Treatment for cephalic arch stenosis with cephalic vein to external jugular vein bridging graft.

AIM: Percutaneous transluminal angioplasty or cephalic vein transposition to the axillary vein is mainly used for treatment of cephalic arch stenosis, a common complication of brachiocephalic fistulas. However, the results of such interventions have been disappointing. METHODS: We used a polytetrafluoroethylene prosthesis with a 6 mm diameter to bridge the cephalic vein and the ipsilateral external jugular vein, and successfully created a new drainage outlet and established immediate restoration of flow through brachiocephalic fistulas. RESULTS: This surgery allowed the cephalic venous arch and subclavian vein, which are vulnerable to stenosis, to be bypassed altogether and the puncture segment could be elongated by about 20 cm. CONCLUSION: It is a safe and effective alternative to traditional methods of treatment for cephalic arche stenosis.

[Percutaneous transluminal angioplasty combined with thrombolysis for acute thrombosis in arterio-venous fistula and graft].

OBJECTIVE: To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF) or grafts (AVG). METHODS: One hundred and ninety-two hemodialysed patients, in whom the thrombosed arterio-venous AVF or AVG developed less than 72 h and there were no contraindications for thrombolysis and PTA, underwent PTA combined with thrombolysis therapy in Sir Run Run Shaw Hospital of Zhejiang University from October 2014 to October 2017. Under ultrasound and/or fluoroscopic guidance, balloon catheter was introduced to thrombosis sites along a guide wire. Then the balloon was inflated and normal saline mixed with urokinase and heparin was injected for thrombolysis. After blood flow was restored, angioplasty was performed on vascular stenosed sites. RESULTS: A total of 274 endovascular interventional operations were performed for 192 patients. The procedure success rate was 98.2%, clinical success rate was 93.8%and complication rate was 1.46%. The post-intervention primary patency rates for AVF group were 87.4%, 76.7%and 63.9%at 3, 6 and 12 months, respectively; while the post-intervention secondary patency rates were 93.7%, 91.6%and 83.0%, respectively. The post-intervention primary patency rates for AVG group were 60.7%, 51.5%and 43.1%at 3, 6 and 12 months, while the post-intervention secondary patency rates were 82.7%, 77.1%and 70.8%, respectively. CONCLUSIONS: PTA combined with thrombolysis is an effective and safe therapeutic option for AVF and AVG thrombosis, which would prolong hemodialysis access and save vascular resources for hemodialyzed patients.

Expression of minichromosome maintenance genes in renal cell carcinoma.

Minichromosome maintenance (MCM) proteins play an essential role in DNA replication. They have been shown to be overexpressed in various types of cancer. However, the role of this family in renal cell carcinoma (RCC) is widely unknown. In this study, we have identified a number of RCC datasets in the Gene Expression Omnibus database and also investigated the correlation between the expression levels of MCM genes and clinicopathological parameters. We found that the expression levels of MCM genes are positively correlated with one another. Expression levels of MCM2, MCM5, MCM6, and MCM7, but not of MCM3 and MCM4, were higher in RCC compared to paired adjacent normal tissue. Only the expression level of MCM4, but not of other MCMs, was positively correlated with tumor grade. In addition, a high-level expression of MCM2 in either primary tumor or metastases of RCC predicted a shorter disease-free survival time, while a high-level expression of MCM4 or MCM6 in primary tumor was also associated with poorer disease-free survival. Interestingly, we also demonstrated that patients with their primary RCC overexpressing 2 or more MCM genes had a shorter disease-free survival time, while those with RCC metastases overexpressing 3 or more MCM genes had a shorter disease-free survival. Importantly, we also demonstrated that overexpression of MCM genes is an independent predictor for survival in RCC patients. Our results suggest that MCM2-7 genes may be an important prognostic marker for patients with RCC.

Synthesis of oxidized ß-cyclodextrin with high aqueous solubility and broad-spectrum antimicrobial activity.

