BACKGROUND & AIMS: Focal and segmental sclerosed lesions in the glomeruli are found in several pathological entities and more often are found in the corticomedullary junction where renal blood flow and filtration pressure is maximal. Experimental data suggest that hyperfiltration injury results in focal and segmental glomerulosclerosis (FSGS). In keeping with this concept, malignant hypertension is a known cause of nephrotic-range proteinuria and nephrotic syndrome pathalobically represented by FSGS. We report a case of unilateral renal artery stenosis associated with nephrotic syndrome and FSGS in the contralateral kidney only. The kidney with the stenosed renal artery showed normal glomeruli with juxtaglomerular hyperplasia, suggesting that protection from hyperfiltration injury was provided by the presence of high-grade stenosis. Serum creatinine concentration, blood pressure, and proteinuria normalized after aorto-renal bypass surgery. This case shows the importance of hemodynamic factors on the pathogenesis of secondary FSGS and the progression of renal disease.

背景与目标： 在几个病理实体中发现了肾小球的局灶性和节段性硬化病变，更常见于肾肾血流和滤过压力最大的皮质肾交界处。实验数据表明，超滤损伤可导致局灶性和节段性肾小球硬化（FSGS）。与这个概念一致，恶性高血压是FSGS病态性代表的肾病范围蛋白尿和肾病综合征的已知病因。我们报道了仅在对侧肾脏中伴有肾病综合征和FSGS的单侧肾动脉狭窄的病例。肾动脉狭窄的肾脏显示肾小球正常，并伴有肾小球增生，提示存在高度狭窄可防止过度滤过损伤。主动脉-肾脏搭桥手术后，血清肌酐浓度，血压和蛋白尿恢复正常。该病例表明血液动力学因素对继发性FSGS的发病机理和肾脏疾病进展的重要性。

BACKGROUND & AIMS: OBJECTIVE:To discover potential differences in known prognostic factors of renal adenocarcinoma in patients under 40 years of age. PATIENTS AND METHODS:A series of 246 patients with renal adenocarcinoma included 17 patients 40 years. Both groups were analyzed for sex, tumour size, histological characteristics and stage, examining the relative proportions within each group and looking for an association between those sets of data and age. RESULTS:No statistically significant associations were found, although it should be noted that in some cases data is incomplete. A larger proportion of low stages at least locally and a greater proportion of granule cell tumours was found in patients 40 years-old compared to those over 40. CONCLUSIONS:Existence of differences in the biological and histological characteristics of renal adenocarcinomas that develop at a younger age is not unlikely. The analysis of each factor and the survival rates in larger series should elucidate these questions, which will also be of interest to improve our understanding of the histogenesis of this type of tumours.

背景与目标： 目的：探讨40岁以下患者肾腺癌的预后因素之间的潜在差异。
患者与方法：246例肾腺癌患者中包括17例40岁的患者。分析两组的性别，肿瘤大小，组织学特征和分期，检查每组内的相对比例，并寻找这些数据与年龄之间的关联。
结果：尽管在某些情况下数据不完整，但未发现统计学上显着的关联。与40岁以上的患者相比，在40岁的患者中，至少局部存在较低比例的低分期，并且颗粒细胞肿瘤的比例更高。
结论：年轻时发生的肾腺癌的生物学和组织学特征存在差异的可能性不大。在较大系列中对每个因素和存活率的分析应阐明这些问题，这对于增进我们对这种类型肿瘤的组织发生的理解也将是有益的。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:To investigate renal preservation by a novel method of perfusion using an oxygenated perfluorocarbon (PFC) emulsion via retrograde access to the kidney, as preserving renal function during urological surgery has been elusive, and the recognized technique of nephron-sparing surgery has increased its application and practice in modern urology. MATERIALS AND METHODS:After institutional review and approval, 30 New Zealand White rabbits were studied. In a solitary kidney model, each rabbit had the ureter catheterized before 40 min of renal artery occlusion. Each rabbit was randomized to one retrograde perfusion group, i.e. sham, normothermic PFC, chilled PFC, normothermic saline, and chilled saline. The rabbits were maintained for 2 weeks, during which renal function, urine output, systemic blood gases, weight and serum creatinine level were measured. After death, the kidneys were individually examined and graded by one renal pathologist unaware of the treatment. RESULTS:The rabbits treated with retrograde PFC perfusion (normothermic and chilled) had less change in their creatinine clearance, at 3.6 and 4.0 mL/min per kg, than the sham group, at 7.8 mL/min per kg, while also having significantly higher systemic venous oxygenation, at 26.3 and 10.0 mmHg, than the sham group, at 0.2 mmHg. Normothermic and chilled perfusion with PFC was also associated with less histological evidence of ischaemic damage, with mean (sd) scores of 13.0 (13.5) and 8.7 (4.5), respectively, than in the sham group, at 33.3 (16.8), while favourably matching the contralateral control kidney group, at 5.5 (2.3). The rabbits treated with saline retrograde perfusion also had better outcomes than the sham cohort. There were no adverse effects in any of the study arms or with the use of PFC. CONCLUSION:Retrograde oxygen delivery to the kidney through the urinary collecting system was successful in this pilot study. Renal function, laboratory and histological data indicate a trend towards renal preservation and even systemic oxygenation in the experimental groups compared with the sham rabbits, with no adverse effects attributed to this technique.

