PURPOSE: Previously, we developed a new method to calculate the flow rate in the hemodialysis vascular conduit based on Bernoulli's theory for surveillance of the arteriovenous fistula (AVF) function. However, the calculated flow rate would be different from the true flow rate because due to various factors. To compare the true flow rate, with intra- conduit pressure, and the calculated flow rate, an ex vivo experimental model was developed. METHODS: The arterial end of the vascular conduit was connected to a saline-filled bottle, with the venous end connected to a flow meter to control the flow rate. By monitoring the change in the true flow rate (Q) with the flow meter, each arterial and venous static pressure (pA, pV) and total pressure (pT) were observed. Using these parameters, the intra-conduit flow rates (QA, QV) were calculated by Bernoulli's equation. Finally, we compared the pA or pV with Q, and calculated the difference between the QA or QV and Q. RESULTS: There were no statistical differences between any of the pressure measurement during the 5 consecutive 5 experiments (P<0.05). The static pressure (pA or pV) was closely correlated with Q (pA, R2=0.950, P=0.000; pV, R2= 0.952, P=0.000). The calculated flow rate (QA or QV) was not in complete in accord with Q, but was closely correlated (QA, R2=0.961, P=0.000; QV, R2=0.961, P=0.000). CONCLUSION: The pressure measurement and calculated flow rate indicate the nature of the true flow rate in the vascular conduit.
Arteriovenous Fistula ; Models, Theoretical* ; Renal Dialysis

OBJECTIVES: Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes. METHODS: Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI). RESULTS: Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively. CONCLUSIONS: Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.
Abdominal Fat/*metabolism ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Diabetes Mellitus, Type 2/*complications ; Humans ; Male ; Middle Aged ; Obesity/*etiology ; Smoking/*adverse effects ; Waist Circumference

BACKGROUND: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. METHODS: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. RESULTS: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. CONCLUSIONS: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.
ABO Blood-Group System/*immunology ; Adult ; *Blood Group Incompatibility/immunology ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Graft Rejection/therapy ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Isoantibodies/immunology/physiology ; Kidney Transplantation/*immunology ; Male ; Middle Aged ; *Plasma Exchange ; Proteinuria ; Transplantation Conditioning ; Transplantation Immunology

Abdominal pregnancy is a very rare case consisting 1% of ectopic pregnancy and occurring once in 372-9714 of normal pregnancies. However, the possibility of massive bleeding which is a main cause of maternal death can lead to the death rate of 5.1 in every 1000 cases and is certainly a difficult subject in proceeding laparoscopic procedures. Here we are reporting with a brief review, an experienced case where an abdominal pregnancy is successfully treated with laparoscopy without massive bleeding or any other complications.
Female ; Hemorrhage ; Laparoscopy ; Maternal Death ; Mortality ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

Although renal aneurysmal formation in polyarteritis nodosa is common, it is rare to form complication of perirenal hematoma caused by spontaneous rupture of renal aneurysm. It should be differentiated from renal tumor, arterio-venous malforrnation, renal infarction, coagulopathy, and acute hydronephrosis in considering the cause of perirenal hematoma. In addition to that, it is a potential life-threatening complication and its early recognition and prompt treatrnent are emphasized. We describe a patient with polyarteritis nodosa who developed spontaneous perinenal hematoma due to repture of renal aneurysm, who had nonspecific symptoms. We thought polyarteritis nodosa based on present illness and clinical background, then immediately performed angiography and coil embolization. So the patient could be treated with cyclophosphamide and steroid successfully. Polyarteritis nodosa is a relatively rare disease, but should be included as one of the differential diagnosis whenever perirenal hematoma occurs.
Aneurysm* ; Angiography ; Cyclophosphamide ; Diagnosis, Differential ; Embolization, Therapeutic ; Hematoma ; Humans ; Hydronephrosis ; Infarction ; Polyarteritis Nodosa* ; Rare Diseases ; Renal Artery* ; Rupture, Spontaneous

