1.Therapeutic effect of microencapsulated porcine retinal pigmented epithelial cells transplantation on rat model of Parkinson's disease.
Hou-Liang ZHANG ; Jian-Jun WU ; Hui-Min REN ; Jian WANG ; Ya-Ru SU ; Yu-Ping JIANG
Neuroscience Bulletin 2007;23(3):137-144
OBJECTTo investigate the therapeutic effect of microencapsulated porcine retinal pigmented epithelial cells (RPE-M) transplantation on rat model of Parkinson's disease (PD).
METHODSPrimary porcine RPE cells were harvested by enzyme digestion and expanded in culture medium. Determine the levels of dopamine (DA) and homovanillic acid (HVA) by high performance liquid chromatography electrochemical (HPLC) assay, and the levels of brain-derived neurotrophic factor (BDNF) and glial-derived neurotrophic factor (GDNF) were detected by ELISA. Alginate-polylysine-alginate (APA) microencapsulated cells were produced by using a high voltage electrostatic system. PD rat model was established by unilateral injection of 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle (MFB). After that, the RPE-M was transplanted into the corpus striatum of PD rat, and then the rotation test scores were recorded and biochemical changes of the corpus striatum were tested.
RESULTSThe levels of DA, HVA, BDNF and GDNF secreted by RPE were stable in the RPE culture supernatant and were not changed by the microencapsulation. Eighty-three percent rats developed PD by unilateral lesion of 6-OHDA in the MFB. The RPE-M transplantation had therapeutic effect on 33% PD rats.
CONCLUSIONPorcine RPE cells grow actively in vitro and could secrete DA, HVA, BDNF, and GDNF constantly, which does not be affected by the passage culture and the APA miroencapsulation. RPE-M transplantation of may be a curative therapy for PD.
Adrenergic Agents ; toxicity ; Animals ; Brain-Derived Neurotrophic Factor ; metabolism ; Cell Transplantation ; methods ; Cells, Cultured ; Disease Models, Animal ; Dopamine ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; metabolism ; transplantation ; Glial Cell Line-Derived Neurotrophic Factor ; metabolism ; Male ; Oxidopamine ; toxicity ; Parkinson Disease ; etiology ; surgery ; Rats ; Rats, Sprague-Dawley ; Retina ; cytology ; Swine ; anatomy & histology ; Time Factors ; Transplantation, Heterologous ; methods ; Tyrosine 3-Monooxygenase ; metabolism
2.Overexpression of lentivirus-mediated glial cell line-derived neurotrophic factor in bone marrow stromal cells and its neuroprotection for the PC12 cells damaged by lactacystin.
Ya-Ru SU ; Jian WANG ; Jian-Jun WU ; Yan CHEN ; Yu-Ping JIANG
Neuroscience Bulletin 2007;23(2):67-74
OBJECTIVETo construct recombinant lentiviral vectors for gene delivery of the glial cell line-derived neurotrophic factor (GDNF), and evaluate the neuroprotective effect of GDNF on lactacystin-damaged PC12 cells by transfecting it into bone marrow stromal cells (BMSCs).
METHODSpLenti6/V5-GDNF plasmid was set up by double restriction enzyme digestion and ligation, and then the plasmid was transformed into Top10 cells. Purified pLenti6/V5-GDNF plasmids from the positive clones and the packaging mixture were cotransfected to the 293FT packaging cell line by Lipofectamine2000 to produce lentivirus, then the concentrated virus was transduced to BMSCs. Overexpression of GDNF in BMSCs was tested by RT-PCR, ELISA and immunocytochemistry, and its neuroprotection for lactacystin-damaged PC12 cells was evaluated by MTT assay.
RESULTSVirus stock of GDNF was harvested with the titer of 5.6 x 100,000 TU/mL. After transduction, GDNF-BMSCs successfully secreted GDNF to supernatant with higher concentration (800 pg/mL) than BMSCs did (less than 100 pg/mL). The supernatant of GDNF-BMSCs could significantly alleviate the damage of PC12 cells induced by lactacystin (10 micromol/L).
CONCLUSIONOverexpression of lentivirus-mediated GDNF in the BMSCs cells can effectively protect PC12 cells from the injury by the proteasome inhibitor.
