The significance of Pax2 expression in the ureter epithelium of children with vesicoureteric reflux.

Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder to the urinary tract; this leads to renal scarring and end-stage renal disease in children. Pax2 is a nuclear transcription factor that is involved in urinary system development. We measured the expression of Pax2 in the ureters of 47 patients with VUR. The messenger RNA expression and the protein level of Pax2 were significantly increased in patients with VUR, suggesting a correlation with VUR. Further studies demonstrated that Pax2 was hypomethylated, and Dnmt3a messenger RNA expression was significantly lower than in the control group. We speculate that the low level of Dnmt2a might decrease PAX2 gene methylation and up-regulate the Pax2 protein. The high level of Pax2 might be related to cellular apoptosis and functional lesions in ureters. In conclusion, our results revealed that the level of Pax2 is correlated with VUR; thus, Pax2 represents a possible target for VUR therapy.

[Manipulative reduction with minimally invasive percutaneous plate osteosynthesis for 60 patients with distal tibiofibular fractures].

OBJECTIVE: To explore clinical effects of manipulative reduction with minimally invasive percutaneous plate osteosynthesis in treating distal tibiofibular fractures. METHODS: From 2009 to 2011, 60 patients with distal tibiofibular fractures were treated by manipulative reduction with minimally invasive percutaneous plate osteosynthesis. Among them, there were 32 males and 28 females aged from 14 to 70 years old with an average of 41.22 +/- 2.06. According to AO classification of fractures,5 cases were type A1, 22 cases were type A2,21 cases were type A3 and 12 cases were type C1. Operation time, blood loss,time of callus and fracture healing were observed, Mazur scoring of ankle joint were used to evaluate therapeutic. RESULTS: Fifty-eight incisions were healed at stage I ,and 2 cases were infected at distal tibial. Operation time was with an average of (62.34 +/- 5.66) min ranged 45 to 90 min;blood loss was 30 to 150 ml with an average of (80.57 +/- 5.59) ml;formation of callus appeared from 4 to 12 weeks,with an average of (8.24 +/- 2.06) weeks, and fracture healing time was from 3 to 6 months, with an average of (4.50 +/- 1.13) months. According to Mazur scoring of ankle joint 40 cases got excellent results, 18 good, and 2 fair. CONCLUSION: Manipulative reduction with minimally invasive percutaneous plate osteosynthesis can obtain reliable fixation. It is a good choice of treating distal tibiofibular fractures by protecting blood supply of fractures.

[Comparative study on effect and safty of treating on calcaneus fractures with manipulative reduction with percutaneous K-wire fixation].

OBJECTIVE: To explore the clinical effects and safty of manipulative reduction with percutaneous poking K-wire fixation for the treatment of the calcaneus fractures and analyze the indication of the minimal invasion. METHODS: From December 2008 to December 2011,135 closed calcaneal fractures cases were divided randomly into poking group and plate group, treated respectively by percutaneous poking reduction and operative reduction. In poking group, there were 69 cases (82 feet) including 60 males and 9 females, with an average age of (43.29+/-10.46) years ranging from 18 to 64 years; 30 cases of left, 26 cases of right and 13 cases of double; 54 feet of Essex-Lopresti classification tongue form, 28 feet of joint compression; 33 feet of Sanders type II ,49 of type III. In plate group, there were 66 cases (75 feet) including 58 males and 8 females,with an average age of (46.00+/-2.42) years ranging from 21 to 63 years; 31 cases of left, 26 cases of right and 9 cases of double; 48 feet of Essex-Lopresti classification tongue form, 27 feet of joint compression; 28 feet of Sanders type II, 47 of type III. According to Kerr scoring standard,clinical effects and complications were evaluated combining with Sanders and Essex-Lopresti classification. RESULTS: All 135 cases were followed up after 24 weeks. Fractures were recoveried in 8 to 12 weeks (means 10.2 weeks). In poking group, there were 2 cases of infection, 5 cases of wire movement; in plate group,18 cases of wound local skin necrosis, 5 cases of calf intestines nerve injured; there were statistical significant (P<0.05). Postoperative evaluation of Sanders type II after 24 weeks, the proportion of excellent results was above 70%,and there were no significant differences on effects of tongue form and compressing form of calcaneus fractures with percutaneous poking and operative redution (P>0.05). In the caes of Sanders type III, there were no significant differences on effects of tongue form fractures with percutaneous poking and operative reduction (P>0.05). There were significant differences on effects and complications of compressing form fractures (P<0.01), operative reduction better than percutaneous poking. Pain, walking,Kerr scoring of tongue form fractures of Sanders II , III with poking reduction were better than compression fractures. In compression fractures of Sanders Ill, plate internal fixation was better than poking redution in working and walking function, there were significant difference (P<0.05). CONCLUSION: For tongue form or compressing form of Sanders type II and tongue form of Sanders type III, manipulative reduction with percutaneous poking K-wire fixation has advantages of minimal invasion, minimized complications. Compressing form of Sanders type III fracture should be treated with operative redution.

[Research progress in the treatment of calcaneal fractures].

Calcaneal fracture is a kind of common injury of foot. Calcaneal fracture could be treated with conservative therapy, open reduction and internal fixation (ORIF), minimal invasive poking reduction and Kirschner wire fixation, arthrodesis or external fixation and other treatment methods. Open reduction and internal fixation as the main treatment method of calcaneus fracture, especially for intra-articular calcaneal fractures, as Sanders type II and III fractures, could gain satisfactory effect. But whether bone grafting should be taken is controversial in Sanders type IV fractures, because soft tissue complications are disadvantages of ORIF. The treatment of minimally invasive percutaneous poking reduction and internal fixation for calcaneal fractures has been paid more and more attention. Because of the differ of the classification of calcaneal fractures, indications of poking reduction and fixation methods, efficacy evaluation standard of choose, the clinical efficacy is different. Because of the complex treatment process, various treatment methods have their own advantages and disadvantages. Through consulting relevant literatures of domestic and abroad in recent years, comprehensive analysis is made and new progress of the calcaneal fractures treatment is summarized.

Clinicopathological features of paediatric renal biopsies in Shanghai over a 31 year period.

AIM: To identify the variations in paediatric renal biopsy pathology and clinicopathological features during the past 31 years. METHODS: A retrospective analysis of paediatric renal biopsies performed at a single institution in Shanghai from January 1979 to December 2009 was conducted. RESULTS: The major pathologies included minor glomerular abnormalities (MGA, 26.1%), IgA nephropathy (IgAN, 17%) and mesangial proliferative glomerulonephritis (MsPGN) without IgA deposition (11.3%). The major clinical presentations included nephrotic syndrome (NS, 39.4%), haematuria with proteinuria (24.4%) and persistent microscopic haematuria (15.1%). MGA accounted for 46.9% of the cases in NS. IgAN and HSN accounted for 24% and 28.9% of patients with concomitant haematuria and proteinuria, and thin basement membrane nephropathy accounted for 51.2% of cases with persistent microscopic haematuria. The frequency of IgAN (78.6%) was much higher than that of TBMN (29.0%) in patients with persistent microscopic haematuria with abnormal urinary albumin. CONCLUSION: Minor glomerular abnormalities and IgAN were the major renal diseases in our study population, and the focus of our paediatric nephrologists. The high proportion of TBMN suggested that there should be limited use of renal biopsy for patients with persistent microscopic haematuria and renal biopsy should be performed in the presence of proteinuria or abnormal levels of urinary albumin.