Objective To present the experience of diagnosis and treatment of 21 cases of retrocaval ureter. Methods 21 cases of retrocaval ureter were retrospectively analysed. Results The main clinical symptom was right waist pain in 20 cases,4 of them with typical renal colic.8 cases had gross hematuria and calculus in the renal pelvis.1 case was void of symptom.The diagnosis of the disease depended mainly on intravenous urography (IVU) and retrograde ureteropyelography (RGU).IVU and RGU showed a "S" shaped upper ureteral segment with dilatation. Ureteral replacement and ureteroplasty were carried out in 20 cases which have been followed up from 2 months to 28 years with an average of 13 years.The symptom disappeared in 19 cases,with hydronephrosis and hydroureter significantly reduced on IVU and ultrasonography.1 case underwent ureteral reanastomosis because of stenosis at anastomosis site. Conclusions In patients with hydronephrosis and hydroureterosis of upper segment on the right side,the possibility of retrocaval ureter should be considered.Intravenous urography and retrograde ureteropyelography are the main means of diagnosis.Ureteral replacement and ureteroplasty are the treatment of choice.

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.

AIM: To establish the quality standard of Shajun Zhiyang Lotion (Radix Sophorae Flavescentis, Cortex Phellodendri Chinensis, Fructus Cnidii, Borneolum Syntheticum, etc.). METHODS: Cortex Phellodendri Chinensis and Fructus Cnidii and Borneolum Syntheticum were identified by TLC. The content of matrine was determined by HPLC. RESULTS: TLC identification was highly specific and the sports were clear. The linear range for matrine was in the range of 0.295 3-2.362 0 ?g and its average recovery was 100.38% and RSD was 1.5%, respectively. CONCLUSION: The quality of Shajun Zhiyang Lotion could be controlled effectively according to the quality standard.

Objectives To investigate the practical application of modified peritoneal equilibration test (modified PET) employing 4.25% glucose exchange in peritoneal dialysis patients and to assess the reference values and clinical significance of the test. Methods Modified PETs were performed in 97 patients without peritonitis for at least 4 weeks. Mass transfer area coefficient (MTAC) was calculated according to the Garred model. Creatinine D/P concentration ratio at 4 hr (4 h D/Pcr), sodium D/P concentration ratio at 1 hr (1 h D/PNa+) and net ultrafiltration (nUF) were also assessed. Ultrafiltration 0.05). 4 h D/Pcr and MTACcr of modified PET were significantly correlated with 4h D/Pcr of standard PET (P

Objective To obtain information on the application value of percutaneous epididymal sperm aspiration(PESA) and percutaneous testicle sperm aspiration(PTSA) in the differentiating diagnosis of obstructive and nonobstructive azoospermia.Methods Sperm recovery procedures were done in infertile men with obstructive azoospermia(OA)(n=37) and nonobstructive azoospermia(NOA)(n=28) by PESA or PTSA.Cytological smears were analysed.Results Sperm was found in the 32 epididymides and 5 testicles of OA group and in the 7 epididymides and 11 testicles of NOA group.Sperm counts were significantly different in two groups.Conclusion PESA and PTSA are efficient methods in differentiating OA and NOA.

Objective To measure the expression of activin receptor-like kinases 1(ALK1)in dermal fibroblasts from patients with systemic scleroderma(SSc)and to estimate its role in the production of fibronectin and plasminogen activator inhibitor-1(PAI-1).Methods Dermal fibroblasts were isolated from the lesions of 12 patients with SSc as well as the normal skin of 14 healthy controls,and subjected to a primary culture.The third-passage fibroblasts were used in the next experiment.Western blot and indirect immunofluorescence technique were utilized to quantify the expression of ALK1.A specific siRNA targeting ALK1 was designed,constructed,and transiently transfected into the control dermal fibroblasts,which were then classified into 2 groups to be cultured with or without the presence of transforming growth factor(TGF)-β1 for 72 hours followed by the detection of fibronectin and PAI-1 expression with Western blot.Results As Western blot and direct immunofluorescence technique showed,both control and SSc fibroblasts showed an expression of ALK1 in the cytoplasm and membrane,and the expression intensity of ALK1 in SSc fibroblasts was significantly higher than that in the control fibroblasts(1.97 ± 0.05 vs.1.12 ± 0.03,t =50.96,P ＜ 0.05).The expression of ALK1,fibronectin and PAI-1 was decreased by 90％,58％ and 31％ respectively in specific siRNA-transfected SSc fibroblasts compared with the control siRNA-transfected fibroblasts.TGFβ1 significantly increased the expression of ALK1,fibronectin and PAI-1 in the control siRNA-transfected fibroblasts,but the increase was markedly inhibited by the siRNA-targeting ALK1.Conlusion TGFβ1 can promote the production of fibronectin and PAI-1 via ALK1 in fibroblasts,and ALK1 may be involved in the development of sclerosis in SSc.