背景与目标： 目的：研究通过使用含氧的全氟化碳（PFC）乳剂通过逆行进入肾脏的一种新的灌注方法来保护肾脏，因为在泌尿外科手术中保留肾脏功能一直是遥不可及的，而保留肾单位的手术技术已经得到了广泛应用在现代泌尿外科中的应用和实践。
材料与方法：经过机构审查和批准，对30只新西兰白兔进行了研究。在孤立的肾脏模型中，每只兔子在肾动脉闭塞40分钟之前就已经插入了输尿管。每只兔子被随机分为一个逆行灌注组，即假手术，常温PFC，冷冻PFC，常温盐水和冷冻盐水。维持兔子2周，在此期间测量肾功能，尿量，全身血气，体重和血清肌酐水平。死亡后，由一名不了解治疗方法的肾脏病理学家对肾脏进行单独检查和分级。
结果：逆行PFC灌注（常温和冷藏）处理的兔子的肌酐清除率变化较小，分别为3.6和4.0 mL / min / kg，而假手术组则为7.8 mL / min / kg，但也显着高于假手术组。全身静脉氧合分别为26.3和10.0 mmHg，而假手术组为0.2 mmHg。 PFC的常温灌注和冷灌注也与缺血性损伤的组织学证据较少相关，与假手术组相比，平均（sd）评分分别为13.0（13.5）和8.7（4.5），而有利的是匹配对侧对照肾脏组，为5.5（2.3）。盐水逆行灌注治疗的兔子也比假手术组有更好的预后。在任何研究组中或使用PFC均无不良影响。
结论：在这项初步研究中，通过尿液收集系统向肾脏逆行输氧是成功的。肾脏功能，实验室和组织学数据表明，与假兔子相比，实验组的肾脏保存趋势甚至全身性充氧都有趋势，而该技术没有任何不良反应。

BACKGROUND & AIMS: STUDY DESIGN:Clinical case series. OBJECTIVE:To describe a series of patients with progressive sagittal decompensation caused by failure at the caudal end of an instrumented lumbar fusion. SUMMARY OF BACKGROUND DATA:Lumbar kyphosis in association with global sagittal decompensation can be a disabling problem, particularly as a late complication of distraction instrumentation. Although kyphosis at the rostral end of instrumented fusions secondary to adjacent segment degeneration has been well described, substantially less has been documented about failure and kyphosis at the caudal end. METHODS:Patients who have a progressive lumbar kyphosis and sagittal decompensation requiring operative revision were retrospectively reviewed, and radiographic measurements of lumbar lordosis and sagittal balance were performed to study this problem. RESULTS:There were 13 patients identified. The most common mode of caudal junctional decompensation was related to failure of the most distal fixation. Sagittal decompensation occurred even in the presence of satisfactory lumbar lordosis. Revision surgery and improved sagittal balance were achieved typically using the technique of pedicle subtraction osteotomy and extension of the instrumentation to the sacrum. Osteoporosis, hip osteoarthritis, and substance abuse were commonly observed associations. CONCLUSIONS:Fixation failure at the caudal end of lumbar-instrumented fusion should be considered in patients with progressive sagittal decompensation. The high potential for failure of L5 pedicle screws after the index surgery warrants serious consideration of extending such fusions into the sacrum/ilium.