Oxidized ß-cyclodextrins with different oxidation levels were prepared using hydrogen peroxide as the oxidant and copper sulfate as the catalyst. The physicochemical, antimicrobial and antifungal properties of oxidized ß-cyclodextrin were systematically studied. The results showed that the oxidation level of oxidized ß-cyclodextrin was successfully controlled by adjusting the dosage of hydrogen peroxide. The aqueous solubility of oxidized ß-cyclodextrin was highly improved as expected. However, oxidation changed the morphology and partly reduced the crystallinity of oxidized ß-cyclodextrin due to the introduced carbonyl and carboxyl groups. It is interesting that oxidized ß-cyclodextrin presented a broad-spectrum antimicrobial activity, which was efficiently improved with the increasing oxidation level. Growth of A. niger spores was efficiently inhibited in the presence of oxidized ß-cyclodextrin. Moreover, oxidized ß-cyclodextrin could effectively extend the storage time of apple. In summary, oxidized ß-cyclodextrin shows potential as antimicrobial and antifungal agents in food industry.

Oxidized amylose with high carboxyl content: A promising solubilizer and carrier of linalool for antimicrobial activity.

The oxidized amyloses with different carboxyl content were prepared to include linalool for antimicrobial activity in aqueous environment. The results show that linalool can be effectively reserved from volatilization through encapsulation into amylose and oxidized amyloses. The inclusion ability of oxidized amyloses towards linalool is decreasing with the increase of oxidation level due to the depolymerization of amylose. However, the solubilization effect of oxidized amyloses to linalool is enhanced efficiently owning to the high water solubility of oxidized amyloses. It is interesting that the inclusion complexes have good antimicrobial activity in aqueous environment. Linalool solubilized by oxidized amyloses presents better antimicrobial performance than that solubilized by amylose, mainly resulting from that amylose-linalool inclusion complex would aggregate and retrograde fast in aqueous solution, which is disadvantageous for the release of linalool. The study suggests that oxidized amylose is a promising solubilizer and carrier of linalool for antimicrobial activity in aqueous environment.

Biological properties of dialdehyde carboxymethyl cellulose crosslinked gelatin-PEG composite hydrogel fibers for wound dressings.

Gelatin-based composite hydrogel fibers were prepared by gel-spinning with PEG6000 as the modifier. Dialdehyde carboxymethyl cellulose (DCMC), as an ideal crosslinking reagent for protein, was used to fix the composite hydrogel fibers. Then the biological properties of the hydrogel fibers for wound dressings were evaluated. The results indicate that the hydrogen bond interactions and CN linkages between gelatin and DCMC can be formed. The addition of DCMC can efficiently improve the mechanical properties, enzymatic stability and blood compatibility of the hydrogel fibers. Crosslinking with DCMC can reduce the degree of swelling of the hydrogel fibers, which is beneficial for hydrogel fibers to avoid undesired reduction in mechanical properties. Moreover, the composite hydrogel fibers present three-dimensional structure, porous networks and low cytotoxicity. The study suggests that DCMC is an effective crosslinking reagent for biomaterials fixation. The developed composite hydrogel fibers can be well-suited for biomedical applications such as wound dressings.

Increasing Proliferation of Intrinsic Tubular Cells after Renal Ischemia-reperfusion Injury in Adult Rat.

The kidney is capable of regeneration following injury. However, whether renal stem/progenitor cells contribute to the repair process after injury, as well as the origin of the cells that repair and replace damaged renal tubule cells remains debated. Therefore, better understanding of the repair process will be critical to developing new strategies for the treatment of acute renal failure. Using an ischemia-reperfusion injury mode and an immunocytochemistry method, we counted the number of BrdU-positive cells in damged regions at different durations of reperfusion. We found that BrdU, a cell proliferative marker, was mainly incorporated in the tubular cells of both medulla and cortex 1 day after reperfusion. The number of BrdU-positive cells reached a peak at 3 days and lasted for two months after injury. BrdU-positive cells were barely found in the renal glomerulus and the parietal layer of Bowman's capsule after injury, and only a few were found in the intersititium. PAX2, an embryonic renal marker, was also increased in renal tubule cells. Confocal images show that BrdU-positive cells co-expressed PAX2, but not the activated form of caspase-3, a cell death marker. Our data suggest that renal stem-like cells or dedifferentiation of surviving renal tubular cells in both the medulla and cortex may predominantly contribute to the repair process after renal ischemia-reperfusion injury in rat.

