bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with Ureteral Stone Management in 1,082 Patients Using Semirigid Ureteroscopes
Authors: Hamano Satoshi , Nomura Hiroyuki , Kinsui Hidetoshi , Oikawa Takehiro , Suzuki Noriyuki , Tanaka Masashi , Murakami Shino , Igarashi Tatsuo , Ito Haruo
Published: April 2003

Objectives: To assess the efficacy and complications of ureteroscopic lithotripsy (URS) using semirigid ureteroscopes. Methods: We retrospectively analyzed the records of 1,082 consecutive patients with ureteral stones who were treated with URS with or without auxiliary extracorporeal shock wave lithotripsy for stone fragments. The efficacy was estimated using the stone-free rate and efficiency quotient (EQ). Results: The stone-free rates were 79.0, 90.4 and 93.2% for upper, middle and lower ureteral stones, respectively. The EQ was 0.49 for upper, 0.79 for middle and 0.87 for lower ureteral stones. Ureteral perforation occurred in 54 cases (5.0%), of which 13 cases (1.2%) required nephrostomy (n = 11, 1.0%) or open surgery (n = 2, 0.2%). Conclusions: URS is a reasonable procedure with minor complications for stones located in the lower and middle ureter, but cannot be recommended as a first-line treatment for upper ureteral stones.
Comparison of Symptoms, Morphological, Microbiological and Urodynamic Findings in Patients with Chronic Prostatitis/Pelvic Pain Syndrome
Authors: Strohmaier Walter L. , Bichler K.-Horst
Published: April 2003

164 patients with prostatitic symptoms were evaluated by segmented urinalysis and culture and classified according to the National Institutes of Health classification system: 64 patients (38%) suffered from chronic bacterial prostatitis; 12 (7%) from inflammatory chronic pelvic pain syndrome, and 92 (55%) from non-inflammatory chronic pelvic pain syndrome. Transrectal ultrasound of the prostate, uroflowmetry and measurement of residual urine were also performed. Complaints were recorded using a questionnaire. Our studies revealed that leukocytes in expressed prostatic secretions could be detected in only 24 and 36% of patients with positive bacterial or chlamydial culture. Complaints, ultrasound and urodynamic findings were similar in the 3 groups. Therefore the differential diagnosis and therapy, based on the results of the 4-glass test and cultures as well as on transrectal ultrasound of the prostate, seem to be difficult.
Squamous Cell Carcinoma of the Prostate without Evidence of Recurrence 5 Years after Operation
Authors: Imamura Masaaki , Nishiyama Hiroyuki , Ohmori Kouhei , Nishimura Kazuo
Published: April 2003

A 54-year-old man underwent radical cystoprostatectomy after prostatic needle biopsy which revealed squamous cell carcinoma of the prostate. However, the positive surgical margin of the pubis suggested residual disease. He received chemotherapy with methotrexate, peplomycin and cisplatin (MPD regimen). He is at present still alive without evidence of recurrence 5 years after the operation. This suggests that MPD chemotherapy is effective for squamous cell carcinoma of the prostate.
Effect of Endothelin Receptor Antagonist (TAK-044) on Autotransplanted Perfused Kidneys in Dogs
Authors: Yoshida Katsunori , Kagebayashi Yoriaki , Kitauchi Takanori , Kimura Shoki , Yoneda Tatsuo , Ozono Seiichirou , Hirao Yoshihiko , Watanabe Toshifumi
Published: April 2003

Background: Endothelin-1 (ET-1) is involved in some diseases, including renal disease. Recently, the role of ET-1 in postrenal transplantation has been demonstrated in experimental and clinical studies. A new endothelin receptor antagonist, TAK-044, blocks both, ETA and ETB receptors, and was useful in treating acute renal failure in rats. In this study, we evaluated the effect of TAK-044 on autotransplanted kidneys with 18 h of perfusion. Materials and Methods: TAK-044 was injected subcutaneously at 15 mg/kg/day for 2 weeks in one group of dogs, and blood analysis and renal function, were evaluated. A control group was given saline in the same manner as that used for the TAK-044 group. Histopathological examination and immunohistochemistry for ET-1 were performed in the two groups. Results: In the control group, 5 of the 7 dogs died of renal failure within 2 weeks after autotransplantation of the kidney. In the TAK-044 group, 5 of the 7 dogs survived and 2 died of renal failure within the same period. Although the histological changes in the tubules in both groups were severe due to the 18 h of perfusion, TAK-044 ameliorated these changes. Immunohistochemical staining for ET-1 was seen in tubules in the control group. Conclusion: These findings suggest that TAK-044 effectively reduces damage in autotransplanted perfused kidneys in dogs, and may be useful in limiting damage to the kidney by acute tubular necrosis after renal transplantation in humans.
Infected Hydrocele in a Neonate
Authors: Ku Ja-Hyeon , Yim Yong-Soon , Lee Nam-Kyu , Park Young-Ho
Published: April 2003

A case of infected hydrocele in a neonate is presented. We describe this unusual condition, and discuss the diagnosis, pathophysiology and treatment.
Idiopathic Congenital Dysmorphic Megascrotum
Authors: Ehle Joe J. , Hutcheson Joel C. , Snyder, III Howard M. , Cooper Christopher S.
Published: April 2003

