Atrial natriuretic peptide(ANP) is a 28-amino acid hormone with potent natriuretic effect and diuretic one. ANP wag originally thought to be involved in the regulation of blood pressure and blood volume. However, recent studies have indicated that ANP has much wider physiologic roles, such as the regulation of mitoses, the secretion of thyroglobulin, the production of cerebrospinal fluid and aqueous fluid formation. This peptide hag been detected in the anterior uvea, retina and corneal endothelium. It was reported that ANP decreased intraocular pressure and aqueous humor formation. However the distribution of ANP in the eye was not clearly confirmed. This study was carried out to localize the immunoreactive ANP in the rat eye. The distribution of alpha-ANP in the rat eye was studied by immunohistochemistry using a polychnal antibody against synthetic rat alpha-ANP. Immunoreactive ANP was localized intensely in the epithelium of the ciliary body. ANP immunoreactivity was also strong in the corneal endothelium, iris and in the anterior epithelium of the lens. The immunoreactivity was observed in the nerve fiber layer, ganglion cell layer and inner plexiform layer in the retina. These data clearly confirm that ANP is widerly distributed and that it takes part in diverse functions in the rat eye.
Animals ; Aqueous Humor ; Atrial Natriuretic Factor ; Blood Pressure ; Blood Volume ; Cerebrospinal Fluid ; Ciliary Body ; Endothelium, Corneal ; Epithelium ; Ganglion Cysts ; Immunohistochemistry ; Intraocular Pressure ; Iris ; Mitosis ; Natriuretic Agents ; Nerve Fibers ; Rats* ; Retina ; Thyroglobulin ; Uvea

Using immunohistochemical technique, we observed time-sequentially to T and B lymphocyte in the ciliary body of the endotoxin induced uveitis in rat. The primary antibodies for immunohistochemical stain of the lymphocyte were IgM heavy chain, IgG heavy chain, T suppressor/cytotoxic (CD8) and T helper/macrophage (CD4) was performed in the frozen section. The intensity of immunohistochemical reaction for surface IgM positive cells increased from 12hours and reached most strong intensities at 24hours after endotoxin injection and then decreased rapidly, but the intensity for surface IgG positive cells increased from 48hours and sustained 96hours. There were no significant changes of intensity of immunohistochemical reaction for T cells except slightly increased T suppressor/cytotoxic cells (CD8).
Animals ; Antibodies ; Ciliary Body ; Frozen Sections ; Immunoglobulin G ; Immunoglobulin M ; Lymphocytes ; Rats* ; T-Lymphocytes ; Uveitis*

Nandrolone decanoate(ND), one of the anabolic steroids, has been used by athletes to build muscle mass and enhance weight-lifting performance and has also shown to be useful in malnourished ESRD patients. However, ND has several adverse effects including edema. After we experienced a case of severe edema and transient ultrafiltration failure(TUF) requiring more frequent number of dialysis during ND treatment, we prospectively studied the incidence and clinical characteristics of TUF during ND treatment. Among 30 ND-treated patients, 7 patients developed TUF. All TUF+ patients were female and had sigificantly higher number of patients with congestive heart failure, more use of minoxidil and moderate to severe malnutrition than TUF- patients. There were no significant differences in age, duration of dialysis, and number of diabetics between TUF+ and TUF- group. In ND-treated male patients, the number of patients with CHF and moderate to severe malnutrition and with use of minoxidil were significantly lower than TUF+ ones. Body weight and serum albumin concentrations were significantly increased 2-3 months after ND treatment in TUF+ patients. But there were no differences in body weight and serum albumin in TUF-patients. In TUF+ patients, frequency of HD increased from 3 times to 4 to 6 times a week. CAPD patients with TUF+ had more frequently used 4.25% dialysate and number of exchanges were increased. In most TUF+ patients, severe edema and TUF were disappeared about 2 weeks after treatment. Most TUF+ patients returned to previous schedle of dialysis. In conclusion, ND seems to induce TUF in ESRD patients who had risk for volume regulation such as CHF, hypoalbuminemia, or the use of minoxidil.
Athletes ; Body Weight ; Dialysis* ; Edema ; Female ; Heart Failure ; Humans ; Hypoalbuminemia ; Incidence ; Kidney Failure, Chronic* ; Male ; Malnutrition ; Minoxidil ; Nandrolone* ; Peritoneal Dialysis, Continuous Ambulatory ; Prospective Studies ; Renal Dialysis ; Serum Albumin ; Steroids ; Ultrafiltration*

