后腹腔镜保留肾单位手术术式对术肾肾功能的影响

目的：探讨后腹腔镜保留肾单位手术（LNSS）术式对术肾肾功能的影响。方法：2009年1月-2010年12月行经后腹膜途径腹腔镜保留肾单位手术例26。男16例,女10例。随访时间〉1年的有18例。年龄40-70岁。肾细胞癌23例,肾嫌色细胞癌2例,肾平滑肌瘤1例。肿瘤直径2.6-3.2cm,平均2.9cm。所有患者术中阻断肾动脉,剪刀切除肿瘤。术中肾动脉阻断时间20-30min,平均26.4分钟。分别于术前、术后2周、术后3月、术后1年测定双肾显像、血清肌酐、血清胱抑素。结果：18例患者术肾术前GFR及占总GFR的比例分别为53.2±7.8 ml/min和50.7±3.6%,术后两周GFR及占总GFR的比例分别为31.2±8.9 ml/min和35.8±5.8%,术后3月GFR及占总GFR的比例分别为34.7±8.6 ml/min和38.4±5.3%,术后1年GFR及占总GFR的比例分别为41.1±9.7 ml/min和43.2±6.2%。血清肌酐及血清胱抑素术前术后对比因为受对侧肾功能的影响不能反映对分肾功能的影响。结论：LNSS术式对于直径小于4cm的肾早期肿瘤是切实可行的。     

后腹腔镜保留肾单位手术术式对术肾肾功能的影响

目的:探讨后腹腔镜保留肾单位手术(LNSS)术式对术肾肾功能的影响。方法:2009年1月-2010年12月行经后腹膜途径腹腔镜保留肾单位手术例26。男16例,女10例。随访时间>1年的有18例。年龄40-70岁。肾细胞癌23例,肾嫌色细胞癌2例,肾平滑肌瘤1例。肿瘤直径2.6-3.2cm,平均2.9cm。所有患者术中阻断肾动脉,剪刀切除肿瘤。术中肾动脉阻断时间20-30min,平均26.4分钟。分别于术前、术后2周、术后3月、术后1年测定双肾显像、血清肌酐、血清胱抑素。结果:18例患者术肾术前GFR及占总GFR的比例分别为53.2±7.8 ml/min和50.7±3.6%,术后两周GFR及占总GFR的比例分别为31.2±8.9 ml/min和35.8±5.8%,术后3月GFR及占总GFR的比例分别为34.7±8.6 ml/min和38.4±5.3%,术后1年GFR及占总GFR的比例分别为41.1±9.7 ml/min和43.2±6.2%。血清肌酐及血清胱抑素术前术后对比因为受对侧肾功能的影响不能反映对分肾功能的影响。结论:LNSS术式对于直径小于4cm的肾早期肿瘤是切实可行的。     

后腹腔镜下保留肾单位肾部分切除术后肾功能的影响因素分析

目的:分析后腹腔镜下保留肾单位肾部分切除术后患肾肾功能的影响因素。方法:回顾性分析2011年5月~2013年10月本院收治的45例行后腹腔镜下肾部分切除术肾癌患者的临床资料,采用99mTc-DTPA肾核素扫描评估术前及术后3月术侧肾的肾小球滤过率(GFR)。结果:手术时间100~240min,平均(135±33.21)min。肾动脉阻断时间(20.01±7.35)min,肿瘤大小(3.05±1.24)cm。术前及术后3月术肾GFR分别是(46.53±6.35)、(32.22±4.65)ml/min。术侧肾术后GFR下降(15.36±2.36)ml/min,与术前相比下降约34%。经随访1月-2年,无复发及转移病例,患者全部无瘤生存。影响手术前后血肌酐水平变化的相关因素主要为手术时间、阻断时间、气流量、术中失血量(P0.05);影响手术前后GFR水平变化的相关因素主要为阻断时间、气流量、手术时间(P0.01)。术前肾功能情况、缺血时间和肿瘤最大径是术侧肾功能下降程度的独立预测因子;术前肾功能情况和肿瘤最大径是总体肾功能下降程度的独立预测因子。结论:后腹腔镜下保留肾单位肾部分切除术后患肾肾功能的影响因素包括术前肾功能、手术时间、肾动脉阻断时间、气流量、术中失血量、肿瘤大小等。     