An enlarged scrotum in the pediatric population constitutes a relatively frequent physical finding requiring evaluation. Most cases of scrotomegaly have a clearly identifiable etiology. We present a patient with an idiopathic congenital dysmorphic megascrotum.
Telomerase Activity in Giant Condyloma acuminatum
Authors: Ikeda Ryosuke , Kobayashi Yuichi , Shiroma Kazuo , Suzuki Koji , Ueda Yoshimichi
Published: April 2003

A 46-year-old male came to our hospital 1 month after noticing a 2-cm penile tumor. Since malignant findings such as atypical cells and mitosis were not observed in the frozen sections obtained at operation, the pathological diagnosis of this tumor was giant condyloma acuminatum. This tumor was analyzed by a telomeric repeat amplification protocol method, and telomerase activity was revealed. For comparison, a case of squamous cell carcinoma and a case of condyloma acuminatum were examined. Telomerase activity was observed in our case and in the case of squamous cell carcinoma. To our knowledge, this is the first case of telomerase activity in giant condyloma acuminatum ever reported. In addition to the histological examination, measurement of telomerase activity may provide valuable objective diagnostic information on evaluating the degree of malignancy of giant condyloma acuminatum and in obtaining a differential diagnosis between the benign and malignant.
Hydrodynamic Contributions to Multimodal Guidance of Prey Capture Behavior in Fish
Authors: Montgomery John C. , Davies Fiona , Baker Cindy F. , Carton Alexander G.
Published: April 2003

Water movements, of both abiotic and biotic origin, provide a wealth of information of direct relevance to the guidance of prey capture behavior. To gather hydrodynamic information, fish have sensors of two basic types: those scattered over the surface of the body known as superficial neuromasts and similar sensors embedded in subdermal lateral line canals. Recently, the anatomical dichotomy between superficial and canal neuromasts has been matched by demonstrations of a corresponding functional dichotomy. Prey detection and localization are evidently mediated by canal neuromasts, whereas superficial neuromasts are more sensitive to water flows over the surface of the fish and participate in the orientation to water currents, a behavior known as rheotaxis. However, rheotaxis in combination with chemosensory inputs can also guide fish to their prey. Thus there is evidence that both lateral line sub-modalities either alone or in concert with other senses play a role in prey capture. Are there circumstances where prey capture requires integration of information from both lateral line sub- modalities? Recent evidence shows that fish are capable of tracking other fish on the basis of the hydrodynamic trails left behind by their swimming motion. Pharmacological and physical ablation of lateral line end organs shows that indeed integration of information from both sub-modalities is required for the complex hydrodynamic task of natural prey capture in the dark. Furthermore, these experiments provide an excellent demonstration of the integration of hydrodynamic, chemosensory, tactile and visual information for the multimodal guidance of prey capture behavior.
Actions of Farnesol and Xylitol against Staphylococcus aureus
Authors: Akiyama Hisanori , Oono Takashi , Huh W.-K. , Yamasaki Osamu , Ogawa Shigeyuki , Katsuyama Masako , Ichikawa Hideyuki , Iwatsuki Keiji
Published: April 2003

Background: Heavy colonization of atopic dermatitis (AD) with Staphylococcus aureus is well documented. The isolation rate of methicillin-resistant S. aureus is high in strains from AD in Japan. Our objective in the present study was to investigate the actions of farnesol and xylitol against S. aureus for the control of AD skin lesion-colonizing S. aureus.Methods: We examined the actions of farnesol on plasma coagulation and superantigenic exotoxin production by S. aureus, the antimicrobial activity of β-lactam antibiotics combined with farnesol at concentrations below the minimal inhibitory concentration (MIC) and the effect of xylitol on glycocalyx production. Results: Coagulation by S. aureus cells was inhibited in plasma containing farnesol at a concentration of 1/12 of the MIC (100 µg/ml) after incubation for 24 h. The production of superantigenic exotoxins by S. aureus cells with farnesol (100 µg/ml) was about 10 times lower than that by S. aureus cells alone. The MICs of ampicillin and cefdinir against S. aureus were reduced to ≤0.06 µg/ml in Mueller-Hinton agar plates with farnesol (100 µg/ml). We suggest that farnesol at concentrations above the MIC had a suppressive effect against S. aureus cells in the exponential and stationary phase and acted on the cell wall of S. aureus cells in both phases. Conclusions: Farnesol is a promising adjuvant agent against S. aureus skin infections treated with β-lactam antibiotics. Further, 5% xylitol inhibited glycocalyx production by S. aureus cells and consequently had a suppressive effect on the colonization of S. aureus on the horny cells of AD lesions.
Hox Genes and Spinal Cord Development
Authors: Carpenter Ellen M.
Published: April 2003

The spinal cord is differentiated along the rostrocaudal axis into large domains with regional distinctions reflected in the position and projection of specific cell types. Spinal cord patterning is likely to be mediated by the local expression and activity of transcription factors. This review will examine the expression of one class of transcription factors, encoded by the Hox genes, that are active in spinal cord patterning. Hox genes encode homeodomain-containing proteins with overlapping rostrocaudal domains of expression in the developing spinal cord. Rostrally expressed Ant-p/Ubx/Abd-D-related Hox genes may function in patterning the cervical spinal cord, while Abd-D-related, caudally expressed Hox genes may pattern the lumbar spinal cord. Changes in spinal cord patterning are apparent following Hox gene inactivation, supporting a role for these genes in defining or establishing this pattern.
Levels of Amino Acid Neurotransmitters during Neurogenesis and in Histotypic Cultures of Mouse Spinal Cord
Authors: Miranda-Contreras Leticia , Benítez-Díaz Pedro , Peña-Contreras Zulma , Mendoza-Briceño Rosa Virginia , Palacios-Prü Ernesto
Published: April 2003

