advanced renal cell carcinoma, new drugs or new combinations are needed to improve the clinical efficacy and minimize adverse effects.
Carcinoma, Renal Cell ; blood supply ; therapy ; Humans ; Kidney Neoplasms ; blood supply ; therapy

OBJECTIVETo investigate the instant changes in heart function and organ blood flow, and their relations in rats at early stage of severe burn.

METHODSThirty-six SD rats were divided into sham injury group (S, n = 6) and burn group (B, n = 30) according to the random number table. Rats in B group were subjected to 30% TBSA full-thickness burn. Five time points for observation: 10 and 30 minutes, and 1, 3, and 6 hour (s) post injury (PIM/H) were set up, with 6 rats at each time point. Rats in S group were sham scalded with 37 degrees C warm water. Hemodynamics indexes including heart rate (HR), mean artery pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), LV + or - dp/dt max were determined. Blood flow of heart, brain, kidney, spleen, stomach, and ileum was determined respectively with fluorescent microspheres method. The correlation between LV + or - dp/dt max and myocardial blood flow was analyzed.

RESULTS(1) Compared with those of S group, HR in B group decreased gradually after injury; MAP, LVSP, LV +dp/dt max, LV -dp/dt max and myocardial blood flow in B group decreased obviously at PIM 10 (with F value respectively 12.062, 12.629, 11.066, 18.374, 9.468, and P values all below 0.01). Among them, myocardial blood flow decreased from (6.8 + or - 0.8) mL x min(-1) g(-1) to (2.6 + or - 0.5) mL x min(-1) x g(-1). Above-mentioned indexes increased gradually as the time after injury went on, with the highest values (except for LV +dp/dt max) observed at PIH 1, which decreased again later, with values at PIH 3 and 6 significantly lower than those in S group (the same F values as above, P values all below 0.01). There was no obvious difference in LVEDP between S group and B group at each time point (F = 1.205, with P values all above 0.05). (2) Compared with those of S group, blood flow of kidney, spleen, stomach, and ileum of rats in B group at PIM 10 declined obviously (with F value respectively 22.694, 20.856, 12.653, 7.293, P < 0.05 or P < 0.01), but the decline range was smaller than that in heart. The lowest values of above-mentioned indexes were observed at PIH 1 or PIH 3. Brain blood flow of rats in B group at each time point was close to that in S group (F = 1.812, with P values all above 0.05). (3) The correlation coefficient r between LV +dp/dt max, LV -dp/dt max and myocardial blood flow was respectively 0.651 and 0.617, showing significant positive correlation (with t value respectively 4.456 and 4.222, and P values all below 0.01).

CONCLUSIONSThe myocardial ischemia and decrease in cardiac function may occur in a very short time after severe burn (PIM 10). The rapid decrease of heart blood flow plays an important role in the change in cardiac function. Myocardial damage and decrease of cardiac function may be one of the important factors result in the decline of blood flow in other organs.

Animals ; Brain ; blood supply ; Burns ; physiopathology ; Disease Models, Animal ; Heart ; physiopathology ; Hemodynamics ; Ileum ; blood supply ; Kidney ; blood supply ; Male ; Myocardial Ischemia ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Regional Blood Flow ; Spleen ; blood supply ; Stomach ; blood supply

OBJECTIVETo investigate the influence of myocardial inhibition on injury to liver, kidney and intestine and blood perfusion at early stage in rat with severe burn.

METHODSThirty-two healthy male Wistar rats were enrolled in the study and randomly divided into sham scald, propranolol, scald control and scald + propranolol groups, with 8 rats in each group. After intraperitoneal injection of 10 g/L pentobarbital sodium for anesthesia, rats of the former two groups were sham scalded in a water bath of 37 degrees C for 18 s, while the latter two groups were inflicted with 30% TBSA full-thickness scald in a 97 degrees C water bath for 18 s. Rats were resuscitated with Ringer's lactate solution (4 mL x kg(-1) x 1% TBSA(-1), i. p.) following the Parkland formula 30 mins after the injury. At the same time, rats in propranolol and scald + propranolol groups received propranolol 0.75 mg/kg intravenously. After 6 hours, parameters of myocardiac mechanics (SBP, DBP, MAP, LVSP, LVEDP, +/- dp/dt max) were recorded by the multiple channel physiological signal collecting and processing system; blood flow of liver, kidney and intestine were detected with the laser doppler flowmetry; the serum contents of cTnI, TBA, beta2-MG and DAO were determined for reflecting injuries to the heart, liver, kidney and intestine, respectively.

RESULTSMyocardiac mechanics parameters, with the exception of LVEDP, were decreased in propranolol group as compared with those in sham group (P <.05). All myocardiac mechanics parameters in burn control group were lower than those in sham group and higher than those in burn + propranolol group (P < 0.05). Blood flow of organs showed similar changes in above-mentioned 3 groups (P < 0.05). Organ damages as shown in burn control group [cTnI (4.86 +/- 0.29) microg/L, TBA (83.6 +/- 18.2) micromol/L, beta2-MG (2.75 +/- 0.19) mg/L, DAO (1.45 +/- 0.09) x 10(3) U/L] were more serious than those in sham control group [cTnI (1.73 +/- 0.09) microg/L, TBA (24.5 +/- 2.4) micromol/L, beta2-MG (1.15 +/- 0.18) mg/L, DAO (0.87 +/- 0.13) x 10(3) U/L], and less serious than those in scald + propranolol group [cTnI 5.95 +/- 0.42 microg/L, TBA 125.8 +/- 21.3 micromol/L, beta2-MG 3.25 +/- 0.17 mg/L, DAO (1.83 +/- 0.13) x 10(3) U/L] (P < 0.05).