NGAL对直接PCI术后对比剂肾病的早期诊断价值

目的:评价NGAL在急性心肌梗死患者直接PCI术后预测CIN的诊断作用.方法:选择2009.01～2009.12我科收治的65例行直接PCI的急性心肌梗死患者,测定介入治疗前和术后8～12h、48h的血清肌酐变化情况,确定发生对比剂肾痛的患者.分别收集术前、术后8～12h血清标本置于-80℃冰箱,采用ELISA法测定各组血清中NGAL表达水平,观察术后NGAL浓度对CIN的诊断价值.结果:①145例术前肌酐正常的PCI患者,术后共有14例患者被诊断为CIN,其中研究组有8例(12.3%)、对照组有6例(7.5%)诊断为发生了CIN.②研究组中被诊断为CIN的患者术后8～12h血清NGAL的浓度与术前比较[(9.21±0.18 vs 4.05±1.30)ng/ml,p＜0.01]有显著差异,而术后8～12h Scr、BUN、GFR等指标与术前比较差异无统计学意义,血清NGAL较Scr提前至少24h诊断CIN.ROC曲线下的面积为0.851±0.052,AUC 95%的可信区间为(0.748,0.953).根据ROC曲线结果分析,NGAL预测CIN的临界点为9.04ng/ml,对应的灵敏度为78.6%,特异度为85.2%,③单变量分析示术前NGAL水平与GFR呈负相关,与Scr、BUN、舒张压(DBP)呈正相关;术后NGAL水平与GFR呈负相关,与Scr、对比剂用量呈正相关;多元Logistic回归分析显示Scr、GFR、对比剂用量是NGAL水平的独立影响因子.结论:NGAL对于AMI患者直接PCI术后发生的CIN具有良好的预测诊断作用,为早期诊断CIN提供了新思路.     

肾脏部分切除手术对T1a期肾癌患者炎性因子与肝肾功能的影响

目的:探讨肾脏部分切除手术对T_(1a)期肾癌患者炎性因子与肝肾功能的影响。方法:回顾性分析我院2013年6月至2016年12月收治的91例T_(1a)期肾癌患者的临床资料,按治疗方式不同分为对照组与试验组,对照组48例接受后腹腔镜根治性肾癌切除术治疗,试验组43例接受后腹腔镜肾脏部分切除手术治疗。比较两组的手术指标、治疗前后血清炎性因子、肝肾功能的变化及并发症发生情况。结果:对照组的手术时间、术中出血量均少于试验组(P0.05)。治疗后,试验组血清IL-1变化值低于对照组[(-19.47±-2.57)μg/L比(-41.61±-6.38)μg/L]、IL-6变化值低于对照组[(-8.71±-1.05)ng/L比(-18.96±-3.10)ng/L]、CRP变化值低于对照组[(-12.72±-1.54)mg/L比(-17.46±-2.64)mg/L]、TNF-α变化值低于对照组[(-5.66±-0.15)ng/L比(-14.33±-2.04)ng/L]、BUN变化值低于对照组[(-1.53±-0.19)mmol/L比(-3.01±-0.79)mmol/L]、AST变化值低于对照组[(-15.29±-2.46)U/L比(-33.70±-3.78)U/L]、ALT变化值低于对照组[(-19.46±-2.27)U/L比(-34.02±-5.51)U/L],试验组Ccr变化值低于对照组[(19.78±2.94)mL/min比(28.26±3.52)mL/min]、GFR变化值低于对照组[(14.45±1.48)mL/min比(29.36±1.91)mL/min],除CRP和GFR外,其余指标差异均有统计学意义(P0.05)。对照组和试验组并发症发生率分别为16.67%(8/48)和9.30%(4/43),两组比较差异无统计学意义(P0.05)。结论:后腹腔镜肾脏部分切除手术治疗T_(1a)期肾癌患者的临床效果优于后腹腔镜根治性肾癌切除术治疗,其对患者炎性因子及肝肾功能的影响较小,安全性更高。     

