PURPOSE:The stenosis of vascular access for hemodialysis is caused by neointimal hyperplasia with the proliferation of vascular smooth muscle cells (SMC) as a prominent feature. C-reactive protein (CRP) is known to be produced in vascular SMC and can promote SMC proliferation. However, it is unclear of which factors regulate CRP production in neointimal hyperplasia. In the present study, we evaluated the factors affecting production of CRF in aortic SMC. METHODS:Human aortic SMC were cultured in a American type culture collection (ATCC) medium containing 10% FBS. Platelet-derived growth factor (PDGF) (10, 100 ng/mL), interferon-gamma(INF-gamma (1, 10, 100 ng/mL), hydroxymethylglutaryl-coA reductase inhibitor (lovastatin) (10 ?M/L) were added. After 72 hours, the level of CRP in SMC was measured by Western blot analysis and cell proliferation was assessed by MTT dye reduction assay. We used RT-PCR to observe PDGF receptor expression in SMC. RESULTS:Both INF-gammaand PDGF were found to stimulate CRP production and SMC proliferation. In contrast, lovastatin inhibited PDGF or INF-gammainduced CRP production and SMC proliferation. The expression of PDGF receptor-alphain aortic SMC was increased after treatment of 100 ng/mL of IFN-gamma CONCLUSION:SMC proliferation and CRP production in SMC are stimulated by PDGF or INF-gammaand inhibited by statin.
Acyl Coenzyme A ; Blotting, Western ; C-Reactive Protein ; Cell Proliferation ; Constriction, Pathologic ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperplasia ; Interferon-gamma ; Lovastatin ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Oxidoreductases ; Platelet-Derived Growth Factor ; Receptors, Platelet-Derived Growth Factor ; Renal Dialysis

BACKGROUND: Peritoneal fibrosis is one of the major causes of technical failure in patients on peritoneal dialysis. Epithelial-to-mesenchymal transition (EMT) of the peritoneum is an early and reversible mechanism of peritoneal fibrosis. Human peritoneal mesothelial cells (HPMCs) have their own renin-angiotensin-aldosterone system (RAAS), however, it has not been investigated whether aldosterone, an end-product of the RAAS, induces EMT in HPMCs, and which mechanisms are responsible for aldosterone-induced EMT. METHODS: EMT of HPMCs was evaluated by comparing the expression of epithelial cell marker, E-cadherin, and mesenchymal cell marker, alpha-smooth muscle actin after stimulation with aldosterone (1-100nM) or spironolactone. Activation of extracellular signal-regulated kinase (ERK)1/2 and p38 mitogen-activated protein kinase (MAPK) and generation of reactive oxygen species (ROS) were assessed by western blotting and 2',7'-dichlorofluororescein diacetate staining, respectively. The effects of MAPK inhibitors or antioxidants (N-acetyl cysteine, apocynin, and rotenone) on aldosterone-induced EMT were evaluated. RESULTS: Aldosterone induced EMT in cultured HPMCs, and spironolactone blocked aldosterone-induced EMT. Aldosterone induced activation of both ERK1/2 and p38 MAPK from 1 hour. Either PD98059, an inhibitor of ERK1/2, or SB20358, an inhibitor of p38 MAPK, attenuated aldosterone-induced EMT. Aldosterone induced ROS in HPMCs from 5 minutes, and antioxidant treatment ameliorated aldosterone-induced EMT. N-acetyl cysteine and apocynin alleviated activation of ERK and p38 MAPK. CONCLUSION: Aldosterone induced EMT in HPMCs by acting through the mineralocorticoid receptor. Aldosterone-induced generation of ROS followed by activation of ERK, and p38 MAPK served as one of the mechanisms of aldosterone-induced EMT of HPMCs.
Actins ; Aldosterone* ; Antioxidants ; Blotting, Western ; Cadherins ; Cysteine ; Epithelial Cells ; Humans ; p38 Mitogen-Activated Protein Kinases ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Peritoneum ; Phosphotransferases ; Protein Kinases ; Reactive Oxygen Species ; Receptors, Mineralocorticoid ; Renin-Angiotensin System ; Spironolactone