The development of spinal cord interneurons and the formation of interneuronal synaptic connections has received little attention; the most comprehensively studied developing circuit has been the connection between motoneurons and the muscle they innervate. All motoneurons are cholinergic whereas spinal interneurons are mostly glutamatergic, glycinergic or GABAergic neurons. In this study, we show quantitative data, obtained by high-pressure liquid chromatography (HPLC), on the levels of amino acid neurotransmitters during mouse spinal cord neurogenesis, from embryonic day (E) 12 until postnatal day (P) 30. At E12, high levels of glutamate, glycine and taurine were already detected but between E16 and P3, significant increments in their contents were observed, indicating the occurrence of maximum synaptogenesis during this period. Important reductions in their contents were also observed in two stages: between E12–E16 and P3–P7. These results suggest that the apoptotic death of interneurons and motoneurons in the developing brain or the synapse refinement of neural circuitry during maturation reduced the number of synapses, thereby decreasing the levels of neurotransmitters. The contents of these neurotransmitters were also analyzed in primary cultures of mouse spinal cord prepared from embryos between E13 and E19. As deduced from light microscopy, ultrastructural studies, as well as results from HPLC analysis, the cultures derived from E15–E16 embryos showed the highest degree of histotypic features and neurotransmitter contents comparable with those obtained in situ. Although glycine, GABA and taurine levels reached about 80–90% of normal in situ values, the contents of aspartate and glutamate were lower by about 40%, which could be mainly due to deafferentation of both sensory and supraspinal afferent axon terminals. These results indicate that intrinsic synaptic circuits can be maintained in histotypic spinal cord cultures prepared from E15–E16 mouse embryos. Histotypic cultures of the spinal cord will serve as a good model for studies on the pathophysiology of amino-acid-based neurotransmission and repair strategies in many CNS disorders.
Expression of Nuclear Transcription Factor PAX2 in Renal Biopsies of Juvenile Nephronophthisis
Authors: Murer Luisa , Caridi Gianluca , Della Vella Manuela , Montini Giovanni , Carasi Carla , Ghiggeri GianMarco , Zacchello Graziella
Published: April 2003

PAX2, a homeotic gene of ‘paired box family’, is a nuclear transcription factor expressed in mesenchymal/epithelial conversion during the early stages of nephrogenesis; however, its repression is necessary for terminal differentiation of mature tubular cells. Transgenic overexpression in animal model causes epithelial hyperproliferation and microcyst formation. In humans, PAX2 expression has been observed in cystic and dysplasic tubular epithelia in kidney malformation and in kidney disease. We have investigated PAX2 expression and its colocalization with cytokeratin and/or vimentin in 17 biopsies of juvenile nephronophthisis (NPH), an autosomal-recessive renal disease characterized by diffuse renal fibrosis and occasional cysts. Fourteen cases were analyzed for deletion and mutation in the NPH1 gene locus and 33% resulted to be deleted or mutated; for the remaining cases the diagnosis was based on clinical and pathological criteria. The control group included 4 congenital dysplastic kidneys, and 10 biopsies of nephropathies with secondary chronic tubulointerstitial damage. In all cases of renal dysplasia a strong nuclear positivity was observed in immature tubules surrounded by αSMA-positive mesenchymal cells. In NI biopsies the tubular epithelia were almost PAX2 negative, although tubulointerstitial damage was severe. In 14/17 NPH1 moderate-to-strong nuclear PAX2 positivity of tubular cells was observed, particularly in cystic distal tubules located at the corticomedullary junction, but also in proximal tubular sections. The PAX2 signal co-localized more with cytokeratin staining than with vimentin. Our results confirm the observation of PAX2 expression in immature dysplastic tubules and its repression in mature renal tubular cells, also in the presence of severe secondary interstitial fibrosis. PAX2 seems to be overexpressed in NPH. The genetic defect of NPH, a disease probably due to a primary defect along the cascade of mesenchymal epithelial differentiation, could generate a functionally abnormal protein involved in focal adhesion signaling and cell/matrix interaction. The failure of PAX2 repression or its reactivation in NPH could be a marker of hyperproliferation and incomplete maturation of epithelial tubular cells, probably due to a defect cell/matrix cross-talk, and involved in interstitial fibrosis and cysts formation.
Impact of Hemodialysis Membrane and Permeability on Neutrophil Transmigration in vitro
Authors: Moshfegh Ali , Jacobson Stefan H. , Halldén Gunilla , Thylén Pia , Lundahl Joachim
Published: April 2003