CONCLUSIONSPropranolol can aggravate injury to the liver, kidney and intestine at early stage in rat with severe burn, suggesting that "shock heart" may be one of initial factors in lowering blood flow to the organs, thus inducing injury to them.

Animals ; Blood Pressure ; Burns ; metabolism ; physiopathology ; Intestines ; blood supply ; Kidney ; blood supply ; Liver ; blood supply ; Male ; Myocardium ; metabolism ; Propranolol ; adverse effects ; Rats ; Rats, Wistar ; Shock

OBJECTIVETo evaluate the clinical value of color Doppler in monitoring graft flow in patients who underwent simultaneous pancreas-kidney (SPK) transplantation.

METHODSTotally 18 patients received color Doppler ultrasonography on day 1, 3, and 7 after SPK. Volumes and arteriovenous velocities of the kidney and pancreas grafts were recorded, and resistance index (RI) was calculated.

RESULTSColor Doppler ultrasound clearly displayed the modality, size, and flow of the kidney and pancreas grafts. Compared with the single kidney grafts, the modality, volume, and arteriovenous velocity of kidney grafts in SPK was not significantly different. Although the volume of pancreas graft was remarkably larger than the normal control pancreas early after transplantation, no difference in artery velocity was found between pancreas graft and normal pancreas. The spectrum of the portal vein in pancreas grafts showed the typical spectrum of iliac veins.

CONCLUSIONColor Doppler ultrasound is sensitive in monitoring the graft flow of SPK recipients and can be used to identify postoperative vascular complications and evaluate tissue perfusion.

Humans ; Iliac Vein ; diagnostic imaging ; Kidney ; blood supply ; diagnostic imaging ; Kidney Transplantation ; Pancreas ; blood supply ; diagnostic imaging ; Pancreas Transplantation ; Portal Vein ; diagnostic imaging ; Ultrasonography, Doppler, Color

OBJECTIVETo investigate the instigating effect of "shock heart" on injury to liver, kidney and intestine at early stage of severe burn in rat.

METHODSFifty-six healthy male Wistar rats were enrolled in the study and randomly divided into normal control (n=8, without treatment, NC) and burn (n=48, inflicted with 30% TBSA full-thickness scald, B) groups. The rats in B group were intraperitoneally injected with Ringer's lactate solution (4 ml x kg(-1) x 1% TBSA(-1) 30 minutes after burn following the Parkland formula, and they were observed at 0.5, 1.0, 3.0, 6.0, 12.0, 24.0 post-burn hour (PBH), with 8 rats at each time point. The parameters concerning myocardial mechanics, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure( LVEDP), +/-dp/dt max were recorded. The volume of blood flow in liver, kidney and intestine were detected. The serum contents of cTnI, TBA, 32-MG, DAO were determined.

RESULTSIn B group, LVSP and +/- dp/dt max decreased at 1.0 PBH, SBP, DBP and MAP decreased at 3.0 PBH ,all parameters of myocardial mechanics, decreased at 6.0 PBH and still lower than those in NC group at 24.0 PBH (P < 0.01). The volume of blood flow in liver, kidney and intestine in B group were markedly decreased at 1.0 PBH, and gradually decreased during 1.0-12.0 PBH, which were still lower than those in NC group at 24.0 PBH (P < 0.05 or P < 0.01). Compared with that in NC group (1.71 +/- 0.07 microg/L), the serum content of cTnI in B group were increased at 0.5 PBH (2.22 +/- 0.08 microg/ L, P < 0.01), and peaked at 12.0 PBH (7.07 +/- 0.44 microg/L), and persisted at high level (4.57 +/- 0.30 microg/L) at 24.0 PBH. The serum contents of TBA at 3.0 PBH, beta2-MG at 1.0 PBH, DAO at 1.0 PBH was obviously higher than those in NC group (P < 0.05 or P < 0.01), which all showed ascending tendency during 1.0-12.0 PBH.

CONCLUSIONMyocardial damage is earlier than other organs after severe burn, which is significantly correlated with the parameters of other organs damage and their blood flow volume. Shock heart may be one initiate factor to induce the damage of liver, kidney and intestine and decrease of their blood flow volume after severe burn.