Stroke is one of the leading causes of death and physical disability among adults. It has been 15 years since clinical trials of stem cell therapy in patients with stroke have been conducted using adult stem cells like mesenchymal stem cells and bone marrow mononuclear cells. Results of randomized controlled trials showed that adult stem cell therapy was safe but its efficacy was modest, underscoring the need for new stem cell therapy strategies. The primary limitations of current stem cell therapies include (a) the limited source of engraftable stem cells, (b) the presence of optimal time window for stem cell therapies, (c) inherited limitation of stem cells in terms of growth, trophic support, and differentiation potential, and (d) possible transplanted cell-mediated adverse effects, such as tumor formation. Here, we discuss recent advances that overcome these hurdles in adult stem cell therapy for stroke.
Adult Stem Cells* ; Adult* ; Biocompatible Materials ; Bone Marrow ; Cause of Death ; Humans ; Mesenchymal Stromal Cells ; Stem Cells ; Stroke*

BACKGROUND: Major stroke clinical trials have failed during the past decades. The failures suggest the presence of heterogeneity among stroke patients. Biomarkers refer to indicators found in the blood, other body fluids or tissues that predicts physiologic or disease states, increased disease risk, or pharmacologic responses to a therapeutic intervention. Stroke biomarkers could be used as a guiding tool for more effective personalized therapy. MAIN CONTENTS: Three aspects of stroke biomarkers are explored in detail. First, the possible role of biomarkers in patients with stroke is discussed. Second, the limitations of conventional biomarkers (especially protein biomarkers) in the area of stroke research are presented with the reasons. Lastly, various types of biomarkers including traditional and novel genetic, microvesicle, and metabolomics-associated biomarkers are introduced with their advantages and disadvantages. We especially focus on the importance of comprehensive approaches using a variety of stroke biomarkers. CONCLUSION: Although biomarkers are not recommended in practice guidelines for use in the diagnosis or treatment of stroke, many efforts have been made to overcome the limitations of biomarkers. The studies reviewed herein suggest that comprehensive analysis of different types of stroke biomarkers will improve the understanding of individual pathophysiologies and further promote the development of screening tools for of high-risk patients, and predicting models of stroke outcome and rational stroke therapy tailored to the characteristics of each case.
Biomarkers ; Body Fluids ; Humans ; Precision Medicine ; Mass Screening ; Population Characteristics ; Risk Factors ; Stroke

Studies describing the effects on blood pressure control by hemodialysis(HD) or continuous amulatory peritoneal dialysis(CAPD) have yielded conflicting results with respect to 24 hour blood pressure control, diurnal variation and blood pressure loads. The aim of the study was to investigate the effect of beginning with HD or CAPD on blood pressure control, diurnal variation and blood pressure loads using ambulatory blood pressure monitoring(ABPM). Twen-ty-seven end-stage renal disease(ESRD) patients(12 on HD and 15 on CAPD) were enrolled into the study. Patients with cardiovascular diseases, erythro-poietin therapy, or severe edema were excluded. ABPM were performed two times before and after the initiation of dialysis. Mean duration of interval between pre- and post-dialysis ABPM were 17+/-4 days on HD and 13+/-3 days on CAPD. Daytime and nighttime were defined as the time from 6:00 AM to 10:00 PM and from 10:00 PM to 6:00 AM of the next day. Systolic and diastolic loads were defined as the percentage of the incidence of systolic and diastolic blood pressure over l% and 90mmHg. Dipper meaning the presence of normal diurnal difference were defined as the differences of daytime- nighttime mean arterial pressure more than 5mmHg. In HD patients, mean systolic and diastolic blood pressure and mean arterial pressure were significantly decreased after dialysis during 24 hour, day- time and nighttime. In CAPD patients, those were also significantly decreased after dialysis during 24 hour, daytime and nighttime(p<0.05). Diurnal differences were increased after CAPD(3.3+/-9.4 vs 5.4+/-6.8mmHg) but decreased after HD(4.3+/-6.2 vs 2.4+/-10.8mmHg) and the differences of diurnal difference between two groups were significantly different(+2.1+/-9.0 vs 1.9+/-8.4mmHg, p<0.05). Proportions of dipper among patients were increased from 16.7 to 66.7% in HD and from 33.3% to 60% in CAPD without statistical significance between two groups. Systolic and diastolic loads were significantly decreased after HD(from 75.0+/-38.0 to 37.5+/-43.8%, from 45.2+/-29.7 to 12.5+/-12.8%, respectively, p<0.05) and after CAPD(from 63.1+/-30,1 to 32.3+/-27.1%, from 43.4+/-36.2% to 12.2+/-16.9%, respectively, p<0.05). Systolic and diastolic loads of daytime and nighttime were significantly decreased after each dialysis modality except nighttime diastolic pressure load in HD. In conclusions, both HD and CAPD improve BP control in ESRD patients. CAPD has more benefit to control of diurnal variations in ESRD patients.
Arterial Pressure ; Blood Pressure* ; Cardiovascular Diseases ; Dialysis ; Edema ; Humans ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis*