后腹腔镜下肾部分切除术对肾癌患者肾功能和预后的影响

目的:探讨后腹腔镜下肾部分切除术对肾癌患者肾功能以及近远期预后的影响。方法:回顾性分析2012年1月～2017年8月在我院接受手术治疗的肾癌患者92例,根据不同手术治疗方法分为观察组(n=48)和对照组(n=44)。对照组行传统开放手术治疗,观察组行后腹腔镜下肾部分切除术。对比两组患者术前、术后血清肌酐(Cr)、血尿素氮(BUN)、β2-微球蛋白(β2-MG)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平的变化,术后1年、3年、5年生存率及切口感染、肺部感染、腹部疼痛、肾周血肿等并发症的发生情况。结果:观组患者手术时间、术后胃肠功能恢复时间、住院时间均明显短于对照组(P0.05),术中出血量、术后引流管引流量均显著低于对照组(P0.05)。术后1个月、术后2个月,两组患者血清Cr、BUN、β2-MG表达水平均较治疗前上升,且观察组以上指标显著低于对照组(P0.05)。术后,两组患者血清CRP、IL-6水平虽有升高,但观察组以上指标明显低于对照组(P0.05)。两组患者术后3年、5年的生存率均较术前下降,但观察组均分别高于对照组(P0.05)。术后,两组患者均有出现切口感染、肺部感染、腹部疼痛、肾周血肿等并发症,观察组总发生率(10.42%)明显低于对照组(29.54%,P0.05)。结论:后腹腔镜下肾部分切除术治疗肾癌患者可缩短患者的住院时间,对肾功能影响小,明显提高患者术后3年、5年生存率,且安全性更高。     

腹腔镜膀胱癌根治术的治疗效果及对血清前梯度蛋白-2的影响及其意义

目的:探讨腹腔镜膀胱癌根治术的治疗效果及对血清前梯度蛋白-2(AGR2)的影响及其意义。方法:选取2013年3月～2016年5月我院收治的80例膀胱癌患者为研究对象,同时选取同期体检健康的志愿者30例作对照组。膀胱癌患者择期行腹腔镜根治术,观察手术时间、术中出血量、术后肠道排气时间、住院时间和术后并发症。采用ELISA法检测膀胱癌患者术前和术后4周血清AGR2水平的变化。术后随访至2017年12月25日,分析血清AGR2水平与患者总生存期(OS)和无进展生存期(PFS)的关系。结果:80例患者顺利完成腹腔镜根治术,无中转开放手术,无死亡,手术时间(359.8±45.7)min,术中出血量(423.8±109.4)mL,术后肠道排气时间(3.2±1.4)d,术后住院时间(12.9±2.4)d。膀胱癌患者术前血清AGR2水平显著高于对照组[(33.5±9.4) vs.(8.5±2.1)ng/m L,P0.05],术后4周血清AGR2较术前显著降低[(17.8±4.1) vs.(33.5±9.4) ng/mL,P0.05]。术后4周血清AGR2低水平患者PFS(23vs14月,P0.05)和OS (36vs23月,P0.05)均显著大于高水平患者(P0.05)。结论:腹腔镜膀胱癌根治术治疗效果满意,可显著降低患者血清AGR2水平。血清AGR2水平的变化有助于腹腔镜根治术的治疗效果和预后预测。     

