Comparative analysis of domestic Octoparms and imported Celect inferior vena cava filter in interventional treatment of venous thromboembolism / 实用放射学杂志

Objective To compare and analyze the application value of domestic Octoparms and imported Celect inferior vena cava filter(IVCF)in the interventional treatment of venous thromboembolism(VTE).Methods Forty patients with VTE were randomly divided into Octoparms group(experimental group)and Celect group(control group)according to the double-blinded method of the central random system.All the patients underwent filter placement,catheter-directed thrombolysis and filter retrieval.The primary end point was the success of filter placement and retrieval,and the secondary end point included indwelling complications such as the occurrence of pulmonary embolism(PE)and filter tilt and migration.Results Forty patients were enrolled in this study,22 patients and 18 patients were divided into the experimental group and the control group,respectively.Among them,11 cases were identified with right lower extremity deep vein thrombosis,29 cases with left lower extremity deep vein thrombosis,17 cases with PE,and 6 cases with inferior vena cava thrombosis.The success rate of IVCF placement was 100%in all participants.Immediately after filter place-ment,the angle of filter tilt was(3.8±2.3)° in the experimental group and(4.9±2.8)° in the control group(t=1.44,P=0.16).Filter retrieval was successful in 21 cases(21/22,95.5%)of the experimental group and 17 cases(17/18,95.5%)of the control group.There was no significant difference between the two groups(t=0.14,P=0.89).The mean indwelling time of filter was(8.0±2.1)days in the experimental group and(9.7±3.1)days in the control group(t=0.73,P=0.47).The angle of filter tilt was(5.3±3.4)° in the experimental group and(5.7±7.7)° in the control group(t=0.19,P=0.85).There was no significant difference for filter placement and retrieval between the two groups(t=0.48 and 2.00,P=0.06 and 0.64,respectively).There were no complications of filter migration,strut penetration or new PE in both groups.Conclusion The application value of domestic Octoparms and impor-ted Celect IVCF is similar in interventional treatment of VTE.

Clinical application of individualized coil embolization in interventional therapy of renal artery aneurysm / 实用放射学杂志

Objective To explore the clinical application of individualized coil embolization in the interventional treatment of renal artery aneurysm(RAA).Methods Data of 23 patients with RAA treated by individualized coil embolization were analyzed.There were 27 RAAs,in which narrow-necked RAAs were treated with coil embolization and wide-necked RAAs were treated with stent-assisted coil embolization.The efficacy of the two embolization methods were analyzed and the changes of renal function and symptoms were observed.Results A total of 27 RAAs in 23 patients were successfully embolized at one time,including 23 narrow-necked RAAs in 19 cases treated with coil embolization and 4 wide-necked RAAs in 4 patients treated with stent-assisted coil embolization.The embolization effect of 20 cases(86.96%)reached Raymond grade Ⅰ,and 3 cases(13.04%)reached gradeⅡ.Postoperative computed tomography angiography(CTA)showed that all parent arteries were patent,the RAA was not visualized,and there was no renal infarction.There was no statistical difference in creatinine values before operation,1 month,6 months and 1 year after operation(P>0.05).In the 12 patients with hypertension,there were statistically significant differences in blood pressure at 1 year after operation compared with preoperative,1 month,and 6 months after operation(P<0.05).The symptoms of low back pain and hematuria disappeared after operation.Conclusion Individualized coil embolization for RAA is safe,effective and worthy of clinical promotion.