Background/Aim: The impact of dialysis membrane permeability on neutrophil transmigration properties in vitro was examined in the present study. This issue has not been fully scrutinized before. Methods: We studied the capacity of neutrophils collected from a group of dialysis patients randomly treated with cuprophan, low- or high-flux polysulfone, to transmigrate in vitro through a membrane covered with fibronectin (a main constituent of the endothelial basement membrane). The hemodialysis-induced quantitative changes in expression of adhesion molecules were examined in parallel. Results: At the end of dialysis, neutrophils collected from patients treated with high-flux polysulfone dialyzers had a significantly higher transmigration index than neutrophils from patients treated with low-flux polysulfone membrane (p < 0.01) or cuprophan membrane (p < 0.01), and approached the level of transmigration observed in neutrophils collected from healthy controls. In the groups treated with low-flux polysulfone and cuprophan dialyzers, the transmigration capacity was significantly lower (p < 0.02) compared to neutrophils from healthy subjects. We also noted that differences between low- and high-flux polysulfone dialysis, in the context of transmigration properties, were not mirrored by changes in adhesion phenotype, which strengthens the view that there is no strict relationship between these two features. Conclusion: The study demonstrates that high-flux polysulfone dialysis, as opposed to low-flux polysulfone and cuprophan treatment, improves the transmigration properties of circulating neutrophils, despite similar effects on adhesion molecule phenotypes. A plausible mechanism is that potentially toxic middle range molecules that inhibit neutrophil migration are more efficiently eliminated during high-flux polysulfone dialysis, but this explanation requires further support.
Renal Proximal Tubular Metabolism of Protein-Linked Pentosidine, an Advanced Glycation End Product
Authors: Asano Manabu , Fujita Yuji , Ueda Yasuhiko , Suzuki Daisuke , Miyata Toshio , Sakai Hideto , Saito Akira
Published: April 2003

Background: Pentosidine, an advanced glycation end product, accumulates in plasma proteins of uremic patients. Its fate is, however, yet to be fully understood. Methods: Three cell lines, JTC-12 (proximal tubular cells), MDCK (distal tubular cells), and BALB3T3 (nonrenal cells), were cultured in a double chamber system and were exposed to uremic serum, and the contents of protein-linked pentosidine derived from uremic sera were determined in each medium by HPLC assay. The presence of pentosidine in the cytoplasm of these cells was assessed by immunoperoxidase staining. Results: When the apical cell membrane was exposed to uremic serum (fortified in the upper chamber), the contents of protein-linked pentosidine in the upper medium decreased by up to 30% after 24- and 48-hour incubations of JTC-12 cells but not of other cells. On the other hand, the contents of protein-linked pentosidine in the lower medium did not change. By contrast, exposure of the basolateral cell membrane of the three cell lines to uremic serum (fortified in the lower chamber) did not change the contents of protein-linked pentosidine both in the upper and lower medium after a 24-hour incubation. Pentosidine was detected immunohistochemically in the cytoplasm of JTC-12 cells, but not of BALB3T3 and MDCK cells, the apical membranes of which were exposed to uremic sera for 8 h. The immunoreaction disappeared 48 h after exposure. Pentosidine was not detected in the cytoplasm of JTC-12 cells, the basolateral membranes of which were exposed to uremic sera. The relevance of the in vitro results to humans was demonstrated by immunohistochemical studies in normal human kidney tissues showing that pentosidine was identified in the proximal renal tubules. Conclusion: These results suggest that the proximal tubular cells play a role in the disposal of plasma pentosidine.
Mechanisms Underlying the Ameliorative Property of Lisinopril in Progressive Mesangioproliferative Nephritis
Authors: Shinosaki Toshihiro , Miyai Ikuko , Nomura Yasuharu , Kobayashi Tatsuo , Sunagawa Norio , Kurihara Hidetake
Published: April 2003

The present study was performed to clarify the mechanism underlying the beneficial effects of lisinopril on chronic glomerulonephritis. Chronic glomerulonephritis was induced by a single injection of E30 monoclonal antibody (E30) recognizing Thy-1.1 antigen to unilaterally nephrectomized rats. E30 injection resulted in persistent massive proteinuria with a decrease in anionic charge sites on the glomerular basement membrane (GBM) at 8 weeks. Also, renal tissue from rats treated with E30 showed typical glomerulosclerosis and tubulointerstitial fibrosis. Lisinopril exerted a potent antiproteinuric effect and suppressed the progression of both glomerulosclerosis and tubulointerstitial fibrosis. Lisinopril recovered the reduced number of anionic charge sites on GBM, accounting for the positive action against massive proteinuria. Immunostaining for desmin revealed that lisinopril treatment prevented the injury of glomerular epithelial cells (GECs) occurring in the chronic nephritic stage. Also, the level of gene expression of transforming growth factor-β (TGF-β) and plasminogen activator inhibitor-1 (PAI-1) in the renal cortex were reduced, suggesting that lisinopril improved extracellular matrix (ECM) metabolism. These results indicated that proteinuria in Thy-1.1 antibody-induced chronic nephritis is associated with a decrease in anionic charge sites on GBM, and that the antiproteinuric effect of lisinopril is attributable to protection against GEC damage. Suppression of TGF-β and PAI-1 expression contributed to the preventive effect of lisinopril on ECM deposition in renal tissue.
Interaction between Erythropoietin and Peripheral Polymorphonuclear Leukocytes in Continuous Ambulatory Dialysis Patients
Authors: Shurtz-Swirski Revital , Kristal Batya , Shasha Shaul M. , Shapiro Galina , Geron Ronit , Sela Shifra
Published: April 2003