Systemic multiple aneurysms are rare, and an association between intracranial and visceral arterial or abdominal aortic aneurysm in the same patient is a very rare occurrence. We report herein three such cases. In one case, aneurysms of the right internal carotid artery(ICA) and the right middle cerevral arterial bifurcation(MCAB) coexisted with the inferior pancreaticoduodenal arterial pseudoaneurysm and two ileal arterial aneurysms. In another case, the patient had the A-com arterial aneurysm and the right renal arterial aneurysm. And in the other patient, he had the right vertebral artery dissecting aneurysm with the abdominal aortic aneurym. Initially, all patients were referred to our hospital with subarachnoid hemorrhage(SAH), and thereafter first two patients developed visceral arterial aneurysm rupture in the course of hospital stay and in the last patient, the abdominal aortic aneurysm was detected incidentally during carotid angiogram for Guglielmi detachable coil(GDC) embolization of vertebral dissecting aneurym. After thorough review of our cases together with pertinent literatures, we emphasize the possibility of underlying extracranial aneurysms in ruptured intracranial arterial aneurysm patient and it's uncommon but fatal complication.
Aneurysm* ; Aneurysm, Dissecting ; Aneurysm, False ; Aortic Aneurysm, Abdominal ; Humans ; Length of Stay ; Rupture ; Vertebral Artery

OBJECTIVE: Ultrasound can be used in the treatment of large intracerebral hematoma. The authors present our experiences with Ultrasound-guided catheter placement for lysis and drainage of ganglionic hematoma, with emphasis on technical aspects. METHODS: The authors applied real-time ultrasonography for the aspiration of intracerebral hematoma in 6cases. Ultrasound-guided aspiration via a burrhole was performed under local anesthesia. We selected a temporal entry point instead of the frequently used precoronal approach in ganglionic hematoma. A burrhole was made 4 to 6cm posterior from posterior border of frontal process of the zygomatic bone at the level of 4 to 5cm above the external auditory meatus. RESULTS: In all patients, the catheter was placed accurately into the hematoma target. All patients were irrigated with urokinase once to three times a day. The catheter could be removed within two or three days. The mean hematoma volume was reduced from initially 32mL to 5mL in an average of two days. There were no intraoperative complications related to the use of real-time ultrasonography and no postoperative infections were noted. CONCLUSION: Ultrasound allows an easy and precise localization of the hematoma and the distance from the surface to the target can be calculated. Ultrasound-guided catheter placement for fibrinolysis and hematoma drainage is a simple and safe procedure.
Anesthesia, Local ; Basal Ganglia* ; Catheters ; Cerebral Hemorrhage* ; Drainage ; Fibrinolysis ; Ganglion Cysts ; Hematoma ; Humans ; Intraoperative Complications ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator

Female phenotype of a 46,XY male may originates from male pseudohermaphroditism due to 17alpha-hydroxylase deficiency. Lack of cortisol increases adrenocorticotropic hormone (ACTH) and mineralocorticoid production, leading to low renin hypertention and hypokalemia. A 41-year-old phenotypic female presented primary amenorrhea and hypertension. In the hormonal profile, the levels of serum estradiol, testosterone, rennin, and cortisol were decreased and ACTH and deoxycorticosterone were increased. Laparoscopic bilateral gonadectomy was performed, and corticosteroid, antihypertensive drugs, and estrogen were administered. We report this case with a brief review of the literatures.
46, XY Disorders of Sex Development* ; Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Adult ; Amenorrhea ; Antihypertensive Agents ; Chymosin ; Desoxycorticosterone ; Estradiol ; Estrogens ; Female ; Humans ; Hydrocortisone ; Hypertension ; Hypokalemia ; Male* ; Phenotype ; Renin ; Testosterone