Atherosclerotic cardiovascular disease(AVD) is a major cause of the mortality and morbidity in end-stage renal disease(ESRD) patients undergoing chronic dialysis therapy. The factors such as lipopretein metabolism abnormality, diabetes, hypertension, hyperhomocysteinemia and oxidative stress have been implicated as underlying causes related AVD. Malnutrition, chronic inflammation, increased oxidative stress, hyperparathyroidism and its related lipoprotein abnormalities are suggested to accelerate AVD in ESRD patients. High-resolution B-mode ultrasono-graphy has been used to evaluate atherosclerotic change in carotid artery in a number of epidemiologic or clinical studies because of its non-invasive advantage and proven effects in predicting AVD or cardiovascular mortality. Using high-resolution B-mode sonography, we evaluated the presence of plaque and carotid intima-media area(cIM area), which is known to be a good predictor of athero-sclerosis. We compared and analyzed those sonographic findings according to a number of selected clinical and laboratory factors. Study subjects were 27 stable ESRD patient receiving hemodialysis(HD) or chronic ambulatory peritoneal dialysis(CAPD) at least over 24 months. The patients with present or past coronary, cerebral or peripheral vascular disease, history of anti-platelet agents or age over 70 years were excluded. Nine HD and 18 CAPD patients were included and mean age was 52.1+/-2.6 years and number of male and female patients were sixteen and eleven. Among many factors, sex, age, dialysis duration, diabetes, smoking history, blood pressure, body mass index, albumin, creatinine, high-density lipoprotein, triglyceride, C-reactive protein, total calcium, phosphorus, intact-parathyroidid hormone were selected and analyzed for their correlation with carotid sonograpic findings. 1) Mean cIM area of all patients was 15.4+/-0.7 mm2. cIM area was significantly increased in CAPD patients compared to HD patients(16.5+/-1.2 vs 14.9+/- 0.9mm2, p<0.05). Atherosclerotic plaques were found in 48.1% and bilateral lesion was found in 18.5% of all patients. The incidence of the plaque was 42.1% in HD and 55.6% in CAPD patients. 2) cIM area was more significantly increased in male than female(16.7+/-0.8 vs 13.6+/-1.2mm2, in diabetes than non-diabetes(16.4+/-0.8 vs 14.7+/-l.lmm2) and in smoker than non-smoker(18.8+/-0.7 vs 12.8+/-0.7mm2, p<0.05). It was also significantly inereased in patients with body mass index more than 2.3kg/ m(18.3+/-1.1 vs 14.6+/-0.8mm), systolic blood pres-sure more than 14mmHg(16.6+/-0.7 vs 13.0+/-1.2mm) and C-reactive pretein more than 0.5 mg/dL(18.9+/-1.5 vs 14.2+/-0.77mm2p<0.05). Among those factors, age, systolic blood pressure, body mass index and C-reactive protein were proven to positively correlate to cIM area with statistical significance(p<0.05). Even though cIM area was increased in patients with high serum parathyroid hormone, high total cholesterol and triglyceride and low high-density lipoprotein level, no statistical significances were found in these factors. 3) In comparison of each factor according to the presence of the plaque, age and the presence of diabetes were proven to be significantly different between patients without the plaque and with the plaque(45.7+/-2.7 vs 59.5+/-3.8 year, 33.3% vs 53.8%, respectively, p<0.05). Systolic blood pressure and C-reactive protein were increased in patients with the plaque but no statistical significance was shown. In conclusions, we found that old age, male sex, presence of diabetes, smoking history, high systolic blood pressure, increased body mass index and increased C-reactive protein were significantly related to increased cIM area and the plaque was more frequent in old age and diabetes patients using high resolution B-mode ultrasonography. It can be assumed that inflammatory state as reflected by C-reactive protein would be more related with atherosclerosis in ESRD patients than such as nutritional state, parathyroid hormone or lipoprotein metabolism based on these results. Fusing prospective analysis demonstrating causeeffect relationship or analyzing inflammatory index such as TNF-a or interleukin would be necessary to prove this assumption.
Age Factors ; Atherosclerosis* ; Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Calcium ; Carotid Arteries* ; Cholesterol ; Creatinine ; Dialysis ; Female ; Humans ; Hyperhomocysteinemia ; Hyperparathyroidism ; Hypertension ; Incidence ; Inflammation ; Interleukins ; Kidney Failure, Chronic* ; Lipoproteins ; Male ; Malnutrition ; Metabolism ; Mortality ; Oxidative Stress ; Parathyroid Hormone ; Peripheral Vascular Diseases ; Peritoneal Dialysis, Continuous Ambulatory ; Phosphorus ; Plaque, Atherosclerotic ; Sex Factors ; Smoke ; Smoking ; Triglycerides ; Ultrasonography*