The effect of erythropoietin (EPO) on the oxidative stress (OS) and inflammation caused by polymorphonuclear leukocytes (PMNLs) in end-stage renal failure patients undergoing continuous ambulatory peritoneal dialysis (CAPD) was investigated in vivo and in vitro. The studies were performed on isolated PMNLs from peripheral blood of CAPD patients before and following 6 weeks of EPO treatment and from healthy controls. OS was expressed by the rate of superoxide release from phorbol 12-myristate 13-acetate (PMA) stimulated isolated PMNLs and the inflammatory state was evaluated by PMNL counts of the enrolled subjects. Following 6 weeks of EPO treatment in CAPD patients, both the rate of superoxide release from PMNLs and PMNL counts fell significantly when compared with the pretreatment values. In vitro incubation of PMNLs from CAPD patients with increasing amounts of EPO displayed a significant reduction in their rates of superoxide release. EPO, by direct interaction with PMNLs, attenuated their primed state, causing reduction in oxidative stress and inflammation.
Electrocardiographic QT Prolongation and Sudden Death in Renal Hypokalemic Alkalosis
Authors: Zanolari Calderari Maura , Vigier Rodo O. , Bettinelli Alberto , Bianchetti Mario G.
Published: April 2003

A 3-year-old boy was found to have a mixed tubulopathy with hypokalemia (1.9 mmol/l), alkalosis (blood pH 7.51, plasma carbon dioxide pressure 46 mm Hg, plasma bicarbonate 35.7 mmol/l) and hypophosphatemia (1.21 mmol/l). An electrocardiogram disclosed a prolonged heart rate corrected QT interval of 490 ms. The boy was put on potassium chloride, phosphate and nonsteroidal anti-inflammatory agents. With this treatment plasma phosphate normalized and plasma potassium increased up to 3.0–3.3 mmol/l. Three years later the child, who did not have history of gastroesophageal reflux or epileptic convulsions, suddenly died during sleep. The cause of death could not be determined through gross examination of the body. The history of hypokalemia, the QT-prolongation, the sudden death and the failure to assess the cause of death through gross examination of the body suggest that death was caused by an arrhythmia secondary to hypokalemia.
Surgical Treatment of Fibrous Dysplasia of the Skull in Children
Authors: Maher Cormac O. , Friedman Jonathan A. , Meyer Fredric B. , Lynch James J. , Unni Krishnan , Raffel Corey
Published: April 2003

Introduction: We evaluate the role of surgery in the treatment of fibrous dysplasia of the skull in children. Methods: We identified 48 consecutive cases of fibrous dysplasia of the skull that were surgically treated at a single institution over a 23-year interval. The 28 patients that initially presented during the first two decades of life were selected for further analysis. Presenting symptoms, signs, surgical treatment, surgical outcome and the state of the disease at the extended follow-up interval were recorded. Results: Fibrous dysplasia of the skull in children most often involved the frontal, sphenoid and ethmoid bones. Most patients presented with facial asymmetry or proptosis. A gross total resection was achieved in 7 patients, subtotal resection in 17 patients, and 4 patients underwent biopsy alone. Over the follow-up interval, 7 patients had symptomatic progression of subtotally resected fibrous dysplasia and 3 patients had asymptomatic progression. The extent of resection was correlated with recurrence risk. Conclusions: In order to prevent progression of disease, an attempt at gross total resection is indicated in cases of fibrous dysplasia of the skull in childhood where the risk of neurologic morbidity is low and cosmetic results will be acceptable.
Implications of Genetic Testing for the Insurance Industry: The UK Example
Authors: Raeburn Sandy
Published: April 2003

This report summarises the controversy of genetic tests and insurance, with a focus on the UK situation during the past decade. UK experience provides insight for future strategies to help people with genetic disadvantages make insurance provision for themselves and their families. Non-disclosure of genetic test results (already carried out for clinical purposes) may not benefit people at risk of genetic disorders or with positive genetic tests. The pressure of geneticists over a decade to prevent disclosure to insurers may have masked opportunities to use insurance to provide help for people with genetic disadvantages. To seize the opportunities now, there must be collaboration, not conflict. Politicians, geneticists, social scientists and all elements of the insurance industry can contribute to wise solutions.
Immunological Variables Mediate Cognitive Dysfunction in Gulf War Veterans but Not Civilians with Chronic Fatigue Syndrome
Authors: Brimacombe Michael , Zhang QuanWu , Lange Gudrun , Natelson Benjamin H.
Published: April 2003

We explored the relationship between a set of immunological variables and a set of cognitive and functional status measures and a diagnosis of chronic fatigue syndrome (CFS) in civilians and veterans using various regression and factor analytic methods. Our approach emphasized the extraction of a few distinct factors in order to limit statistical problems associated with doing large numbers of multiple comparisons. This approach led to our finding cytokine data grouping into type 1 and type 2 clusters. A type 2 cluster plus a T and B cell factor predicted CFS caseness for Gulf War veterans but not for civilians with CFS. When a cognitive variable, reaction time, was added into the model, both immunological factors lost statistical significance; this indicates that the cognitive variable reaction time moderated the effects of the immunological factors in predicting patient status. We did a similar analysis on the roles of the immunological and cognitive variables in functional status using SF-36 data. Higher levels of these same two immunological factors predicted poorer general health as well as poorer physical and social functioning in Gulf War veterans but not in civilians with CFS. When the reaction time factor was added, only the lymphocyte factor remained significant. This implies that lymphocytes are directly related to functional status in Gulf War veterans with CFS, but the Th2 factor produces its effect on functional status via changes in cognitive abilities.
Risk Factors for Hip Fracture in Hemodialysis Patients
Authors: Kaji Hiroshi , Suzuki Mizune , Yano Shozo , Sugimoto Toshitsugu , Chihara Kazuo , Hattori Saburo , Sekita Kenichi
Published: April 2003

