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2014| July-September | Volume 1 | Issue 1
Online since
July 25, 2014
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REVIEW ARTICLE
Vacuum erectile device for penile rehabilitation
Haocheng Lin, Grace Wang, Run Wang
July-September 2014, 1(1):4-10
DOI
:10.4103/2225-1243.137541
The vacuum erectile device (VED) uses negative pressure to increase blood inflow and oxygen into the corpora cavernosum, with a ring at the base of the penis to maintain the erection for intercourse or without a ring for penile rehabilitation. As the limitation of phosphodiesterase 5 inhibitors (PDE5I) showed in the treatment of refractory erectile dysfunction (ED), the use of VED resurged and is becoming the first-line therapy in treatment of ED after radical prostatectomy. Currently, the combination therapy of VED and PDE5I and of VED and intracavernous injection are advocated. Furthermore, there has been increasing interest in the use of VED to preserve penile length in inflatable penile prosthesis preoperation procedure and Peyronie's disease. Hereby, we reviewed the underlying mechanisms, the status of VED in penile rehabilitation, the combination therapy and the expanded use of VED.
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CASE REPORT
Clinical, radiologic, and pathologic analysis of penile epithelioid hemangioendothelioma: A diagnostic and management dilemma
Darshan P Patel, Jeffrey D Redshaw, Ting Liu, Jeremy B Myers, James M Hotaling, William O Brant
July-September 2014, 1(1):48-50
DOI
:10.4103/2225-1243.137555
Epithelioid hemangioendotheliomas (EHE) are rare soft tissue tumors and only 17 cases involving the penis have been reported in the literature. These tumors are often incorrectly diagnosed as Peyronie's disease or superficial penile thrombosis. We present the case of a 59-year-old male referred to our institution with EHE after being incorrectly diagnosed with Peyronie's disease. A color Doppler ultrasound of the penis showed a highly vascular mass superficial to the tunica albuginea and a subsequent biopsy demonstrated EHE with low-grade features. Complete local excision was performed and given the patient's low-risk pathological features, he has been followed with only close surveillance. Early recognition of epithelioid vascular tumors is important and using adequate imaging modalities is critical to avoid prolonged periods of misdiagnosis.
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EDITORIALS
Preface
Run Wang
July-September 2014, 1(1):1-1
DOI
:10.4103/2225-1243.137537
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Inaugural editorial for
Journal of Integrative Nephrology and Andrology
Wen Peng
July-September 2014, 1(1):2-3
DOI
:10.4103/2225-1243.137538
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10,143
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MINI REVIEW
Elevated uric acid levels as another cause of erectile dysfunction: Hypothesis and rationale?
Baris Afsar
July-September 2014, 1(1):11-13
DOI
:10.4103/2225-1243.137543
Elevated uric acid (UA) levels has been shown to be associated with cardiovascular disease such as hypertension, coronary heart disease, heart failure, renal failure, peripheral vascular disease, metabolic syndrome, and stroke. In addition, in recent years various novel pathological entities such as endothelial dysfunction, oxidative stress, inflammation, activation of the renin angiotensin system (RAS) has been found to be associated with increased UA levels. Erectile dysfunction (ED) on the other hand has also been associated with cardiovascular risk. Besides, similar mechanisms such as endothelial dysfunction, oxidative stress and RAS have been found to be related with ED. Thus, the current hypothesis tried to explain why UA may be associated with ED.
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ORIGINAL ARTICLES
Improved compliance with prophylactic antibiotic guidelines in urologic prosthetic surgery using a simple protocol: Should antimicrobial prophylaxis be administered exclusively in the operating room?
Jeffrey D Redshaw, Elizabeth M Mobley, Harriet W Hopf, William T Lowrance, Jeremy B Myers, William O Brant
July-September 2014, 1(1):14-19
DOI
:10.4103/2225-1243.137545
Context:
Established guidelines advocate for the administration of antimicrobial prophylaxis (AMP) within 60 min of the surgical incision. An internal audit of genitourinary prosthetics at our institution revealed, we were compliant in only 25% of cases and led to the development of a standardized protocol emphasizing administration of AMP in the OR by the anesthesia provider and specific duties for each member of the surgical team (anesthesia, surgery, and nursing).
Aims:
The aim was to describe the system factors that we recognized as responsible and determine our protocols effect on compliance.
Settings and Design:
A retrospective review of urologic prosthetics cases performed by a single surgeon at our institution from October 2009 to January 2011 was conducted. Sixty consecutive cases occurring: Prior to the protocol, immediately after, and 18 months after it went into effect were reviewed.
Statistical Analysis:
Categorical data were compared using the Fisher's exact test and continuous variables using the Student's
t
-test at the
P
> 0.05 significance level.
Results:
System factors associated with noncompliance included: Location of antibiotic administration (OR vs. preoperative area) and timing of the case (first case vs. not). Ninety-six percent of noncompliance was the result of AMP being administered too early. Compliance increased from 25% to >91% and the proportion of AMP administered in the OR increased from 20% to >88%. No drop-off in compliance occurred 18 months after initiation of the protocol.