PURPOSE: Icodextrin in peritoneal cavity is absorbed via the lymphatics to the blood and metabolized to maltose and maltriose which may interfere with correct measurement of glucose. In an attempt to evaluate the effects of icodextrin on the erroneous results of blood glucose, we measured blood glucose by different methods. METHODS: Peripheral capillary blood and venous blood were obtained from 12 patients using icodextrin and from 12 patients not using icodextrin. Venous blood glucose was measured by using the laboratory technique (glucose oxidase method), and capillary blood glucose was measured by using a Surestep (glucose oxidase method) and an Acucheck (GDH-PQQ method). To estimate icodextrin and its metabolites indirectly, we calculated osmolal gap. We measured blood icodextrin and its metabolites with amyloglucosidase in icodextrin group. RESULTS: In icodextrin group, glucose was overestimated in the results of the GDH-PQQ method (delta= GDH-GOD=56.2+/-30 mg/dL [vein] 58+/-32 mg/dL [capillary]), but in the control group, there were no significant differences in the results between the glucose oxidase method and the GDH-PQQ method. There was a correlation between the osmolal gap and the differences in the results (delta=GDH-GOD) (r=0.741, p=.006 [vein], r=0.671, p=.017 [capillary]). Blood icodextrin and its metabolites were related with the differences in the results (delta=GDH-GOD) (p=.026, r=0.635), but there was no significant correlation between the osmolal gap and the icodextrin and its metabolites (p=0.086, r=0.515). CONCLUSION: Icodextrin and its metabolites may lead to erroneously high blood glucose levels when measured by GDH-PQQ method. It is necessary to be aware of this factor in order to prevent overlooking dangerous hypoglycemia.
Blood Glucose* ; Capillaries ; Glucan 1,4-alpha-Glucosidase ; Glucose ; Glucose Oxidase ; Humans ; Hypoglycemia ; Maltose ; Oxidoreductases ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory*

OBJECTIVE: To investigate the effects of female age on in vitro maturation and fertilization of immature oocytes from controlled ovarian hyperstimulation (COH) in human IVF-ET program. METHOD: A total of 96 immature oocytes (GV & metaphase I) obtained from 40 cycles of IVF-ET (29 patients). The mean age of female patients was 31.8+/-3.1 years. Ovulation was triggered by urinary or recombinant hCG. Immature oocytes were cultured with YS medium containing 30% of patients' human follicular fluids, LH (1 IU/mL), FSH (1 IU/mL) and EGF (10 ng/mL), and then matured oocytes were fertilized by ICSI. In vitro maturation and fertilization of immature oocytes were analyzed according to age of female (< 34 or > or = 34 years). RESULTS: The maturation rate was similar between two groups (68% vs 64%). The fertilization rate of in?vitro-matured oocytes was higher in patients < 34 years old, but there was no statistical significance (64% vs 50%, p=0.347). The fertilization rate of in-vitro-matured oocytes was significantly lower compared with those of in-vivo-matured oocytes in both age groups (64% vs 79%, p=0.035, 50% vs 86%, p=0.007). CONCLUSION: In older female group, fertilization rate of in-vitro-matured oocytes seems to be decreased. Further investigations should be warranted to increase fertilization potential of in-vitro-matured oocytes.
Adult ; Epidermal Growth Factor ; Female ; Fertilization* ; Follicular Fluid ; Humans* ; Metaphase ; Oocytes* ; Ovulation ; Sperm Injections, Intracytoplasmic

We encountered one case of Chinese Herb Nephropathy in Korea. But clinical feature of our case was different from those of CHN in Belgium. The purpose of this case report was clarified the features of CHN in Asia. The subjects consisted of a patient diagnosed as interstitial nephritis in Hanyang University Hospital and of those reported in the literature in Asia and Belgium. We investigated the clinical and histological features of CHN patients in Asia and compared them with the Belgian cases. The remarkable differences were as follows; (1) relatively high prevalence in males compared with Belgian cases, (2) digestion with multiple object and mode in Asia, (3) Most of renal failure in Asia were improved or were in stable status. (4) Fanconi's syndrome was found in most cases of Asia. In conclusion, CHN in Asia has some characteristics distinguished from Belgian Chinese Hreb Nephropathy. These findings could indicate that susceptibility to aristolochic acid may be different among races. Furthermore, it is likely that different components of AA could cause different features, that the amount of ingested AA, mode in digestion, or interaction with other components except nephrotoxic agent such as AA might reflect clinical pictures. Other hypothesis may be some other toxic substances affecting the clinical findings although they are not identified at present. Further studies must be undertaken to clarify these differences.
Asia ; Asian Continental Ancestry Group* ; Belgium ; Continental Population Groups ; Digestion ; Humans ; Korea ; Male ; Nephritis, Interstitial ; Prevalence ; Renal Insufficiency