Background: The incidence and mortality of hip fractures were several times greater in the patients with hemodialysis (HD) than in the general population. Although patients with end-stage renal disease develop renal osteodystrophy, few published data examined the risk factor of hip fractures in the dialysis population. Methods: The present study was performed to compare various indices and bone mineral density (BMD) of HD patients with or without the history of hip fractures. Moreover, we analyzed the factors which predicted hip fractures in 183 patients with chronic HD enrolled in the cross-sectional study. Results: Serum level of alkaline phosphatase was significantly higher in HD patients with hip fractures, compared to those without hip fractures. Oral calcium carbonate dose was significantly lower in HD patients with hip fractures. 1/3 radius (R)-BMD and ultradistal (UD)R-BMD were significantly lower in HD patients with hip fractures. However, lumbar spine (LS)-BMD was comparable in HD patients with or without hip fractures. Although there was no significant differences of BMD between with and without hip fractures in diabetes mellitus, UDR-BMD of patients with hip fractures was significantly lower than that of patients without hip fractures in chronic glomerulonephritis. Radial BMD was lower in female patients with hip fractures, compared to without hip fractures, although there were no significant differences in male patients. In multiple logistic regression analysis, oral calcitriol dose and 1/3R-BMD were selected as a risk factor of hip fractures in HD patients. Conclusion: Radial BMD was lower in HD patients with hip fractures. However, its contribution is different, depending on gender and the original disease leading to HD. Radial BMD and oral calcitriol dose seemed to be important to predict the risk of hip fractures.
Transfer of a Speed of Processing Intervention to Near and Far Cognitive Functions
Authors: Edwards Jerri D. , Wadley Virginia G. , Myers Renee S. , Roenker Daniel L. , Cissell Gayla M. , Ball Karlene K.
Published: April 2003

Background: Evidence establishing the potential for modification of cognitive functioning in later adulthood has begun to accumulate. Objective: The primary goal of the current study was to evaluate, among older adults, the extent to which standardized speed of processing training transfers to similar and dissimilar speeded cognitive measures as well as to other domains of cognitive functioning. Methods: Ninety-seven older adults (mean age 73.71 years) were administered a battery of cognitive tests assessing intelligence, memory, attention, verbal fluency, visual-perceptual ability, speed of processing, and functional abilities. Forty-four of the participants received ten 1-hour sessions of speed of processing training. The remainder of participants were in a no-contact control group. Approximately 6 weeks after the pretraining assessment, all participants repeated the same battery of tests. Results: The results revealed training effects for some speed of processing measures, including performance of instrumental activities of daily living, but no transfer to other domains of cognitive functioning. Conclusion: Speed of processing training may enhance the speed at which older adults can perform instrumental activities of daily living.
Relation of Distal Nephron Changes to Proximal Tubular Damage in Uranyl Acetate-Induced Acute Renal Failure in Rats
Authors: Sun Di Fei , Fujigaki Yoshihide , Fujimoto Taiki , Goto Tetsuo , Yonemura Katsuhiko , Hishida Akira
Published: April 2003

Aims: To elucidate the pathophysiological roles of the changes of distal nephron in uranyl acetate (UA)-induced acute renal failure (ARF), we investigated the relation of changes of constituent molecules in distal nephron to proximal tubular damage and repair in UA-treated rats. Methods: ARF was induced in rats by intravenous injection of UA, and all rats received bromodeoxyuridine (BrdU) intraperitoneally 1 h before sacrifice. Results: Proximal tubular damage with necrosis appeared as early as day 2, mainly in the outer stripe of outer medulla and reached a peak level at day 5. Slight cellular damage was evident in the distal nephron as early as day 3, reaching a peak level around day 9. Immunoreactive BrdU- or vimentin-positive regenerating proximal tubules (PT) appeared at day 2 and regenerating PT relining was almost completed by day 7. Immunostaining for EGF, which was constitutively expressed in the thick ascending limb (TAL) and distal convoluted tubule (DCT), diminished significantly as early as day 2, when PT regeneration became evident, and remained below normal levels until day 21. In contrast, slight immunoreactivity for EGF was observed in regenerated PT accompanying brush-border formation mainly after day 9, suggesting newly expressed EGF might contribute to PT maturation. Lectin staining or immunostaining for representative constituent molecules of the thin descending limb, TAL, DCT and collecting duct demonstrated marked and transient reduction after day 5. Conclusions: EGF was not associated with regenerating PT, but may be involved in the maturation of PT. Transient reduction in expression of constituent molecules of the distal nephron following the reduction in EGF could reflect dedifferentiation or phenotypic simplification during regenerative repair of PT in UA-induced ARF in rats.
Broad Antiproliferative Effects of Benidipine on Cultured Human Mesangial Cells in Cell Cycle Phases
Authors: Ono Takahiko , Liu Ning , Kusano Hitoshi , Nogaki Fumiaki , Makino Toshiaki , Muso Eri , Sasayama Shigetake
Published: April 2003