背景与目标： 研究设计：临床病例系列。
目的：描述一系列由于器械性腰椎融合器尾端衰竭引起的进行性矢状代偿失调的患者。
背景资料摘要：腰椎后凸畸形与整体矢状位代偿失调可能是一个致残的问题，特别是作为牵张器械的晚期并发症。尽管已经很好地描述了继相邻节段变性之后的器械融合术的延髓末端处的后凸畸形，但有关尾端处的失败和后凸畸形的文献报道却很少。
方法：回顾性分析需要进行手术翻修的进行性腰椎后凸畸形和矢状面代偿失调的患者，并对腰椎前凸和矢状面平衡进行射线照相以研究该问题。
结果：共鉴定出13例患者。尾椎关节失代偿的最常见模式与最远端固定失败有关。即使在令人满意的腰椎前凸下，也会发生矢状面代偿失调。通常使用椎弓根减法截骨术和将器械扩展至the骨的技术可实现翻修手术和改善矢状位平衡。骨质疏松症，髋骨关节炎和药物滥用是常见的协会。
结论：进行性矢状代偿失调的患者应考虑腰椎融合器尾端的固定失败。分度手术后L5椎弓根螺钉失败的可能性很高，因此必须认真考虑将这种融合扩展到s骨/ il骨中。

BACKGROUND & AIMS: BACKGROUND:We examined loss of heterozygosity (LOH) of the P53 gene in bladder cancer, and investigated the role of the P53 gene on malignant progression of papillary tumors. In addition, the clonality of recurrent bladder cancer was examined. METHODS:LOH of the P53 gene was analyzed in 67 bladder cancers from 47 patients. DNA was extracted from formalin-fixed, paraffin-embedded tissues, amplified by the polymerase chain reaction (PCR) at 3 polymorphic loci in the P53 gene, and analyzed with nonradioisotopic single-strand conformation polymorphism (Non-RI SSCP) analysis. RESULTS:Out of 40 informative samples, LOH was detected in 13 samples, containing 4 of 7 in grade 3 (57%), 9 of 23 in grade 2 (39%), and none of 10 in grade 1 (10%). Statistical significance was observed between the LOH in grades 1 and 2, and in grades 1 and 3. An analysis of 5 cases showing malignant progression revealed that 3 (60%) showed an LOH in the primary tumor, and 2 showed LOH in recurrent tumors, in contrast to LOH found in 3 cases of 19 (16%) not showing malignant progression. Four cases with metachronous recurrence exhibited LOH; 2 at recurrent tumors, 1 only at the initial tumor, and 1 at both tumors. CONCLUSIONS:The alterations of the P53 gene were considered to correlate with tumor grade, and contribute to the malignant progression of bladder cancer. LOH in the P53 gene may serve as a clinical indicator for prognosis in superficial bladder cancer.

背景与目标： 背景：我们检查了膀胱癌中P53基因的杂合性（LOH）缺失，并研究了P53基因在乳头状瘤恶性进展中的作用。另外，检查了复发性膀胱癌的克隆性。
方法：分析了47例患者的67例膀胱癌中P53基因的LOH。从福尔马林固定，石蜡包埋的组织中提取DNA，在P53基因的3个多态性位点处通过聚合酶链反应（PCR）进行扩增，并通过非放射性同位素单链构象多态性（Non-RI SSCP）分析。
结果：在40个信息量样本中，在13个样本中检测到LOH，其中3个7级中有4个（57％），2个23级中有9个（39％），1个10级中没有10个（10％）。在1级和2级以及1级和3级的LOH之间观察到统计学意义。对5例恶性进展的分析表明，3例（60％）在原发性肿瘤中显示LOH，2例在复发性肿瘤中显示LOH。 ，与LOH在19例（16％）的3例中未显示出恶性进展的情况相反。 4例异时复发表现为LOH。在复发性肿瘤中2个，仅在初始肿瘤中1个，在两个肿​​瘤中1个。
结论：P53基因的改变被认为与肿瘤的分级有关，并有助于膀胱癌的恶性进展。 P53基因中的LOH可作为浅表性膀胱癌预后的临床指标。