Correlation analysis of preoperative red blood cell distribution width and prognosis of patients undergoing TACE for hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To evaluate the relationship between red blood cell distribution width (RDW) and prognosis of patients with hepatocellular carcinoma (HCC) andergoing transcatheter arterial chemoembolization (TACE).Methods:Clinical data of 212 patients with HCC andergoing TACE for the first time in Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University from January 2011 to May 2018 were retrospectively analyzed, including 184 males and 28 females, aged (56.8±11.2) years. Follow-up for survival. X-tile software was used to determine 13.1% as the optimal threshold for preoperative RDW prediction of prognosis, and enrolled patients were divided into a low level group (RDW<13.1%, n=70) and a high level group (RDW≥13.1%, n=142). Aspartate aminotransferase, total bilirubin, albumin, hemoglobin and lipoprotein a, Barcelona clinical liver cancer (BCLC) stage and other indexes were compared between the two groups. Survival analysis was performed by Kaplan-Meier method, survival rate was compared by log-rank test, and the effect of RDW on prognosis was analyzed by Cox regression. Results:The 1-year, 2-year and 3-year cumulative survival rates in RDW high level group were 34.5%, 14.1% and 6.3%, respectively, while those in RDW low level group were 64.3%, 38.6% and 21.4%, respectively, with significant difference ( χ2=23.09, P<0.001). Compared with the low level group, the levels of aspartate aminotransferase and total bilirubin were higher, the levels of albumin, hemoglobin and lipoprotein a were lower, the proportion of portal vein cancer thrombin was higher, and the stage of BCLC was later, with statistical significance (all P<0.05). Cox regression analysis showed that HCC patients with RDW≥13.1%( HR=1.732, 95% CI: 1.223-2.452, P=0.002) had poor survival prognosis after TACE. Conclusion:Preoperative RDW≥13.1% is an independent risk factor for survival after TACE in patients with HCC. RDW has potential predictive value for prognosis of patients with HCC.

Efficacy of TIPS in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding / 中华肝胆外科杂志

Objective:To study the efficacy, feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding.Methods:Cirrhotic patients with recurrent portal hypertension after splenectomy and devascularization and presenting with upper gastrointestinal bleeding from August 2015 to December 2020 were studied. Thirty-nine patients were included in this study. There were 24 males and 15 females, with age of (51.56±9.08) years old. These patients were treated with TIPS by using the Viabahn stent. Intraoperative portal vein pressure, success operative rate, hemostasis rate after surgery, changes in hematological indicators and postoperative efficacy and complication rate were studied.Results:Thirty-eight of 39 patients successfully underwent TIPS shunt and 1 patient failed because of portal vein spongiosis. The success rate was 97.44%(38/39). Thirty-three patients underwent TIPS and variceal vein embolization, while 5 patients were treated with TIPS alone. Thirty-nine Viabahn stents with a diameter of 8 mm were implanted in 38 patients, of which 5 patients had the stent expanded to its nominal diameter of 8 mm. The remaining 33 patients (86.84%) had a shunt with a diameter of 6 mm. The hemostasis rate of postoperative gastrointestinal bleeding was 97.37% (37/38). The portal vein pressure and portal venous pressure gradient decreased from (31.28±6.24), (20.61±5.14) mmHg (1 mmHg=0.133 kPa) to (19.58±4.69), (9.24±3.07) mmHg respectively, the differences were significant (all P<0.001). All patients were followed-up for 3 to 36 months, with a median follow-up of 12 months. The postoperative rebleeding rate was 6.90% (2/29). The incidence of hepatic encephalopathy was 13.79% (4/29), and the incidence of shunt disorder was 13.79% (4/29). Conclusion:TIPS was safe, effective and feasible in treating patients with recurrent portal hypertension after splenectomy and devascularization presenting with upper gastrointestinal bleeding. Most patients obtained good clinical outcomes with a 6 mm diameter shunt.

Analysis of risk factors of Budd-Chiari syndrome associated with hepatocellular carcinoma in patients who underwent endovascular recanalization / 中华肝胆外科杂志