Background and Purpose: Recently, in vitro studies have shown that some calcium channel blockers inhibit the proliferation of mesangial cells. In the present study, we evaluated the antiproliferative effects of benidipine, a calcium channel blocker, in comparison with other calcium channel blockers, and attempted to further clarify its mechanism of action on cultured human mesangial cells in relation to cell cycle. Methods: Human mesangial cells were cultured in medium containing 5% fetal calf serum (FCS), with or without benidipine, or other calcium channel blockers for 20 h, and [3H]thymidine incorporation were measured. Analysis of cell cycle dependency was carried out, using platelet-derived growth factor as a competence factor, which transfers cells from the G0 to the G1 (G0/G1) phase, and insulin as a progression factor, which transfers cells from the G1 to the S (G1/S) phase. Cells were also analyzed by flow cytometry. Results: Benidipine and nifedipine showed significant inhibitory effects on FCS-induced proliferation (p < 0.001 and p < 0.01, respectively, by ANOVA), with 3.8 and 41.9% of the control level of [3H]thymidine incorporation at the concentration of 10 µM of the blockers, respectively. Diltiazem had no inhibitory effect at this concentration. Benidipine was found to inhibit cells in both the boundaries of G0/G1 and G1/S phases (p < 0.001 and p < 0.0001, respectively), whereas nifedipine inhibited only cells in G1/S phase (p < 0.05). The effects of benidipine (10 µM) on cells in G1/S were stronger than those on cells in the G0/G1 phase (p < 0.0001). Furthermore, flow cytometry showed that 10 mM benidipine significantly inhibited the G1 to S phase transition of FCS-stimulated mesangial cells (p < 0.03). Conclusions: Benidipine markedly inhibited the proliferation of mesangial cells, at both the G0/G1 and G1/S phases, and it might be effective to suppress the progression of mesangioproliferative glomerular diseases.
Skin Tuberculosis with Atypical Mycobacteria 8 Years after Combined Pancreas-Kidney Transplantation
Authors: Schmekal Bernhard , Janko Othmar , Zazgornik Jan , Schinko Herwig , Bogner Stefan , Syre Gehard , Biesenbach Georg
Published: April 2003

We report on a Mycobacterium marinum infection in a diabetic woman 8 years after undergoing a combined pancreas-kidney transplantation. This is, to our knowledge, the first case report on an isolated skin infection with atypical mycobacteria after simultaneous pancreas-kidney transplantation. A genetic probe categorization revealed an infection with M. marinum. Skin tuberculosis caused by M. marinum is an uncommon complication in kidney or pancreas-kidney transplant recipients, hence the diagnosis can be delayed.
Metabolic and Skeletal Effects of Low and High Doses of Calcium Acetate in Patients with Preterminal Chronic Renal Failure
Authors: Phelps Kenneth R. , Stern Marc , Slingerland Alice , Heravi Mahin , Strogatz David S. , Haqqie Syed S.
Published: April 2003

Background: Secondary hyperparathyroidism commonly evolves, as the glomerular filtration rate falls. The metabolic and skeletal effects of a possible remedy, calcium acetate, have not been studied in patients with preterminal chronic renal failure. Methods: Men with a mean creatinine clearance of approximately 30 ml/min took calcium acetate for 24 weeks at doses which provided 507 or 1,521 mg calcium/day with meals. Metabolic determinations were made at intervals of 4–8 weeks, and the bone mineral density (BMD) was measured at the beginning and at the end of the trial. Results: The low-dose regimen produced no metabolic or skeletal effect. In subjects prescribed the high-dose regimen, the 24-hour urine phosphorus excretion fell from 0.53 mg/mg creatinine to values ranging from 0.34 to 0.41 mg/mg creatinine. The theoretical phosphorus threshold concentration rose by a maximum of 38.6%, and the serum phosphorus concentration did not change. The mean serum calcium concentration rose by a maximum of 7.2%. The mean fractional changes in parathyroid hormone and 1,25-dihydroxyvitamin D concentrations ranged from –27.0 to –39.6% and from –5.0 to –20.3%, respectively. The BMD increased at L1, L3, and L4. Conclusion: Calcium acetate prescribed to deliver 1,521 mg calcium/day with meals reduced parathyroid hormone and 1,25-dihydroxyvitamin D concentrations and increased lumbar BMD in men with preterminal chronic renal failure.
Acute Renal Failure following Massive Mannitol Infusion
Authors: Pérez-Pérez Angel J. , Pazos Beatriz , Sobrado José , Gonzalez Luis , Gándara Argimiro
Published: April 2003

Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 ± 439 g (mean ± SD) during a time period of 58 ± 28 h. The infusion rate was 0.25 ± 0.02 g/kg/h. The onset of acute renal failure was detected 48 ± 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 ± 11 mEq/l), and hyperosmolality (osmolar gap 70 ± 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension – one of them while recovering – on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.
Clinical Profiles and Outcomes of End-Stage Renal Failure Patients with Late Initiation of Renal Replacement Therapy Based on Uremic Symptoms under Intensive Renoprotective Therapies
Authors: Kaizu Kazo , Uriu Kohei , Inada Yoshifumi , Hashimoto Osamu , Mizobe Takamitsu , Takagi Ichiro , Ito Aki , Suzuka Kanako , Qie Yue Ling , Lee Wei , Miyamoto Hidemitsu , Tanaka Yoshiya
Published: April 2003