PURPOSE: Recently, many studies have investigated that Methylenetetrahydrofolate Reductase (MTHFR) polymorphism may be not a only cause for hyperhomocysteinemia, but also an independent risk factor for cardiovascular disease or atherosclerosis in renal failure patients. In this study, we analyzed MTHFR polymorphisms in chronic renal failure (CRF) patients, and investigated relationship between MTHFR polymorphism and peripheral atherosclerosis. METHODS: One hundred twenty eight CRF patients with GFR < 30 mL/min were enrolled. We analyzed their MTHFR polymorphism by standard PCR/restriction fragment length polymorphism and measured their ankle brachial index (ABI) using blood pressure cuff and Doppler stethoscope. Plasma homocysteine, vitamin B12, and folic acid levels were measured. 170 healthy peoples were enrolled for control group. RESULTS: The distribution of MTHFR 677 polymorphism of CRF patients was as follows: CC genotype, 33.6%; CT, 47.7% and TT 18.7%. Plasma homocysteine concentration was higher in TT group than in CC group (p < 0.05). The distribution of MTHFR 1298 polymorphism of CRF patients was as follows: AA type, 63.78%; AC, 33.07% and CC 18.7%. The distributions of MTHFR polymorphisms in control group were not different from patients group, respectively. There was no definite correlation between ABI and plasma homocysteine concentration. A trend of lower ABI in TT type compared with CC type within CRP patients group, but no statistical significance was shown. CONCLUSIONs: No difference of the distribution of MTHFR polymorphism was noted between CRF patients and healthy population. In CRF patients, MTHFR C677T mutation was closely associated with hyperhomocysteinemia, but both did not significantly influence to peripheral arterial disease.
Ankle Brachial Index ; Atherosclerosis* ; Blood Pressure ; Cardiovascular Diseases ; Folic Acid ; Genotype ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Kidney Failure, Chronic* ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Plasma ; Renal Insufficiency ; Risk Factors ; Stethoscopes ; Vitamin B 12

BACKGROUND: Vascular access failure, a major cause of morbidity in hemodialysis (HD) patients, occurs mainly at stenotic endothelium following an acute thrombotic event. Microparticles (MPs) are fragments derived from injured cell membrane and are closely associated with coagulation and vascular inflammatory responses. METHODS: We investigated the relationship between levels of circulating MPs and vascular access patency in HD patients. A total of 82 HD patients and 28 healthy patients were enrolled. We used flow cytometry to measure endothelial MPs (EMPs) identified by CD31+CD42- or CD51+ and platelet-derived MPs (PMPs) identified by CD31+CD42+ in plasma samples of participants. Vascular access patency was defined as an interval from the time of access formation to the time of first access stenosis in each patient. MP counts were compared according to access patent duration. RESULTS: The levels of EMP (both CD31+CD42- and CD51+) and CD31+CD42+PMP were significantly higher in patients than in healthy participants. Levels of CD31+CD42-EMP and CD31+CD42+PMP showed a positive correlation. In nondiabetic HD patients, CD31+CD42-EMPs and CD31+CD42+PMPs were more elevated in the shorter access survival group (access survival <1 year) than in the longer survival group (access survival > or = 4 years). CONCLUSION: Elevated circulating EMP or PMP counts are influenced by end-stage renal disease and increased levels of EMP and PMP may be associated with vascular access failure in HD patients.
Blood Platelets ; Cell Membrane ; Constriction, Pathologic ; Endothelial Cells ; Endothelium ; Flow Cytometry ; Humans ; Kidney Failure, Chronic ; Plasma ; Renal Dialysis