Objective:To study the risk factors of Budd-Chiari syndrome (BCS) associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.Methods:The data of 340 patients with BCS who underwent endovascular recanalization at the Affiliated Hospital of Xuzhou Medical University between January 2015 and June 2021 were retrospectively collected. Using propensity score matching, a total of 57 patients (40 males and 17 females) were enrolled into this study, with the age of (50.4±8.7) years. Patients were divided into the hepatocellular carcinoma group ( n=19) and the control group ( n=38) according to whether occurrence of hepatocellular carcinoma after cardovascular recanalization. Preoperative indicators including gender, age, BCS type, and model for end-stage liver disease (MELD) score, and postoperative indicators including alpha fetoprotein, intrahepatic nodule formation, vascular restenosis, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared between the two groups after propensity score matching. Multivariate logistic regression analysis was used to analyze the risk factors of BCS associated with after endovascular recanalization in these patients. Results:There were no significant differences in gender, age, BCS type, MELD score and other preoperative data between the two groups (all P>0.05). The proportions of patients with postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, ALT>50 U/L, intrahepatic nodules and vascular restenosis after endovascular treatment in the hepatocellular carcinoma group were significantly higher than those in the control group (all P<0.05). Multivariate analysis showed postoperative alpha fetoprotein >9.0 μg/L ( OR=46.778, 95% CI: 3.310-661.140), AST>40 U/L ( OR=36.307, 95% CI: 1.317-1 001.009), intrahepatic nodule formation ( OR=66.254, 95% CI: 4.225-1 038.974) and vascular restenosis ( OR=16.276, 95% CI: 1.712-154.773) to have an increased risk of being associated with hepatocellular carcinoma in these BCS patients (all P<0.05). Conclusion:Postoperative alpha fetoprotein>9.0 μg/L, AST>40 U/L, intrahepatic nodule formation and vascular restenosis were independent risk factors of BCS associated with hepatocellular carcinoma in patients who underwent endovascular recanalization.

Emergency Viabahn covered stenting in treatment of postoperative ruptured hepatic artery pseudoaneurysm / 中华肝胆外科杂志

Objective To evaluate the safety and efficacy of Viabahn covered stent in treatment of hepatic artery pseudoaneurysm (HAPA) caused by surgery.Methods Clinical data of 7 patients with postoperative massive intra-abdominal hemorrhage and diagnosed as HAPA with emergency angiography were collected from November 2015 to May 2016.All the patients underwent Viabahn covered stent implantation.Perioperative and postoperative clinical data of the patients were recorded,and with 1-month follow-up.Results All the 7 cases were diagnosed as extrahepatic HAPA and successfully completed Viabahn covered stent procedure,and curative rate was up to 100％.One case experienced transient vasospasm in the hepatic artery proximal to the stent.All the patients repeated hepatic artery CT angiography scans one week after surgery,with no evidence of bleeding.With 1-month follow-up,all the patients were in stable conditions.Conclusion Viabahn covered stent is minimally invasive,simple and effective interventional approach for HAPA.

Application of reduced glutathione in protecting liver function in HCC patients after interventional therapy: a clinical study / 介入放射学杂志

Objective To evaluate the clinical effect of reduced glutathione in protecting the liver function for patients with hepatocellular carcinoma (HCC) after receiving international therapy.Methods The clinical data of 110 HCC patients,who were admitted to authors' hospital during the period from January 2010 to June 2013,were retrospectively analyzed.According to the random number table method the patients were divided into the control group (n=50) and the treatment group (n=60),and transcatheter arterial chemoembolzation (TACE) and transcatheter arterial infusion (TAI) were carried out in all patients.After the treatment,intravenous infusion of 2.0 g vitamin C,0.2 g vitamin B6,2.0 g inosine,and 250 ml branched chain amino acid was employed per day for one week for the patients of both groups,and additional intravenous dripping of 1.8 g reduced glutathione (added in 250 ml of 5％ glucose solution) was adopted for the patients of the treatment group.Various liver function indexes were tested before and one week after the treatment,the results were compared between the two groups.Results Before the treatment,no obvious differences in the hepatic functions and in the clinical condition existed between the two groups.One week after the treatment,in both groups the aminotransferase (ALT and AST) and total bilirubin (TBIL) were significantly increased when compared with the preoperative data (P＜0.05),while the serum pre-albumin (PA) was remarkably decreased when compared with the preoperative data (P＜0.05);these changes of various indexes in the treatment group were apparently better than those in the control group (P＜0.05).Conclusion The use of reduced glutathione can effectively relieve the liver function damage caused by interventional therapy in HCC patients,therefore,reduced glutathione has a very good clinical application value.