Objective To investigate the impact of calcium phosphate crystals induced by uremic serum on calcification of human aortic smooth muscle cells (HASMCs).Methods Uremic serum was incubated at 37℃ for 3 days.Calcium phosphate crystals and uremic supernatant were isolated from uremic serum by uhracentrifugation.Scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDX) were performed for analysis of morphological and chemical characteristics of the crystals.HASMCs were treated in vitro with control medium,uremic serummedium,calcium phosphate crystals-medium and uremic supernatant-medium.Calcification was visualizcd by Alizarin red staining.Calcium loads in cells were quantified by o-cresolphthalein complexone method.Gene expression of bone morphogenetic protein-2 (BMP-2),osteopontin (OPN) and core-binding factor α1 (Cbfα1),alkaline phosphate (ALP) and matrix gamma carboxyglutamic acid protein (MGP) were quantified by real-time PCR.Cbfα1,OPN and BMP-2 protein levels were determined by Western blotting or ELISA.Results Calcium phosphate crystals which induced by uremic serum displayed laminated shapes containing crystallized needle-like projections and ranged from 30-500 nm,with Ca/P ratios of 1.41 ±0.05.Compared with the cells in control group,uremic serum induced HASMCs calcification,increased calcium loads (P ＜ 0.05),up-regulated BMP-2,OPN,Cbfα1 mRNA and protein expression (all P＜ 0.01).Similar to uremic serum,calcium phosphate crystals also induced HASMCs calcification,increased calcium loads (P＜0.05),and up-regulated BMP-2,OPN,Cbfα1 mRNA and protein expression (all P ＜ 0.01).However,there was no significant difference between HASMCs growing in uremic supernatant and control medium in calcium loads or the expression levels of these osteogenic proteins (P ＞ 0.05).Conclusions Calcium phosphate crystals induced by uremic serum promote HASMCs calcification,which might be one of the mechanisms of uremic vascular calcification.

Objective To compare the outcomes of patients starting peritoneal dialysis (PD)within two weeks and more than two weeks after catheter implantation.Methods All the patients undergoing Tenckhoff catheter implantation and initiating PD in Renji Hospital from January 2001 to December 2010 were enrolled in the study.Patients started PD within 2 weeks after catheter insertion were defined as urgent group,and those started PD 2 weeks later were defined as planned group.Kaplan-Meier curves and Log-rank tests were used to compare outcomes between two groups.Results Among 657 patients in this study,median break-in period was 6 days of 469 (71.4％)patients in urgent group and 26 days of 188 (28.6％) patients in planned group.Compared to planned group,patients of urgent group were younger [(52.6± 17.3) vs (56.1± 15.3) year,P =0.017],had less eGFR [(5.36±2.03) vs (6.50±2.50) ml· min-1 · (1.73 m2)-1,P ＜ 0.01],lower serum albumin [(34.0±5.7) vs (36.2±5.9) g/L,P ＜ 0.01] and hemoglobin [(76.9± 18.8) vs (80.8 ± 17.9) g/L,P =0.018],and higher phosphate [(2.19±0.67) vs (1.98±0.52) mmol/L,P＜ 0.01].Urgent group presented more catheter dysfunctions needed to transfer to hemodialysis (2.1％ vs 0％,P =0.044).The 1-,2-,3-and 5-year technique survival rates of urgent and planned group were 94％ vs 98％,92％ vs 94％,90％ vs 92％and 86％ vs 85％ respectively.There was no significant difference in technique survival (Log-rank =1.536,P =0.22) and peritonitis-free survival (Log-rank =0.035,P =0.85) between two groups.The 1-,2-,3-and 5-year patient survival rates of urgent and planned group were 90％ vs 95％,81％ vs 90％,74％ vs 79％ and 67％ vs 74％ respectively,and no significant difference was found (Log-rank =2.364,P =0.12).Conclusions Although patients needing urgent initial PD have poorer residual renal function and nutritional condition compared to those of planned initial PD,their outcomes are similar.Peritoneal dialysis may be a feasible and safe dialysis modality for patients who need urgent start.

Objective To observe the clinical efficacy of HMME-SDT therapy for the treatment of hypertrophic scar (HS) of rabbit ear.Methods 60 white rabbits were randomly divided into five groups.The model group and HMME-SDT treatment group were used to establish the models of hypertrophic scar in ears.Results The effect of HMME-SDT on the fibroblastic density in the hypertrophic scarring models was observed in rabbit ears.The HMME-SDT could lower the fibroblastic density,compared with the model group,with significant difference (P＜ 0.05).The effect of HMME-SDT on the collagen area density was noted in the hypertrophic scarring models in rabbit ears.The HMME-SDT could lower the collagen area density,compared with the model group,with significant difference from the fourth week of the epithelialization (P＜0.01).Conclusions HMME is an effective sonosensitizer.HMME-SDT can significantly inhibit hypertrophic scar of rabbit ear.

Objective To investigate the association between angiopoietin-2 (Angpt-2) and peritoneal angiogenesis in a uremic peritoneal dialysis (PD) rat model. Methods Uremic (subtotal nephrectomy) rats were established and divided into non-PD, 10 d-PD, 28 d-PD and 56 d-PD groups. Standard PD solution was applied in the study. Rats undergone sham operation without PD were used as control group. Vessel density of the peritoneum was detected and quantified with anti-CD31 immunohistochemical staining. Expressive levels of Angpt-2 and vascular endothelial growth factor (VEGF) were examined in the peritoneum by real-time PCR and Western blotting. Results The non-PD group was characterized by increased vessel density in the peritoneum compared with that of the control group [(5±3)/HP vs (1±1)/HP]. Progressive angiogenesis was found in 10 d-PD, 28 d-PD and 56 d-PD groups [(10±5)/HP, (17±5)/HP, (19±4)/HP]. Furthermore, expressive levels of Angpt-2 and VEGF increased significantly in the non-PD group compared with the control (P<0.01), and such expressions were significantly higher in the PD groups as compared to non-PD group (P<0.01), but no difference was found among the PD groups. Both VEGF and Angpt-2 levels were positively correlated with vessel density(r=0.7756, P<0.01; r=0.5223, P<0.05). Conclusions Uremia and PD promote peritoneal angiogenesis in rats. Increased expression level of Angpt-2 in peritoneum is positively correlated with peritoneal angiogenesis. Angpt-2 may be a new therapeutic target of peritoneal angiogenesis.