Conclusion:
A defined protocol in conjunction with shifting administration of AMP to the OR and into the hands of the anesthesia provider can achieve a durable increase in compliance with established guidelines.
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A study of acute renal failure in patients associated with acute liver dysfunction at vims combined hospital
Bilagumba Ramu Kiran, Jothinath Shashibhusan, Basavareddy Asha, Basavareddy Rakesh, Gadwalkar R Srikant
July-September 2014, 1(1):44-47
DOI
:10.4103/2225-1243.137554
Background and Objectives:
Renal dysfunction is common in liver diseases, either as part of multi-organ involvement in acute illness or secondary to advanced liver disease. The presence of renal impairment in both groups is a poor prognostic indicator. The main aim of the current study is to find out the etiology, clinical features, and incidence of patients who develop both acute liver failure and acute renal failure (ARF).
Materials and Methods:
This is a prospective observational study conducted for patients admitted in VIMS combined hospital from December 2010 to June 2012. All the patients with both ARF and acute liver dysfunction who met the inclusion criteria were included in the study. Data were collected after obtaining informed/written consent from patient. After detailed history, detailed clinical examination, general physical and systemic examination and relevant laboratory investigations were done.
Results:
Studies showed that the maximum number of patients were in the age group of 21-30 years with increased incidence in males, farm workers, lower income group. Most patients presented with nonspecific symptoms like fever and myalgia with more than 90% patients had abnormal urine findings and ultrasound findings implying the need for simple investigations to identify this fatal condition. This study had an overall mortality of 26.67%, with the highest mortality noted in patients with septicemia.
Conclusion:
Our study shows leptospirosis, malaria and sepsis as common causes of combined hepatic and renal dysfunction in this part of the country. Acute cases had a comparatively better prognosis and outcome than chronic cases of combined hepatic and renal dysfunction. Early diagnosis and apt treatment will reduce mortality.
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Comparison of seven kinds of calculation methods on glomerular filtration rate in patients with chronic kidney disease
Xiaoguang Zhang, Gang Yu, Niansong Wang, Qing Xue, Xiaohua Sheng, Yan Yan
July-September 2014, 1(1):20-23
DOI
:10.4103/2225-1243.137547
Objective:
The objective was to compare the diagnostic value of seven kinds of calculation methods on glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD).
Materials and Methods:
A total of 120 cases with CKD and 120 normal people were included in this study. They were grouped according to the GFR results estimated by the plasma clearance of
99m
technetium-diethylene-triamine-pentaacetate. Serum cystatin C (Cys C) concentrations were detected by enzyme-linked immunosorbent assay. GFR and serum creatinine (SCr) was simultaneously analyzed using Automatic Biochemistry Analyzer. Estimated GFR (eGFR) was detected with seven kinds of calculation methods.
Results:
Modification of diet in renal disease (MDRD) equations obtained significantly lower GFR in group CKD2, while Cockcroft-Gault (CG) equation obtained significantly lower GFR in group CKD3. There were no statistical differences between four Cys C-based equations (GFR estimated via cystatin [Cys-eGFR] formula) and GFR from CKD1 to CKD5. In the groups CKD2 and CKD3, GFRs detected by four kinds of formula Cys-eGFR were all superior to that by CG and MDRD. For the CKD patients with GFR <60 mL/min/1.73 m
2
, four kinds of receiver operating characteristic (ROC) curve area of Cys-eGFR were more than GFR estimated via creatinine (Cr-eGFR) formula, the differences were statistically significant. For those with GFR <30 mL/min/1.73 m
2
, the comparative results of ROC curve area had no statistical difference.
Conclusion:
Cys-eGFR is a more accurate equation for estimating GFR than CG and MDRD equation, but not superior to Cr-eGFR, which based on SCr in advanced chronic renal failure patients.
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Investigate the initiation time of continuous blood purification in the multiple organ dysfunction syndrome patients complicated with acute kidney injury
Xiaohua Sheng, Niansong Wang, Guihua Jian, Yan Yan, Yongping Cui, Gang Yu
July-September 2014, 1(1):24-28
DOI
:10.4103/2225-1243.137550
Objective:
The objective was to discuss the initiation time of continuous blood purification (CBP) in the multiple organ dysfunction syndrome (MODS) patients complicated with acute kidney injury (AKI).
Materials and Methods:
We retrospectively analyzed 84 MODS patients combined AKI treated with CBP in intensive care unit during January 2006 to December 2009. The Acute Physiology and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, and other medical records were reviewed. Different indications for CBP (1 - azotemia, 2 - fluid overload, 3 - hyperklemia, 4 - oliguria, and 5 - metabolic acidosis) were recorded. Patients were characterized as "early" or "late" starters, based upon whether the blood urea nitrogen was less than or greater than 25 mmol/L, prior to CBP initiation. Compare the medical records and the mortality of the two groups.
Results:
The overall mortality in hospital rate was 60.7%. The most indications for CBP initiation were azotemia (95.2%) and oliguria (78.6%). The mortality of the early was 32%, the late was 72.9% (
P
= 0.000).