Endovascular treatment of Budd-Chiari syndrome in young child: a case report / 临床儿科杂志

Objective To explore the endovascular treatment of Budd-Chiari syndrome (BCS) in young child. Methods The clinical data of one young child diagnosed with BCS and treated with endovascular therapy were retrospectively analyzed. Results The 23-month-old female suffered from repeated abdominal distension for 3 months and was diagnosed with BCS by vascular ultrasound Doppler and magnetic resonance examination. After confirmation of the diagnosis, endovascular treatment was performed. Then the occluded blood vessels resumed blood stream, urine output increased, and abdominal distension was significant relieved. Conclusions In young children, BCS is rare, the condition is complex, and endovascular therapy is effective.

The technique of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction / 中华肝胆外科杂志

Objective To investigate the value of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction.Methods A retrospective study was conducted on 25 patients with Budd-Chiari syndrome (BCS) with hepatic vein obstruction treated from May 2011 to August 2014.The technique of guide-wire loop was used in these patients.The pressure of the hepatic vein was measured before and after treatment.The difference in the pressure was analyzed by the t test.Results All the patients were treated successfully using guide-wire loop angioplasty.No complications of bleeding,pericardial tamponade and liver capsule hemorrhage were observed.After treatment,the pressure of the hepatic vein reduced from (48.3± 8.0) cmH2O to (20.9 ± 3.8) cmH2O (t =26.82,P ＜ 0.05);The symptoms and physical signs of the patients were relieved or disappeared.BCS-related symptoms reappeared on follow-up in 4 patients,2 were treated by balloon dilation successfully.1 patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) because of decompensated liver cirrhosis.1 patient with ankylosing spondylitis had treatment failure and the symptoms relapsed for the third time.Conclusion The technique of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction is safe and effective,and it can improve the overall success rate of treatment.

Numerical simulation analysis of hemodynamic values of budd-chiari syndrome based on MR image / 医学研究生学报

Objective The hemodynamic mechanism of Budd-Chiari syndrome ( BCS ) has become the research hotspot in recent years.The aim of this study was to discuss the hemodynamic characteristics of BCS through 3D numerical simulation for inferior vena cava stenosis based on the fluid dynamics ( CFD) method. Methods 3D model was established from a patient with Budd-Chiari syndrome based on MR image with Ansys software .The numerical simulation of this model was performed by the CFD . Results The 3D model of inferior vena cava functionally demonstrated the change procedure of hemodynamic characteristics of BCS .Vortex was found above the narrow area , and blood flow velocity achieved maximum in the center of the stenosis throughout the coronal section graph.The static pressure value gradually declined at the narrow area entrance to the narrowest place , and achieved minimum value at the exit.The maximum wall shear stress existed in the stenosis . Conclusion Specific 3D computational hemodynamic model can show the hemodynamic characteristics of BCS , and its hemodynamic parameters could be used for clinical practice .It will facilitate the study on correlation of complex hemodynamic parameters and morphology changes of inferior vena cava vascular .

Considerations of the factors affecting the clinical practice of medical students in interventional radiology at present / 介入放射学杂志

As a newly - developed medical subject, interventional radiology has been widely popularized for recent years., Taking the first affiliated hospital of Xuzhou medical college for instance, this paper aims to discuss the following three major factors that influence the clinical practice of medical students in interventional radiology at present: the importance to clinical teaching, the changes of doctor-patient relationship and the professional ethic quality education. The perfection measures and countermeasures are also discussed.

Clinical study of interventional embolization for the treatment of tiny intracranial aneurysms / 介入放射学杂志