Animals ; Blood Pressure ; Burns ; blood ; physiopathology ; Cardiomyopathies ; etiology ; Kidney ; blood supply ; Liver ; blood supply ; Male ; Random Allocation ; Rats ; Rats, Wistar ; Shock ; physiopathology ; Ventricular Function

Humans ; Kidney ; blood supply ; Nephrectomy ; methods ; Reperfusion Injury ; prevention & control ; Time Factors ; Warm Ischemia

Maintenance of healthy endothelium is essential to vascular homeostasis, and preservation of endothelial cell function is critical for transplant allograft function. Damage of microvascular endothelial cells is now regarded as a characteristic feature of acute vascular rejection and chronic allograft nephropathy, which is an important predictor of graft loss and is often associated with transplant vasculopathy. In this review, we will discuss the role of microvascular endothelium, in renal allograft dysfunction, particularly as it relates to markers of endothelial dysfunction and endothelial repair mechanisms. We also discuss the potential for therapies targeting endothelial dysfunction and transplant graft vasculopathy.
Humans ; Kidney/*blood supply ; *Kidney Transplantation ; Research Support, Non-U.S. Gov't ; Transplantation, Homologous ; Vascular Diseases/*prevention & control/*therapy

OBJECTIVETo study the anatomy characters of renal artery and the treatment of multiple arteries in living donor renal grafts.

METHODSRecords of 142 living donors were analyzed in our center. We analyzed the anatomic structure of renal arteries by DSA and CTA pre-transplantation. Thirty-one kidneys with multiple arteries were transplanted after reconstruction. Then clinical effects were compared between multiple-renal-arteries group (n=31) and single-renal-artery group (n=111).

RESULTSThe incidence of multiple renal artery was 30.99%, and there was no difference between both sides (left kidney 22.54%, right kidney 22.13%). If the multiple artery occurred in left or right kidney, the incidence of the multiple artery occurred in the other side was 56.25% and 60.00%, respectively. The diameter of left main renal artery was more magnanimous (P=0.001) and the first branch was more closed to abdominal aorta (P=0.004). Operation time and warm/cool ischemia time were longer in the multiple-renal-arteries group. However, estimated blood loss, delayed graft function, acute rejection and flow rate of arcuate artery were similar in both groups, the same as serum creatinine and serum creatinine clearance rate on day 7, 1 month and 3 month post-operation. It was shown by repeated measures ANOVA that graft with multiple arteries didn't affect the tendency of renal function at early time post-operation.

CONCLUSIONComprehending the character of renal artery and accurate treatment of multiple artery anastomosis are critical for the effect of the living kidney transplantation.

Arteries ; anatomy & histology ; surgery ; Female ; Follow-Up Studies ; Humans ; Kidney ; blood supply ; Kidney Transplantation ; Living Donors ; Male ; Treatment Outcome

Angiogenesis is a series of processes that include endothelial proliferation, migration and tube formation. Vascular endothelial growth factor (VEGF) is regarded as a potent mediator of angiogenesis, vascular permeability and tumor cell growth in renal cell carcinoma. This study was designed to evaluate the expression of VEGF and the microvessel count (MVC) and to determine their prediction efficacies for prognosis in renal cell carcinoma. The relationship between the expression of VEGF and MVC were evaluated immunohistochemically in 50 patients with renal cell carcinoma who received a radical nephrectomy at Wonju Christian Hospital between 1989 and 1997. Microvessels were identified by immunostaining endothelial cells for CD-31 antigen. The mean follow-up was 96 months (3 - 133 months). Overall 5-year survival rate was 71.5%. VEGF was expressed in the tumor cell cytoplasm. Of the 50 tumors, 23 (46%) were weak to strongly positive for VEGF but 27 (54%) were unreactive. The respective 5-year survival rates for patients with positive and negative expressions of VEGF were 70% and 73% (p > 0.05). The overall mean MVC was 13.4 in a 400x field. Mean MVCs were significantly higher in VEGF-positive tumors (17.6 +/- 12.1) than in VEGF-negative tumors (9.9 +/- 5.4), and the MVCs of the high vascular density group and the low ascular density groups were significantly different. The 5-year survival rates of patients with high vascular density and low vascular density were 59% and 86%. The median survival period for patients with MVCs higher than or equal to 10 vessels/field was 85 months, whereas for those with MVCs lower than 10 vessels/field the median survival time was 102 months. These results suggest that MVC may be a better prognostic factor in renal cell carcinoma than the expression of VEGF.
Adult ; Aged ; Carcinoma, Renal Cell/*blood supply/*metabolism ; Endothelial Growth Factors/*metabolism ; Female ; Human ; Kidney Neoplasms/*blood supply/*metabolism ; Lymphokines/*metabolism ; Male ; Middle Age ; Neovascularization, Pathologic/*pathology ; Prognosis

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage, and renal failure. Among the various hemorrhagic complications of HFRS, the spontaneous rupture of an arteriovenous malformation of the testicular vessels with a retroperitoneal hematoma is a rare finding. Here, we report a case of HFRS complicated by a massive retroperitoneal hematoma that was treated with transcatheter arterial embolization.
Adult ; Arteriovenous Malformations/*complications ; Embolization, Therapeutic ; Hematoma/diagnosis/*etiology/therapy ; Hemorrhagic Fever with Renal Syndrome/*complications ; Humans ; Kidney Cortex/blood supply ; Male ; Retroperitoneal Space ; Rupture, Spontaneous ; Testis/blood supply