Acetylcysteine ; analogs & derivatives ; pharmacology ; Animals ; Bone Marrow Cells ; cytology ; metabolism ; Cells, Cultured ; Culture Media, Conditioned ; metabolism ; DNA, Recombinant ; Genetic Therapy ; methods ; Genetic Vectors ; Glial Cell Line-Derived Neurotrophic Factor ; genetics ; metabolism ; Lentivirus ; genetics ; Neurons ; drug effects ; Neuroprotective Agents ; metabolism ; PC12 Cells ; drug effects ; Plasmids ; genetics ; Protease Inhibitors ; pharmacology ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Stromal Cells ; Transduction, Genetic ; methods
3.Zhuanggu Jianxi Decoction () limits interleukin-1 β-induced degeneration chondrocytes via the caveolin-p38 MAPK signal pathway.
Hu YAN ; You-xin SU ; Xue-yi LIN ; Bao-jun CHEN ; Qing ZHANG ; Zi-yi ZHANG ; Yi-ru WANG ; Ya-nan LI ; Mei-li LU ; Zhen HE ; Lu SHENG ; Wen-ting WANG
Chinese journal of integrative medicine 2014;20(5):353-359
OBJECTIVETo evaluate the effect of Zhuanggu Jianxi Decoction (, ZGJXD) on interleukin-1 β (IL-1 β)-induced degeneration of chondrocytes (CDs) as well as the activation of caveolin-p38 mitogen-activated protein kinase (MAPK) signal pathway, investigating the possible molecular mechanism that ZGJXD treats osteoarthritis.
METHODSSerum pharmacology was applied in the present study, where ZGJXD was orally administrated to New Zealand rabbits and then ZGJXD containing serum (ZGJXD-S) was collected for following in vitro experiments. CDs were isolated aseptically from New Zealand rabbits and then cultured in vitro. Upon IL-1 β stimulation, the degeneration of CDs was verified by inverted microscope, toluidine blue stain and type II collagen immunocytochemistry. After IL-1 β-stimulated CDs were intervened with blank control serum, ZGJXD-S, together with or without SB203580 (a specific inhibitor of p38 MAPK) for 48 h, caveolin-1 protein expression and the phosphorylation level of p38 were determined by Western blotting, and the mRNA expression of IL-1 β, tumor necrosis factor α (TNF-α), matrix metalloproteinase 3 (MMP-3) and MMP-13 were examined by real-time polymerase chain reaction.
RESULTSIL-1 β stimulation induced degeneration of CDs, increased caveolin-1 expression and p38 phosphorylation, up-regulated the mRNA level of IL-1 β, TNF-α, MMP-3 and MMP-13. However, the IL-1 β-induced activation of caveolin-p38 signaling and alteration in the expression of p38 downstream target genes were suppressed by ZGJXD-S and/or SB203580 in CDs.
CONCLUSIONZGJXD can prevent CDs degeneration via inhibition of caveolin-p38 MAPK signal pathway, which might be one of the mechanisms that ZGJXD treats osteoarthritis.
Animals ; Base Sequence ; Blotting, Western ; Caveolins ; metabolism ; Chondrocytes ; drug effects ; enzymology ; metabolism ; DNA Primers ; Drugs, Chinese Herbal ; pharmacology ; Gene Expression Profiling ; Interleukin-1beta ; physiology ; MAP Kinase Signaling System ; Male ; RNA, Messenger ; genetics ; Rabbits ; p38 Mitogen-Activated Protein Kinases ; genetics ; metabolism
4.Research on the equity of Chinese medicine human resource allocation and its driving paths in China:An analysis based on fsQCA method
Yong-Yi GUAN ; Jing ZHAO ; Yun-Han SU ; Ya-Ru LI ; Xin-Ran WANG ; Xin-Yu LIU
Chinese Journal of Health Policy 2024;17(10):46-51
Objective:To analyze the equity of Traditional Chinese medicine(TCM)human resource allocation across 31 provinces in China and explore its influencing pathways,aiming to provide scientific reference for optimizing the allocation of TCM human resources.Methods:The Health Resource Density Index(HRDI)was employed to measure the equity of TCM human resource allocation in China,and the fuzzy-set qualitative comparative analysis(fsQCA)was utilized to explore the configurational pathways influencing this equity.Results:Based on the data from 2021,the HRDI of TCM human resources in China exhibited significant regional disparities,manifesting as a distribution pattern of"high in the east and low in the west."Three pathways promoting high equity were identified:the internal-external balance-driven pathway(H1),the economy-demand co-driven pathway(H2),and the government-led driving pathway(H3).Meanwhile,three pathways leading to low equity were also recognized:the economy-demand constraint pathway(L1)and the internal-external constraint pathways(L2、L3).Conclusion:There are notable regional disparities in the equity of TCM human resource allocation in China,with multiple factors jointly influencing this equity,among which population density serves as a core factor.In subsequent efforts to enhance equity,it is advisable to consider optimizing the synergies among multiple factors and implementing precise policies for different regions to promote efficient allocation and balanced development of TCM human resources.