Objective To explore the therapeutic efficacy of endovascular embolization for the treatment of tiny intracranial aneurysms (≤3.0 mm) and to discuss its technical skill. Methods During the period from Dec. 2010 to July 2013, a total of 12 patients with tiny intracranial aneurysms (≤3.0 mm) were admitted to authors’ hospital to receive endovascular embolization therapy. Of the 12 patients, narrow-necked aneurysm (neck-to-body ratio ≤0.5) was seen in 7 and embolization with coils only was carried out, while wide-necked aneurysm (neck-to-body ratio > 0.5) was seen in 5 and stent-assisted coils embolization was adopted. Based on Raymond grading standard, the immediate therapeutic results were evaluated, and the procedure-related complications were recorded. Thirty days after the treatment , GOS grade was used to assess the results. Follow-up evaluation with angiography or through call was conducted. Results Successful embolization of the aneurysm was obtained in all the 12 aneurysms , with a success rate of 100%. Angiography performed immediately after the treatment showed that complete embolization was achieved in 8 aneurysms (66.7%) and residual aneurysm cavity was seen in 4 aneurysms (33.3%). GOS grading indicated that 12 cases belonged to grade V. The 12 patients were followed up for 1 - 12 months through telephone , and no re-bleeding occurred. Conclusion For the treatment of tiny intracranial aneurysms (≤ 3.0 mm), endovascular embolization is feasible although its safety and efficacy need to be further observed.

Clinical evaluation of interventional treatment for Budd-Chiari syndrome with hepatic vein thrombosis / 中华放射学杂志

Objective To evaluate the effect of interventional therapy for Budd-Chiari syndrome with hepatic vein thrombosis. Methods Twenty-five patients with Budd-Chiari syndrome complicated with hepatic vein thrombosis underwent catheter-directed urokinase thrombolysis, balloon dilation and/or stent placement. During follow-up, re-thrombosis and patency of the recanalized hepatic vein and inferior vena cava were evaluated by liver ultrasound. The pressure gradient of hepatic vein-right atrium or inferior vena cava-right atrium before and after interventional treatment was compared with paired t-test. ResultsTechnical success was obtained in 23 patients. Complete resolution and partial resolution of the thrombi were accomplished in 18 cases and 5 cases, respectively. The recanalized hepatic veins and inferior vena cava were patent. The mean pressure gradient of hepatic vein-right atrium dropped from (29±7) cm H2O to (8±3) cm H2O (1 cm H2O＝0.098 kPa) after the interventional treatment (t=13.7,P<0.01). The mean pressure gradient of inferior vena cava-right atrium dropped from (19±4) cm H2O to (5±2) cm H2O after the interventional treatment (t=13.3, P<0.01). Failures occurred in 2 patients. Over the follow-up period of 1 to 42 months[(18±10) months]after interventional treatment in the 23 patients, one late death occurred. Restenoses of hepatic veins were found in 2 patients, which were all redilated successfully. Neither restenosis of hepatic vein nor recurrence of thrombosis was found in the other 20 patients. Conclusion Interventional therapy could be effectively performed for the treatment of Budd-Chiari syndrome with hepatic vein thrombosis.

Interventional treatment of hepatocellular carcinoma complicated by Budd-Chiari syndrome / 中华放射学杂志

Objective To evaluate the efficacy of interventional therapy for hepatocellular carcinoma complicated by Budd-Chiari syndrome. Methods Clinical data and imaging studies of 17 patients with hepatocellular carcinoma complicated by Budd-Chiari syndrome were retrospectively analyzed. Budd-Chiari syndrome was diagnosed by color Doppler ultrasound and confirmed by cavography in 17 patients. Hepatocellular carcinoma was diagnosed by fine-needle aspiration cytology in 5 patients,and by color Doppler ultrasound, computed tomography and /or MRI, and elevated level of alpha-fetoprotein in 12 patients. Both percutaneous transluminal angioplasty for treatment of obstruction of the inferior vena cava and transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma were performed in all patients. During follow-up, the tumor size, liver function, serum alpha-fetoprotein level and the recanalized inferior vena cava were evaluated by liver ultrasound, CT and laboratory examination. t test was used to compare the pressure. Results Thirty-nine interventional procedures were performed in 17 patients and all operations were successful without complications. Over the follow-up period of 2 to 90 months after percutaneous transluminal angioplasty in 17 patients, re-occlusion of inferior vena cava occurred in only one patient, which was redilated successfully. Following TACE, all 17 patients survived at two months followup, 13 patients survived at 6 months follow-up, 10 patients survived at 1 year follow-up, 5 patients survived at 2 years follow-up. The pressure of vena cava was (20.5±2.1) cm H2O (1cm H2O=0.098 kPa) before the interventional theraphy, while it was (3.6±1.0) cm H2O after it (t=30.32, P＜0.05). Conclusion Interventional therapy can be effectively performed for treatment of hepatocellular carcinoma complicated by Budd-Chiari syndrome.