Peritonitis is one of the major complication of continuous ambulatory peritoneal dialysis (CAPD) and the most common cause of hospital admission and for termination of peritoneal dialysis. We retrospectively analyzed the incidences and causative organisms of CAPD peritonitis according to season/month of the year under the hypothesis that climate factors, increased temperature and humidity, may changes the incidences and causative organisms of peritonitis. There were a few studies about this issue and in most cases the result was inconclusive because of the limitation in the limited range of climate factors such as temperature and humidity. Wide annual differences of temperature (-3.4-25.4 degrees C) and humidity (61-81%) may affect the rate of peritonitis episode in the area where the current study was performed. Data from 80 patients(49 male, 31 female), with a mean age 48.3+/-14.5 years and mean CAPD period 14.0+/-9.0 months, followed from September 1996 to July 1999, were reviewed. Fifty-three cases of peritonitis were found in 1,123 patient-months, a rate of 0.56 episode/patients- year, and 0.047 episode/patient-month. The months in which the incidence of peritonitis above average was March (5.05%), May(7.96%), July (10.8%), August (6.25%), September (6.06%). The incidence of peritonitis was the lowest in November (1.31%). The incidence in hot season (May-September : average temperature for three years 21.9degrees C, humidity 74%) was 0.065 episodes/patient-month, which was significantly higher than in cold season (October-February : 5.9degrees C, 64.4%)(p<0.05). Average temperature for three years in the study area was 13.2degrees C with maximal temperature of 25.4degrees C (August) and minimal of -3.4 degrees C (January). Average humidity for three years in the study area was 68.4% with maximal humidity of 81% (July) and minimal of 61% (April). The incidence of peritonitis paralleled with temperature and humidity, highest in July (0.080/pt-month) and lowest in November (0.013/pt-month) and were directly correlated with temperature (r=0.53, p<0.05) and humidity (r=0.59, p<0.05). Among 53 episodes of peritonitis, gram positive peritonitis, gram negative peritonitis and culture negative peritonitis were 36.9%, 15.0% and 45.2%, respectively. From March to August, gram positive peritonitis was 50% and culture negative peritonitis was 42.4%. From September to February, culture-negative peritonitis was 52.9% and gram negative peritonitis organisms was 29.4%. In contrast to gram positive organisms which showed increased in hot weather, gram negative organisms showed uniform distribution throughout the year. There were no significant monthly differences in peritoneal fluid WBC count on admission and negative conversion period of that. Our data suggest that high temperature and humidity can adversely affect the incidence of CAPD peritonitis and may change the distribution of causative organisms.
Ascitic Fluid ; Climate* ; Humans ; Humidity ; Incidence ; Male ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Retrospective Studies ; Seasons ; Weather