5.Study on the status and related socio-psychological factors of maternal depression among high-risk pregnancy women in Harbin city.
Ya-chun XIE ; Hong-wei YUAN ; Ru-jin ZHUANG ; Cong-hui HAN ; Shu-hong LIU ; Su-fen CHEN ; Zhi-wei FU ; Zhi-ming WANG ; Su-zhen QIAO ; Lin GUO ; Hui-ying ZHANG
Chinese Journal of Preventive Medicine 2012;46(6):543-546
OBJECTIVEThis study aimed to investigate the depression status among high-risk pregnancy women, and to analyze its relevant social and psychological factors.
METHODSA total of 42 high-risk pregnancy women and 40 normal pregnancy women in a teaching hospital in Harbin city were followed up at time points of 32 - 36 weeks pregnancy, one week before labor, one week postpartum, and six weeks postpartum, respectively. During follow-up, the basic situation, social psychosocial factors of pregnancy women were collected and the depression of pregnancy women was measured by self-designed questionnaire and self-rating depression scale. The Edinburgh Postnatal Depression Scale (EPDS) was applied at timepoint of one week postpartum. Single factor analysis and the unconditional multivariate logistic regression were applied for analyzing the on the related social-psychosocial factors among high-risk pregnancy women.
RESULTSThe age of high-risk pregnancy women was (31.0±5.6), and the age of normal pregnancy women was (30.5±3.8) (t=0.169, P>0.05). The results showed that the depression rate in high-risk pregnancy women was 45.2% (19/42), which was 25.0% (10/40) in normal pregnancy women, the difference was significant (χ2=3.671, P=0.045). The depression rates at different time points were 30.9% (13/42), 42.9% (18/42), 23.8% (10/42), 26.2% (11/42) in high-risk pregnancy women respectively, and 25.0% (10/40), 15.0% (6/40), 20.0% (8/40), 17.5% (7/40) in the control group respectively, the difference of the depression rates among groups at one week before labor was significant (χ2=7.680, P<0.01), the difference among groups at 32-36 weeks pregnancy (χ2=0.133, P=0.80), at one week postpartum (χ2=0.174, P=0.79) and at six weeks postpartum (χ2=0.903, P=0.43) were not significant. At one week postpartum and six weeks postpartum periods, the EPDS depression rate were 12.5% (4/32), 30.4% (7/23) in case group respectively, 8.3% (3/36), 22.9% (8/35) in control group respectively, the difference were not significant (χ2=0.319, 0.416, P=0.573, 0.519). There were significantly associations between the depression mood of one week before labor and the depressive symptoms of six weeks postpartum in both groups (r=0.824, 0.677, both P values were <0.05). The risk factors for maternal depression among high-risk pregnancy women were not ready for production (OR=2.73, P<0.01) and fearing of childbirth safety (OR=2.89, P<0.01).
CONCLUSIONThe depression date of high-risk pregnancy was high, especially at the time point one week before labor. Risk factors of maternal depression among high-risk pregnancy were "not ready for production" and "fear of childbirth safety".