Aim: This study describes the clinical profiles and outcomes of renal failure patients with late initiation of renal replacement therapies (RRT) based on uremic symptoms under intensive treatment prior to the start of RRT (IT). Methods: Thirteen patients (male 10, female 3) with end-stage renal disease who preferred to wait for the initiation of RRT until uremic symptoms appeared regardless of serum creatinine (s-Cr) and 24-hour creatinine clearance (24-hour Ccr) were chosen. All patients received IT including a low-protein diet, antihypertensive drugs including enalapril, erythropoietin and others to prevent and manage uremic states until the initiation of RRT. Clinical findings at the initiation of RRT and the outcomes after the start of RRT were examined. Results: RRT was initiated 23.6 ± 16.9 months after IT without any complication in all patients when mild uremic symptoms appeared. Uremic symptoms, blood pressure, serum albumin, potassium, calcium and urinary Cr excretion were well controlled except inorganic phosphate, hemoglobin and cardiac size. 24-hour Ccr and s-Cr were 3.4 ± 0.7 ml/min and 17.4 ± 3.8 mg/dl at initiation of RRT. The outcomes of all the patients were all well during chronic RRT. Conclusion: Intensive treatment prior to the start of RRT can diminish uremic symptoms and complications so that RRT might be initiated safely and with fewer problems, even in the face of lower 24-hour Ccr and markedly higher s-Cr.
Myofibroblast Differentiation: Plasma Membrane Microdomains and Cell Phenotype
Authors: Schelling Jeffrey R. , Sinha Sumita , Konieczkowski Martha , Sedor John R.
Published: April 2003

Myofibroblast differentiation characterizes a prominent cellular phenotype identified in experimental models of progressive kidney disease and human kidney biopsies. Mesangial cells, tubulointerstitial fibroblasts and, perhaps, tubular epithelial cells undergo myofibroblast differentiation, a process characterized by α-actin expression, synthesis of interstitial collagens and a growth response. Inhibition of myofibroblast differentiation could prevent kidney disease progression but may be difficult to accomplish, since inhibition of multiple signaling pathways would be required. Cell biology advances have enabled a better understanding of how information from many microenvironmental stimuli are integrated by spatial compartmentalization of extracellular receptors and cytosolic signaling molecules within specialized plasma membrane domains, such as focal adhesions and lipid rafts. We review this information and hypothesize that myofibroblast differentiation of renal cells can only proceed if the spatial arrangement of intracellular molecules, in large part determined by extracellular matrix-regulated cytoskeletal organization, permits activation of appropriate signaling pathways by soluble molecules interacting with receptors in specialized plasma membrane microdomains. If proven, this hypothesis suggests targeting key molecules within adhesion complexes and rafts (in some cases with drugs that are already clinically available) may provide more effective therapy for kidney disease progression.
Pathogenesis and Diagnosis of Hyponatremia
Authors: Oh Man S.
Published: April 2003

This discussion emphasizes two aspects of hyponatremia: classification according to effective osmolality of the body fluid, and distinction between appropriate and inappropriate ADH secretion. Assessment of the effective osmolality is important because the main deleterious effect of hyponatremia is cell overhydration, which occurs only when the effective osmolality is reduced. Since most cases of hyponatremia are associated with low effective osmolality, cell overhydration is a hallmark of acute hyponatremia. On the other hand, one must be aware of other types of hyponatremia in which effective osmolality is either normal or even increased. Inappropriateness of ADH secretion is defined as ADH secretion that occurs despite low effective osmolality and normal or expanded effective vascular volume. ADH secretion that occurs in hyponatremia is deemed appropriate if the effective vascular volume is low. The use of laboratory parameters is much more reliable in determining effective vascular volume than is careful physical examination.
A Conceptual Approach to the Patient with Metabolic Acidosis
Authors: Shafiee Mohammad A. , Kamel Kamel S. , Halperin Mitchell L.
Published: April 2003

We shall illustrate that management of patients with an acid-base disorder could be improved if the acid-base analysis was based on a better understanding of basic concepts of physiology. Three concepts of acid-base physiology and their clinical implications are emphasized in a patient with diabetic ketoacidosis. First, when an acid is produced from neutral precursors in the body, there is a net increase in the number of hydrogen ions (H+) and new anions. The corollary is that H+ will be removed when the accompanying anion is metabolized to a neutral end-product or is excreted in the urine with H+ or ammonium (NH4+). Second, buffering of H+ is beneficial if H+ are removed by bicarbonate rather than being able to bind to proteins. This latter function depends on having a low tissue PCO2, due to a combination of hyperventilation plus an adequate blood flow rate to vital organs. Third, the kidneys add new bicarbonate to the body when NH4+ is excreted with chloride ions.
Clinical Study of Heparin-Free Hemodialysis with the Inside of Hollow Fibers in Dialyzer Coated by Human Albumins
Authors: Wu Xixin , Chen Huaji
Published: April 2003

Background/Objective: To investigate the therapeutics of heparin-free hemodialysis (HD) with the inside of hollow fibers in a dialyzer coated with human albumins (HFHd-A1). Methods: Clinical contrast study between HFHd-A1 and heparin-free HD with hollow fibers in dialyzer by normal saline flush (HFHd-NS) was performed by adopting the cross-over design method. The dialysis effect, the effect on life signs, blood platelet functions, change of dialyzer fiber-bundle volume, appearance image, and image of scanning electron microscopy of the inside of hollow fibers in dialyzer after dialysis and the biocompatibility of dialyzer of two HD methods were compared. Results: HFHd-A1 could overcome all shortcomings of HFHd-NS and had more merits and increased expenses for HFHd-A1 were not high. Conclusion: HFHd-A1 was an effective and feasible method which could salvage patients with bleeding diseases or bleeding tendency and who need HD.