Testosterone changes bladder and kidney structure in juvenile male rats.

PURPOSE: Testosterone affects male development, maturation and aging but limited data exist on testosterone effects on the juvenile genitourinary system. We hypothesized that testosterone has bladder and kidney developmental effects, and investigated this in juvenile male rats. MATERIALS AND METHODS: To examine the testosterone effect 21-day-old prepubertal male Wistar rats were divided into 3 groups of 12 each, including sham orchiectomy as controls, and bilateral orchiectomy with vehicle and bilateral orchiectomy with testosterone. Starting at age 28 days (week 0) testosterone enanthate (5 mg/100 gm) or vehicle was injected weekly. Testosterone was measured at study week 0 before injection, and at weeks 1, 6 and 16. Whole bladders and kidneys were evaluated for androgen receptor, bladder collagen-to-smooth muscle ratio, and renal morphometry and immunohistochemistry. RESULTS: Testosterone was not detectable at week 0 in all groups. It remained undetectable at weeks 1, 6 and 16 in the orchiectomy plus vehicle group. Testosterone levels were physiological in controls and rats with orchiectomy plus testosterone but levels were higher in the latter than in the former group. Rats with orchiectomy plus testosterone had increased bladder-to-body and kidney-to-body weight ratios (p<0.01 and <0.05, respectively), and decreased collagen-to-smooth muscle ratio than the orchiectomy plus vehicle and control groups. Rats with orchiectomy plus testosterone had a lower renal total glomerular count (p<0.01) but increased androgen receptor density. CONCLUSIONS: In juvenile male rats testosterone was associated with increased bladder and renal mass, and increased bladder smooth muscle. Testosterone associated kidneys also appeared to have fewer but larger glomeruli. These data support an important role for sex hormones in structural and functional development of the bladder and kidney.

Proliferative capacity of stem/progenitor-like cells in the kidney may associate with the outcome of patients with acute tubular necrosis.

Animal studies indicate that adult renal stem/progenitor cells can undergo rapid proliferation in response to renal injury, but whether the same is true in humans is largely unknown. To examine the profile of renal stem/progenitor cells responsible for acute tubular necrosis in human kidney, double and triple immunostaining was performed using proliferative marker and stem/progenitor protein markers on sections from 10 kidneys with acute tubular necrosis and 4 normal adult kidneys. The immunopositive cells were recorded using 2-photon confocal laser scanning microscopy. We found that dividing cells were present in the tubules of the cortex and medulla, as well as the glomerulus in normal human kidney. Proliferative cells in the parietal layer of Bowman capsule expressed CD133, and dividing cells in the tubules expressed immature cell protein markers paired box gene 2, vimentin, and nestin. After acute tubular necrosis, Ki67-positive cells in the cortex tubules significantly increased compared with normal adult kidney. These Ki67-positive cells expressed CD133 and paired box gene 2, but not the cell death marker, activated caspase-3. In addition, the number of dividing cells increased significantly in patients with acute tubular necrosis who subsequently recovered, compared with patients with acute tubular necrosis who consequently developed protracted acute tubular necrosis or died. Our data suggest that renal stem/progenitor cells may reside not only in the parietal layer of Bowman capsule but also in the cortex and medulla in normal human kidney, and the proliferative capacity of renal stem/progenitor cells after acute tubular necrosis may be an important determinant of a patient's outcome.

A case report of double-filtration plasmapheresis for the resolution of refractory chronic urticaria.

A 29-year-old Chinese female was diagnosed with chronic urticaria. Dexamethasone and gamma globulin initially resolved the illness; however, when dexamethasone was decreased and gamma globulin was withdrawn, urticaria emerged again and could not be controlled by any of the medications used. The diagnosis of refractory chronic urticaria was made and double-filtration plasmapheresis (DFPP) was performed. The symptoms were relieved during the first DFPP procedure and the disease resolved shortly thereafter. DFPP theoretically removes medium to large molecular substances such as IgG and IgE from circulation, and therefore may prove to be an effective treatment for refractory chronic urticaria.