Adult ; China ; epidemiology ; Cohort Studies ; Depression ; epidemiology ; psychology ; Depression, Postpartum ; epidemiology ; psychology ; Female ; Humans ; Logistic Models ; Postpartum Period ; psychology ; Pregnancy ; Pregnancy Complications ; epidemiology ; psychology ; Pregnancy, High-Risk ; psychology ; Risk Factors
6.Improvement Effect and Its Mechanism of Marmesin on Cognitive Impairment in Mice with Alzheimer's Disease
Zhuang-Zhuang LIU ; Shi-Jie SU ; Hong-Ying YANG ; Hai-Xia DING ; Ya-Ru PAN ; Han CAI ; Lei-Jie LIN ; Wei-Rong LI ; Qi WANG
Journal of Guangzhou University of Traditional Chinese Medicine 2024;41(10):2758-2768
Objective To investigate the improvement effect and mechanism of marmesin on cognitive impairment in Alzheimer's disease(AD)mice.Methods Fifty mice were randomly divided into five groups:blank group,model group,low-and high-dose marmesin groups and donepezil(positive drug)group,with 10 mice in each group.After 21 days of continuous administration,except for the blank group,the mice in other groups were given intraperitoneal injection of scopolamine to establish the AD model.Network pharmacology was used to construct the protein-protein interaction(PPI)network of common targets of marmesin in the treatment of AD,and gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis were performed to provide further research direction.The cognitive function of AD model mice was evaluated by Morris water maze,open field test and new object recognition test.Nissl staining was used to observe the damage of hippocampal neurons.The levels of acetylcholine(Ach),acetylcholine transferase(ChAT),acetylcholinesterase(AChE),reactive oxygen species(ROS),malondialdehyde(MDA)and catalase(CAT)in hippocampus of mice were detected by kit.The protein expression levels of interleukin 6(IL-6),interleukin 1β(IL-1 β),tumor necrosis factor α(TNF-α),nuclear factor E2-related factor 2(NRF2),silent information regulator homologous protein 3(SIRT3),Kelch-like ECH-associated protein 1(KEAP1),quinone oxidoreductase 1(NQO1)and heme oxygenase 1(HO-1)in hippocampus were detected by Western Blot.Results Compared with the model group,the latency of Morris water maze test was significantly shortened in the high-dose marmesin group,the time of entering the target area in the open field new object test and the movement distance in the central area of the open field were prolonged,the number of neurons in the hippocampal CA1 and CA3 regions was significantly increased,the levels of ChAT and Ach in the hippocampus were significantly increased,AChE level was significantly decreased,CAT level was significantly increased,ROS and MDA levels were significantly decreased,TNF-α expression level was decreased,SIRT3 and HO-1 expression levels were increased,and KE AP1 protein expression level was decreased,the differences being statistically significant(P<0.05 or P<0.01 or P<0.001).Conclusion Marmesin can effectively improve the learning and memory impairment of AD mice,and its mechanism may be related to the activation of NRF2/SIRT3 signaling pathway,thereby alleviating oxidative stress level and neuroinflammation,and repairing cholinergic neuron function.
7.Research in technical regulations for production of pollution-free Chinese herbal medicines.
Lin-Lin DONG ; Li-Li SU ; Guang-Fei WEI ; Meng-Zhi LI ; Ya-Ru XU ; Huan-Huan WANG ; Shi-Lin CHEN
China Journal of Chinese Materia Medica 2018;43(15):3070-3079
Aimed to solve the issues of pesticide residue, heavy metal contents and harmful elements in the productive process of Chinese herbal medicines, the research team built the technical regulations for production of pollution-free Chinese herbal medicines. This regulation included the environment of production area, the process of production, quality of products etc., which were the key steps controlled the quality of Chinese herbal medicines. The environment of production area was selected according to the ecological factors which were stipulated by Ecological Suitability Regionalization of Chinese herbal medicines (second edition). The quality of air should be attain the one or two levels of GB/T3095-2012 standard values. The cultivation soils should reach to the one or two levels of GB15618 and NY/T391 standard values. The quality of irrigation water should accord with the stipulation of GB5084-2005. Aimed to the production of Chinese herbal medicines, disease-resistant and superior varieties which were suitable to the local stations should be selected, and the breeding of superior seeds and seedlings should be strengthened. Additionally, rational fertilizer application of pollution-free Chinese herbal medicines should be conformed to the principles, requirements, and the kinds of fertilizers allowed or limited for use, which were stipulated by the standard of DB13/T454. Furthermore, the plant protection policy of priority to prevention and synthetical prevention should be followed; improving ecological environment and strengthening cultivation management should be served as the basics. Agricultural measures, and biological and physical control strategies should be preferred to use; and high toxicity, residue pesticide and its mixture should be inhibited; the use of chemical pesticides should be minimized and then to decrease contamination and residue. Additionally, the quality of products should be reached to the standard of pollution-free Chinese herbal medicines; high toxicity and detection rate of pesticide residues and the contents of heavy metal and harmful elements (e.g. plumbum, cadmium, mercury, arsenic and cuprum) should accord with the common criteria of pollution-free Chinese herbal medicines. Application of technical regulations for production of pollution-free Chinese herbal medicines guarantees significantly social, economic and ecological benefits.