Interveational therapy for various types of acute iliofemoral venous thrombosis through jugular vein / 中华急诊医学杂志

Objective To evaluate the efficacy of interventional therapy for various types of acute iliofemoraldeep venous thrombosis (IF-VT) through jugular vein. Method Thirty-eight patients with acute IF-VT from theAffiliated Hospital of Xuzhou Medical Collge underwent catheter-directed urokinase thrombolysis through jugularvein. Results Left IF-VT or with extension of thrombus into inferior vena cava was diagnosed in 16 patients,leftIF- VT with left common iliac vein occlusion in 17 ,left IF-VT with extersion of thrombus into inferior vena cava andleft common iliac vein stenosis or occlusion in 3,and both IF-VT with left common iliac vein stenosis or occlusion in2. Complete thrombolysis and partial thrombolysis was carried out in 33 (86.8%) and 5 (13.2%) patients, re-spectively. During a period of 2 - 18 months following-up in 20 patients, reoccurrence was found in 2 patients.Conclusions Interventional therapy for various types of acute lower extremity DVT through jugular vein is a safeand effective method.

The value of three-dimensional DSA in diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of the inferior vena cava / 中华放射学杂志

Objective To investigate the value of three-dimensional digital subtraction angiography (3D-DSA)in the diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of inferior vena cava(IVC).Methods Twenty-one patients with complex Budd-Chiari syndrome caused by the obstruction of IVC underwent 3D-DSA after two-dimensional-DSA(2D-DSA)was performed with posterior-anterior view.The images of 2D-DSA and 3D-DSA were independently reviewed by two senior interventional radiologists iu a double-blinded way.Percutaneous transluminal angioplasty or stent placement of IVC were performed according to the results of 2D-DSA and 3D-DSA.Results Different aspects of the IVC in all patients were demonstrated on the 3D-DSA images,including the mowhology and the location of obstructions,the origins of collateral vessels and their relationships to the IVC.Collateral vessels originated from the site of IVC occlusions in 9 patients were detected by the 3D-DSA.However.the 2D-DSA provided excellent visualization of the vascular structures of the IVC in 7 patients.and the collateral vessels origihated from the site of IVC occlusions were shown in 2 patients.The 3D-DSA was significantly superior to the 2D-DSA in detecting the IVC obstructions and the collateral vessels(P＜0.05).The virtual angioscopy of the 3D-DSA was able to visualize free IVC thrombosis in 3 paitents.and mural IVC thrombosis in 1 patient.The procedures were successful in all patients.There were no other complications except the rupture of IVC in 1 patient.Conclusion The 3D-DSA can offer valuable informations in diagnosis of IVC obstruction.and it may play an important role in interventional treatment of Budd-Chiari syndrome.

Influence of Ginkgo Leaf Extract and Dipyridamole Injection in Diabetic Nephropathy / 医学研究杂志

Objective To study the influence of Ginkgo Leaf Extract and Dipyridamole Injection to urinary albumin (U - Alb) in 24 hours in diabetic nephropathy. Methods 37 patients with diabetic nephropathy were involved in the study. They were divided into test group(20 patients) and control group(17 patients). The test group was grouped into group A(pristine diabetic nephropathy) and group B (clinical diabetic nephropathy) according to urinary albumin. The control group was grouped into group A (pristine diabetic nephropathy) and group B(clinical diabetic nephropathy) according to urinary albumin. The test group was injected Ginkgo Leaf Extract and Dipyridamole Injection 20?g from vein ,one time a day, 14 day continuously ,but control group without Ginkgo Leaf Extract and Dipyridamole Injection. All patients were treated with same blood glucose, blood pressure, plasma lipids, and others. Results After the treatment of two groups, the level of the urinary albumin deceased obviously as compared with before treatment, and deceased significantly as compared with control group. Conclusion Ginkgo Leaf Extract and Dipyridamole Injection can lower urinary albumin in patients with diabetic nephropathy.