Conclusion:
Earlier initiation of CBP may improve the prognosis of the MODS patients with AKI.
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Ambulatory blood pressure as a predictor of diabetic nephropathy
Guihua Jian, Yan Yan, Junhui Li, Niansong Wang
July-September 2014, 1(1):29-32
DOI
:10.4103/2225-1243.137551
Objective:
The aim was to study the ambulatory blood pressure as a predictor of diabetic nephropathy (DN).
Materials and Methods:
A total of 73 patients with DN at Stage III were selected as DN group and 73 cases with 5-10 years of diabetes were as diabetes group. The results of blood routine, biochemical indexes, dynamic blood pressure and the diversity index, which as the predictors of DN, analyzed by multivariate logistic regression analysis and compared between two groups.
Results:
Body mass index, the dose of oral glucose (GLU)-lowering drugs, the levels of fasting plasma GLU, HbA1c, total cholesterol, triglyceride, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and high-sensitivity C-reactive protein index had no statistically significant difference in two groups in the course of the disease. There were significant differences in peripheral blood leukocyte count, platelet count, erythrocyte sedimentation rate, uric acid, estimated glomerular filtration rate, average daytime systolic blood pressure (SBP), average nighttime SBP, average daytime diastolic blood pressure (DBP), average night DBP, 24 h SBP variability, daytime SBP variability and nighttime SBP variability between the two groups. In univariate analysis, we found that platelet count (
P
= 0.03), average night DBP (
P
= 0.01), nighttime SBP variability (
P
< 0.001) were the independent predictor of DN.
Conclusion:
Platelet count, average diastolic pressure and SBP at night are the independent predictors of DN.
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Level changes of adiponectin and cd146 in serum in type 2 diabetic nephropathy
Jiebo Huang, Qing Yu, Sheng Chen
July-September 2014, 1(1):33-37
DOI
:10.4103/2225-1243.137552
Objective:
The aim was to observe the level changes of adiponectin (ADPN) and CD146 in serum and clarify the properties of these peptides in patients with type 2 diabetic nephropathy (DN).
Materials and Methods:
Seventy-five patients with type 2 diabetes and 13 control subjects included in this study. Levels of ADPN and CD146 in serum were measured by enzyme-linked immunosorbent assay.
Results:
The serum level of ADPN was higher in patients with diabetes than that in controls, and it increased significantly in the DN1 group. The serum level of CD146 was considerably higher in the DN1 group than that in the other groups. The serum level of ADPN was positively correlated with the serum level of CD146 and body mass index in diabetics. The serum level of ADPN in 54 patients with diabetes and vascular atherosclerosis was significantly lower than that in 21 patients without vascular atherosclerosis. However, there was a definite relationship between the serum levels of ADPN and CD146.
Conclusion:
The serum levels of ADPN and CD146 appear to increase in patients with early DN and decrease in the final stage of DN. Serum ADPN and CD146 may protect against vascular endothelial dysfunction and mitigate endothelial dysfunction in DN. Further study is required to elucidate the exact role of ADPN and CD146 in the progression of vascular complication in DN.
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Mechanism of glial cell line-derived neurotrophic factor in proliferation of spermatogonial stem cells
Jianxin Hu, Shujie Xia, Dalong Song, Jun Liu, Zhaolin Sun
July-September 2014, 1(1):38-43
DOI
:10.4103/2225-1243.137553
Objectives:
The aim was to investigate the mechanism of glial cell line-derived neurotrophic factor (GDNF) in the proliferation of spermatogonial stem cells (SSCs) through detecting the expression of GDNF, receptor tyrosine kinases (RTKs), fyn and focal adhesion kinase (FAK) messenger ribonucleic acids (mRNAs) after gene interference.
Materials and Methods:
Multiple small interfering RNAs (siRNA) of GDNF were designed and constructed to transfect SSCs. The siRNA of GDNF with the highest efficiency was applied and expressions of GDNF, RTKs, fyn and FAK mRNA and the protein were measured with reverse transcription polymerase chain reaction and western blot, respectively. The proliferation and apoptosis of SSCs were measured with enzyme-labeled meter and flow cytometry, respectively.
Results:
The expression intensity of GDNF mRNA in SSCs of the experimental group and control group was 12.32 ± 1.22% and 54.25 ± 1.34%, respectively; the apoptosis rate was 25.43 ± 1.91% and 5.61 ± 0.16%, respectively; and there was a significant difference between the two groups (
P
< 0.01). The expression intensity of RTKs, fyn and FAK in the experimental group was 16.24 ± 1.35%, 18.32 ± 1.34%, and 20.04 ± 1.65%, respectively; the expression intensity of RTKs, fyn and FAK in the control group was 45.35 ± 1.37%, 38.37 ± 1.55% and 43.27 ± 1.28%, respectively; there was a significant difference between the two groups (
P
< 0.01).
Conclusion:
These results suggest that the constructed positive vector effectively inhibits the expression of GDNF, RTKs, fyn and FAK mRNAs, and the proliferation of SSCs. GDNF plays an important role in the proliferation of SSCs.
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Online since 1 Apr, 2014