8. Clinical characteristics of invasive pulmonary aspergillosis in non-neutropenic patients
Ya-ru WANG ; Li-li HUANG ; Xian-ping YE ; Xin SU
Journal of Medical Postgraduates 2019;32(8):840-844
Objective In recent years, the incidence of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients has been increasing. Most previous studies have focused on the diagnosis and treatment of IPA in severely immunocompromised patients. The purpose of this study was to investigate the clinical characteristics of IPA in non-neutropenic patients. Methods We enrolled 183 IPA patients (including 46 proven IPA cases and 137probable IPA cases) admitted to our hospital from 2008 to 2018, after excluding possible IPA cases and neutropenic cases. The clinical and laboratory data were collected and analyzed. Results In this study, 164 (89.6%) patients had underlying diseases and risk factors, among which chronic obstructive pulmonary disease and prolonged steroid treatment were the most common. Cough (79.8%), dyspnea (71.0%), sputum (68.9%)and fever (61.2%) were the common symptoms. Chest CT findings were mainly consolidation (45.9%), nodule (32.8%), ground-glass opacity (29.0%) and cavity (26.8%). The halo sign (8.2%) and air crescent sign (7.1%) were relatively rare. The mean numbers of leucocyte and neutrophils were 14.6×109/L and 10.2×109/L, respectively. Positive rates of sputum culture and bronchoalveolar lavage fluid culture were 32.5% and 35.1%, respectively. Positive rates of galactomannan (GM) antigen test in serum and bronchoalveolar lavage fluid samples were 55.2% and 77.1%, respectively. Transthoracic needle biopsy and transbronchial lung biopsy were associated with positive rates of 45.3% and 20.6%, respectively. Conclusion The clinical and imaging features of IPA in non-neutropenic patients are atypical. Compared with sputum culture and GM antigen test in serum, alveolar lavage fluid GM test has higher sensitivity which can assist in definitive diagnosis.
9.Acupuncture Enhances Signals at Sensitized Acupoints to Elevate Pressure Pain Threshold in Knee Osteoarthritis Patients.
Xiao-Yu WANG ; Zhong-Yi NIE ; Qing-Quan YU ; Wei CHEN ; Xiao-Ning ZHANG ; Hong-Ye WAN ; Yang-Shuai SU ; Wei HE ; Ru-Ya LI ; Xiang-Hong JING
Chinese journal of integrative medicine 2022;28(12):1105-1110
OBJECTIVE:
To observe the pressure pain threshold (PPT), skin conductance (SC) and blood perfusion (BP) of the sensitized acupoints in patients with knee osteoarthritis (KOA), and explore the mechanism of acupuncture at the sensitized acupoints for treating diseases.
METHODS:
Eleven healthy subjects and 11 unilateral KOA patients were recruited from July 2020 to March 2021 in this study. The PPT, SC and BP of control acupoints in healthy controls, and non-sensitized and sensitized acupoints in KOA patients were measured and compared between baseline and after manual acupuncture (MA) treatment.