Dialister pneumosintes is a nonfermentative, gram-negative anaerobic rod which is considered as a commensal organism of the oral cavity. A 77-year-old man with a history of aortic stenosis was visited to ER for dyspnea and fever. D. pneumosintes and Streptococcus anginosus were isolated from blood culture, and also D. pneumosintes was identified by 16S rRNA-based gene sequencing. This case report is the first case of isolation of D. pneumosintes from blood in Korea, and highlights the usefulness of DNA sequencing to identify pathogens in organism which is difficult to identify by biochemical identification method.
Aged ; Aortic Valve Stenosis ; Bacteremia* ; Dyspnea ; Endocarditis ; Fever ; Humans ; Korea ; Mouth ; Sequence Analysis, DNA ; Streptococcus anginosus*

BACKGROUND: Connective tissue growth factor (CTGF) is demonstrated to mediate the fibrotic effect of TGF-beta1 and to stimulate cell proliferation and matrix production. In the present study, we examined the effect of hypoxia on CTGF gene expression in cultured mouse tubular cell (MTC). METHODS: Quiescent cultures of MTC were exposed to hypoxia (1% O2) or normoxia in serum-free medium. The effects on hypoxia-induced CTGF expression were evaluated by Northern blot and real- time PCR. The role of MAP kinase was assessed using specific biochemical inhibitors. RESULTS: ELISA revealed that TGF-beta in conditioned medium by MTC exposed to hypoxia was maximally greater at 24 hours (41.16+/-6.31 ng/mL) than medium from normoxic cultures (15.742.92 ng/mL). Hypoxia caused a significant increase in CTGF mRNA expression in MTC (p<0.05). The steady-state level of CTGF mRNA was maximally up regulated by 3-fold within 4 hours as compared with the cells cultured under the normoxic condition. The induction of CTGF was not blocked by either JNK or ERK inhibitor, whereas an inhibitor of p38 MAP kinase reduced the hypoxia-induced stimulation of CTGF (p<0.05). Although hypoxia stimulated TGF-beta production, neutralizing anti-TGF-beta1 antibody did not abolish the hypoxia-induced CTGF mRNA expression. CONCLUSION: These data indicate that hypoxia up-regulates CTGF gene expression, and that p38 MAP kinase plays a role in hypoxic-stimulation of CTGF in cultured renal tubular cells. In addition, hypoxia induces CTGF mRNA expression via a TGF-beta1-independent mechanism.
Animals ; Anoxia* ; Blotting, Northern ; Cell Proliferation ; Connective Tissue Growth Factor* ; Connective Tissue* ; Culture Media, Conditioned ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Gene Expression ; Mice ; p38 Mitogen-Activated Protein Kinases ; Phosphotransferases ; Polymerase Chain Reaction ; RNA, Messenger ; Transforming Growth Factor beta ; Transforming Growth Factor beta1

PURPOSE: There were experimental evidences supporting that intrarenal activation of the renin-angiotensin system contributes to increase BP, proteinuria and urinary angiotensinogen (UAGT) excretion. The purpose of this prospective, open label, controlled study was to investigate the effect of losartan on proteinuria and UAGT excretion in chronic non-diabetic proteinuric (0.4 to 2.0 g/day) renal disease with normal renal function (glomerular filtration rate, GFR>60 mL/min/1.73m2). METHODS: Thirty two patients were randomly allocated to the losartan group (100 mg/day; n=17) or the control group (n=15). Systolic BP, diastolic BP, estimated GFR, urinary protein to creatinine ratio (UP/Cr), UAGT and plasma angiotensinogen (PAGT) level were compared between two groups at baseline, 6 months and 12 months. RESULTS: UP/Cr (1.13+/-0.36 g/g vs. 1.07+/-0.34 g/g) was similar in two groups at baseline. Target BP (<140/90 mmHg) was maintained in both groups. After 6 months, UP/Cr (0.63+/-0.35 g/g vs. 0.97+/-0.41 g/g, p<0.01) was significantly decreased in the losartan group compared to the control group. In addition, UAGT (baseline 1.0) was noticeably suppressed in the losartan group (0.72+/-0.42 vs. 1.07+/-0.81, p=0.13). However, PAGT was not changed in both groups. Moreover, our study at 12 months period has demonstrated continuous suppression of UP/Cr (0.79+/-0.53 g/g vs. 1.00+/-0.50 g/g, p=0.06) and UAGT (0.60+/-0.51 vs. 1.51+/-1.36, p<0.05) in the losartan group. UP/Cr was highly correlated with UAGT (Correlation Coefficient=0.74, p<0.01), but not with PAGT. CONCLUSION: Losartan not only induced a remarkable decrease in proteinuria but also contributed a reduction in UAGT in patients with chronic non-diabetic proteinuric renal disease.
Angiotensinogen ; Creatinine ; Filtration ; Humans ; Losartan ; Plasma ; Prospective Studies ; Proteinuria ; Renin-Angiotensin System