BACKGROUND AND PURPOSE: Oxidative stress is involved in the pathophysiological mechanisms of stroke (e.g., atherosclerosis) and brain injury after ischemic stroke. Statins, which inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, have both pleiotropic and low-density lipoprotein (LDL)-lowering properties. Recent trials have shown that high-dose statins reduce the risk of cerebrovascular events. However, there is a paucity of data regarding the changes in the oxidative stress markers in patients with atherosclerotic stroke after statin use. This study evaluated changes in oxidative stress markers after short-term use of a high-dose statin in patients with atherosclerotic stroke. METHODS: Rosuvastatin was administered at a dose of 20 mg/day to 99 patients who had suffered an atherosclerotic stroke and no prior statin use. Blood samples were collected before and 1 month after dosing, and the serum levels of four oxidative stress markers-malondialdehyde (MDA), oxidized LDL (oxLDL), protein carbonyl content (PCO), and 8-hydroxy-2'-deoxyguanosine (8-OHdG)-were evaluated to determine the oxidation of MDA and lipids, proteins, and DNA, respectively, at both of those time points. RESULTS: The baseline levels and the degrees of reduction after statin use differed among the oxidative stress markers measured. MDA and PCO levels were associated with infarct volumes on diffusion-weighted imaging (r=0.551, p<0.05, and r=0.444, p=0.05, respectively). Statin use decreased MDA and oxLDL levels (both p<0.05) but not the PCO or 8-OHdG level. While the reduction in MDA levels after statin use was not associated with changes in cholesterol, that in oxLDL levels was proportional to the reductions in cholesterol (r=0.479, p<0.01), LDL (r=0.459, p<0.01), and apolipoprotein B (r=0.444, p<0.05). CONCLUSIONS: The impact of individual oxidative stress markers differs with time after ischemic stroke, suggesting that different oxidative markers reflect different aspects of oxidative stress. In addition, short-term use of a statin exerts antioxidant effects against lipid peroxidation via lipid-lowering-dependent and -independent mechanisms, but not against protein or DNA oxidation in atherosclerotic stroke patients.
Antioxidants* ; Apolipoproteins ; Atherosclerosis ; Brain Injuries ; Cholesterol ; Coenzyme A ; DNA ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Lipid Peroxidation ; Lipoproteins ; Oxidative Stress ; Oxidoreductases ; Stroke ; Rosuvastatin Calcium

BACKGROUND: Primary angiitis of the central nervous system (PACNS) is a rare disorder and is often difficult to diagnose due to the lack of a confirmatory test. PACNS can generally be diagnosed based on typical angiographic findings. We describe herein a patient diagnosed with PACNS despite the presence of normal findings on conventional angiography. CASE REPORT: A 44-year-old man with a recent history of ischemic stroke in the right posterior cerebral artery territory developed acute-onset vertigo. Diffusion-weighted imaging revealed an acute infarction within the left posterior inferior cerebellar artery. His medical history was unremarkable except for hyperlipidemia; the initial examination revealed mild gait imbalance. During the 10 days of hospital admission, the patient experienced four recurrent ischemic strokes within the posterior circulation territory (occipital lobe, pons, and cerebellum). He was diagnosed with recurrent cerebral infarctions due to PACNS. The basilar artery exhibited no demonstrable luminal stenosis, but there were direct imaging signs of central nervous system angiitis including wall thickening and contrast enhancement. High-dose intravenous steroid therapy followed by oral prednisolone was administered. There was no further stroke recurrence and follow-up imaging of the arterial walls showed normalization of their characteristics. CONCLUSIONS: The present case emphasizes the importance of wall imaging in the diagnosis and treatment of PACNS.
Adult ; Angiography ; Arteries ; Basilar Artery ; Central Nervous System* ; Cerebral Infarction ; Constriction, Pathologic ; Diagnosis* ; Follow-Up Studies ; Gait ; Humans ; Hyperlipidemias ; Infarction ; Inflammation ; Magnetic Resonance Imaging* ; Phenobarbital ; Pons ; Posterior Cerebral Artery ; Prednisolone ; Recurrence ; Stroke ; Vasculitis* ; Vasculitis, Central Nervous System ; Vertigo