RESULTS:
Before MA treatment, lower PPT was observed at the sensitized acupoints compared with non-sensitized and control acupoints (P<0.05). After MA treatment, PPT at the sensitized acupoints increased significantly in KOA patients (P<0.05). Before MA treatment, there was no statistical difference in SC and BP among control, non-sensitized and sensitized acupoints (P>0.05). Compared with the control and non-sensitized acupoints, there were significant increases of SC and BP in sensitized acupoints of KOA patients after MA treatment (P<0.05 or P<0.01).
CONCLUSION
MA at sensitized acupoints could elevate PPT of KOA patients, which may be associated with the increment of SC and BP.
Humans
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Acupuncture Points
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Pain Threshold
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Osteoarthritis, Knee/therapy*
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Acupuncture
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Acupuncture Therapy
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Pain
10.Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients.
Ying ZHENG ; Guang-Yan CAI ; Xiang-Mei CHEN ; Ping FU ; Jiang-Hua CHEN ; Xiao-Qiang DING ; Xue-Qing YU ; Hong-Li LIN ; Jian LIU ; Ru-Juan XIE ; Li-Ning WANG ; Zhao-Hui NI ; Fu-You LIU ; Ai-Ping YIN ; Chang-Ying XING ; Li WANG ; Wei SHI ; Jian-She LIU ; Ya-Ni HE ; Guo-Hua DING ; Wen-Ge LI ; Guang-Li WU ; Li-Ning MIAO ; Nan CHEN ; Zhen SU ; Chang-Lin MEI ; Jiu-Yang ZHAO ; Yong GU ; Yun-Kai BAI ; Hui-Min LUO ; Shan LIN ; Meng-Hua CHEN ; Li GONG ; Yi-Bin YANG ; Xiao-Ping YANG ; Ying LI ; Jian-Xin WAN ; Nian-Song WANG ; Hai-Ying LI ; Chun-Sheng XI ; Li HAO ; Yan XU ; Jing-Ai FANG ; Bi-Cheng LIU ; Rong-Shan LI ; Rong WANG ; Jing-Hong ZHANG ; Jian-Qin WANG ; Tan-Qi LOU ; Feng-Min SHAO ; Feng MEI ; Zhi-Hong LIU ; Wei-Jie YUAN ; Shi-Ren SUN ; Ling ZHANG ; Chun-Hua ZHOU ; Qin-Kai CHEN ; Shun-Lian JIA ; Zhi-Feng GONG ; Guang-Ju GUAN ; Tian XIA ; Liang-Bao ZHONG ; null
Chinese Medical Journal 2013;126(12):2276-2280
BACKGROUNDData on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of hypertension in the non-dialysis CKD patients through a nationwide, multicenter study in China.
METHODSThe survey was performed in 61 tertiary hospitals in 31 provinces, municipalities, and autonomous regions in China (except Hong Kong, Macao, and Taiwan). Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or use of antihypertensive medications. BP < 140/90 mmHg and < 130/80 mmHg were used as the 2 thresholds of hypertension control. In multivariate logistic regression with adjustment for sex and age, we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.
RESULTSThe analysis included 8927 non-dialysis CKD patients. The prevalence, awareness, and treatment of hypertension in non-dialysis CKD patients were 67.3%, 85.8%, and 81.0%, respectively. Of hypertensive CKD patients, 33.1% and 14.1% had controlled BP to < 140/90 mmHg and < 130/80 mmHg, respectively. With successive CKD stages, the prevalence of hypertension in non-dialysis CKD patients increased, but the control of hypertension decreased (P < 0.001). When the threshold of BP < 130/80 mmHg was considered, the risk of uncontrolled hypertension in CKD 2, 3a, 3b, 4, and 5 stages increased 1.3, 1.4, 1.4, 2.5, and 4.0 times compared with CKD 1 stage, respectively (P < 0.05). Using the threshold of < 140/90 mmHg, the risk of uncontrolled hypertension increased in advanced stages (P < 0.05).
CONCLUSIONSThe prevalence of hypertension Chinese non-dialysis CKD patients was high, and the hypertension control was suboptimal. With successive CKD stages, the risk of uncontrolled hypertension increased.
Adult ; Aged ; Awareness ; Female ; Humans ; Hypertension ; complications ; epidemiology ; therapy ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic ; complications