PURPOSE: The significance of metabolic syndrome (MS) was recently raised as a risk factor in chronic kidney disease (CKD). Diabetes and hypertension are not only well known diagnostic criteria for MS, but also risk factors for CKD. However, the association between MS and CKD in patients without diabetes and hypertension is unknown. METHODS: A total of 9586 subjects who registered in the health check service at Samsung Medical Center between January 2004 and December 2005 were included. MS was defined according to the criteria of the revised ATP III, and CKD was defined by the reduction of the glomerular filtration rate or the appearance of albuminuria. RESULTS: The prevalence of MS was 9.0% of study subjects. CKD was noticed in 6.2% of the subjects without MS, and 13.1% with MS. MS was a significant determinant of CKD {Odd ratio (OR) 1.80 and 95% confidence interval (CI) 1.42-2.28, p<0.001}. Compared with subjects lacking components of MS, subjects with one, two, three, four or five components of MS had a higher risk of acquiring CKD (OR, 1.04, 1.43, 1.89, 2.48, 3.29, Respectably). The relationship between each component of MS and CKD was different according to sex and age groups. Abdominal obesity was a significant determinant for CKD in female subjects, while high fasting glucose levels were a significant determinant in younger subjects (<60 years) (p<0.05). CONCLUSION: Even in non-diabetic and non-hypertensive adults, MS is independently associated as a risk factor for CKD.
Adenosine Triphosphate ; Adult* ; Albuminuria ; Fasting ; Female ; Glomerular Filtration Rate ; Glucose ; Humans ; Hypertension ; Metabolic Syndrome X ; Obesity, Abdominal ; Prevalence ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Risk Factors

PURPOSE: Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome with many causes, including Kawasaki disease (KD). The purpose of this study was to identify the laboratory tests needed to easily differentiate KD with HLH from incomplete KD alone. METHODS: We performed a retrospective study on patients diagnosed with incomplete KD and incomplete KD with HLH (HLH-KD) between January 2012 and March 2015. We compared 8 secondary HLH patients who were first diagnosed with incomplete KD with all 247 incomplete KD diagnosed patients during the study period. The complete blood count, erythrocyte sedimentation rate, platelet count, and serum total protein, albumin, triglyceride, C-reactive protein, N-terminal pro-brain natriuretic peptide (NT-proBNP), and ferritin levels were compared. Clinical characteristics and echocardiography findings were also compared between the 2 groups. RESULTS: The total duration of fever was longer in the HLH-KD group than in the KD group. White blood cell and platelet counts were higher in the KD group. Alanine aminotransferase, ferritin, and coronary artery diameter were increased in the HLH-KD group compared with those in the KD group. The median of NT-proBNP was significantly higher in the HLH-KD group than in the KD group at 889.0 (interquartile range [IQR], 384.5–1792.0) pg/mL vs. 233.0 (IQR, 107.0–544.0) pg/mL. CONCLUSION: The NT-proBNP level may be helpful in distinguishing incomplete KD from KD with HLH. The NT-proBNP level should be determined in KD patients with prolonged fever, in addition to the white blood cell count, platelet count, and ferritin level, to evaluate secondary HLH.
Alanine Transaminase ; Blood Cell Count ; Blood Sedimentation ; C-Reactive Protein ; Coronary Vessels ; Echocardiography ; Ferritins ; Fever ; Humans ; Leukocyte Count ; Leukocytes ; Lymphohistiocytosis, Hemophagocytic* ; Mucocutaneous Lymph Node Syndrome* ; Natriuretic Peptide, Brain ; Platelet Count ; Retrospective Studies ; Triglycerides