BACKGROUND & AIMS: :Left ventricular (LV) dysfunction and/or heart failure (HF) are frequent complications of hypertension and myocardial infarction (MI), placing affected patients at increased risk of significant morbidity and premature death. Given that the renin-angiotensin-aldosterone system (RAAS) is activated and of pathophysiological importance in such patients, a strong therapeutic rationale exists to target the main effector mechanism (that is, angiotensin II [Ang II]) in order to lessen the associated morbidity and mortality burden. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce mortality and LV dysfunction and to slow disease progression in patients with HF, including high-risk, post-MI patients. However, ACE inhibitors (ACE-Is) may not provide optimal long-term RAAS blockade (a finding that is associated with a worse prognosis) and many patients are unable to tolerate such therapy (because of troublesome dry cough, for example). In contrast, Ang II receptor blockers (ARBs) may block the RAAS more completely than ACE-Is and appear to be better tolerated. Several large-scale trials gave evaluated the efficacy of ARBs in patients with LV dysfunction and/or HF (including high-risk, post-MI patients), and have confirmed their utility as an efficacious and well-tolerated alternative to ACE-Is in this setting.

背景与目标： ：左心室（LV）功能障碍和/或心力衰竭（HF）是高血压和心肌梗塞（MI）的常见并发症，使受影响的患者罹患显着发病率和过早死亡的风险增加。鉴于肾素-血管紧张素-醛固酮系统（RAAS）已被激活并且在此类患者中具有重要的病理生理意义，因此存在针对主要效应机制（即血管紧张素II [Ang II]）的强大治疗原理，以减轻相关的疾病。发病率和死亡率负担。血管紧张素转换酶（ACE）抑制剂已被证明可以降低HF患者（包括高危MI后患者）的死亡率和LV功能障碍，并减缓疾病进展。但是，ACEI（ACE-Is）可能无法提供最佳的长期RAAS阻断作用（这一发现与更坏的预后相关），并且许多患者无法忍受此类治疗（例如，由于干咳引起的麻烦）。相比之下，Ang II受体阻滞剂（ARBs）可能比ACE-Is更完全地阻断RAAS，并且似乎具有更好的耐受性。几项大规模试验评估了ARB在LV功能不全和/或HF患者（包括高风险，MI后患者）中的疗效，并证实了其作为ACE-Is的有效且耐受性良好的替代品的用途。此设置。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:To assess whether interindividual variation in renal plasma flow or in its response to angiotensin II infusion is associated with interindividual differences in blood pressure in a population-based sample of 287 non-Hispanic whites (143 women and 144 men), aged 20-49.9 years.

METHODS:After seven days of eating a high-sodium diet (260 mmol/day), the renal plasma flow was determined by measuring the clearance of p-aminohippurate before and after infusion of 3 ng/kg per min angiotensin II. Multiple linear regression methods were used to assess whether measures of the renal plasma flow and of its response to angiotensin II infusion were predictive of systolic or diastolic blood pressures measured prior to administration of the high-sodium diet, on day 6 of the high-sodium diet, or during the renal clearance procedure on day 7 prior to angiotensin II infusion.

RESULTS:There was some evidence that measures of the renal plasma flow and of its response to angiotensin II infusion during the high-sodium diet were statistically significant predictors of measures of blood pressure in women; there was less evidence for this for blood pressures in men. Interindividual variation in measures of the renal plasma flow and of its response to angiotensin II infusion explained less than 10% of the interindividual variation in any measure of the blood pressure in both sexes.

CONCLUSION:These results suggest that interindividual variation in renal plasma flow ad in its response to angiotensin II infusion during a high-sodium diet will be of limited utility in elucidating the basis for interindividual differences in blood pressure.

背景与目标： 目标：在以人群为基础的287名非西班牙裔白人（143名女性和144名男性，年龄20-49.9岁。

方法：进食高钠饮食（260 mmol /天）7天后，通过测量来确定肾脏血浆流量输注前后每分钟3 ng / kg血管紧张素II对对氨基马尿酸盐的清除率。使用多种线性回归方法评估在高钠饮食第6天服用高钠饮食之前测量的肾血浆流量及其对血管紧张素II输注的反应是否可预测收缩压或舒张压饮食，或在输注血管紧张素II的第7天进行肾脏清除手术期间。

结果：有证据表明，可以测量肾脏血浆流量及其对血管紧张素II的反应高钠饮食期间的输注是女性血压测量的统计学上显着的预测因子；男性血压下降的证据较少。肾脏血浆流量及其对血管紧张素II输注反应的个体差异解释了男女血压测量中个体差异的不足10％。

结论 >：这些结果表明，在高钠饮食期间，肾血浆流量的个体差异及其对血管紧张素II输注的反应在阐明个体间血压差异的依据方面将发挥有限的作用。