脾切断流术对肝硬化门静脉高压症患者肝功能的影响

目的:观察脾切断流术对肝硬化门静脉高压症患者肝功能的影响.方法:回顾性分析2010年4月-2011年12月在我科住院的肝硬化门静脉高压症患者行脾切除术前后肝功能的变化.应用超声多普勒分别检测手术前后门静脉血流量(portal venous flow,PVF)、肝动脉血流量(hepatic arterial flow,HAF),术中采用水柱法测量自由门静脉压力(free portal pressure,FPP).结果:肝硬化门静脉高压症患者共480例,行脾切除加贲门周围血管离断术450例,单纯脾切除30例.PVF由术前的(1368± 402) ml/min减少至术后的(986±295)ml/min(P＜0.01);HAF由术前的(412± 68)ml/min增加至术后的(526±132)ml/min(P＜0.01);FPP由术前的(30±6)cm H2O降至术后的(26±5)cm H2O(P＜0.01).R15 ICG由术前的(18±8)％降至术后的(16±7)％(P＞0.05).肝功能Child分级A级患者比例由术前的85％增加至术后的95％(P＜0.01).其他肝功能指标如TBIL素、凝血酶原延长时间及腹水消失率都明显好转.结论:脾切断流术后PVF虽然减少,但是HAF增加及术后门体分流减少均有利于肝功能的恢复.     

养血清脑颗粒对老年脑梗死后抑郁患者血清胱抑素C及认知功能的影响

目的:探究养血清脑颗粒对老年脑梗死后抑郁患者血清胱抑素C水平的影响及认知功能水平的影响。方法:选取2015年6月到2016年6月我院神经内科收治的老年脑梗死后抑郁患者74例,根据随机数字对照表分为对照组与试验组,各37例。对照组采用口服盐酸帕罗西汀治疗,试验组联合给予养血清脑颗粒治疗,4周为一个疗程,共治疗一个疗程。比较两组患者临床疗效、血清胱抑素C水平及认知功能水平。结果:治疗结束后,与对照组相比,试验组临床总有效率较高(P0.05),治疗后两组血清胱抑素C水平较治疗前降低(P0.05),MMSE评分较治疗前升高(P0.05);与对照组相比,血清胱抑素C水平较低(P0.05),MMSE评分较高(P0.05)。结论:养血清脑颗粒治疗老年脑梗死后抑郁患者临床疗效显著,认知功能明显改善,推测其与血清胱抑素C水平降低有关。     

胱抑素在肾综合征出血热患者中的动态变化及意义

目的:观察肾综合征出血热(HFRS)患者血清胱抑素的动态变化,并探讨其临床意义。方法:选取2010年10月至2013年06月哈尔滨医科大学附属第二医院感染科住院肾综合征出血热患者106例为研究对象,按病期(发热期、极期、多尿期、恢复期)采集血液标本,采用免疫比浊法检测血清胱抑素(CysC)水平,用全自动生化仪分析血尿素氮(BUN)、血肌酐(SCr)水平,比较不同分期及分型HFRS患者的CysC的水平,并分析CysC与BUN和SCr的相关性。结果:HFRS患者血清CysC各期均明显高于健康对照组(P0.05),病程极期时达高峰,多尿期时开始下降,恢复期时明显降低、但仍高于对照组;重症组患者在发病早期和极期时均显著高于轻症组(P0.05)。CysC与BUN和SCr的Pearson相关系数分别为r=0.7688和r=0.8071(P0.05),CysC与BUN和SCr之间有很好的正相关性。结论:血清CysC可较为敏感地反映HFRS患者肾脏损伤,其检测对于病情的发展和预后判断均有重要的临床意义。     

The glomerular filtration rate,effective renal plasma flow,and renal blood flow in the adult male chacma baboon (Papio ursinus)

Abstract: The radionuclide determination of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) has been validated in man, but not in the primate. GFR, ERPF, and renal blood flow (RBF) were measured in a group of 12 adult male chacma baboons using radiopharmaceuticals. GFR was determined using ^99mtechnetium-labelled diethylenetriamine-pentacetic acid. ERPF was measured with ¹³¹iodine-labelled hippuran. RBF, body surface area, and kidney weights were calculated using standard formulae. GFR was 49 ± 11 ml/min and ERPF was 237.9 ± 54.2 ml/min. Calculated RBF was 430.7 ± 111.9 ml/min and 507.4 ± 138.4 ml/min/100g of renal tissue. The results are in agreement with those obtained using more laborious nonradioisotopic techniques such as para-aminohippurate (PAH) and creatinine clearance and could serve as baseline normal values in the adult male chacma baboon.     

Differential effects of dietary sodium intake on blood pressure and atherosclerosis in hypercholesterolemic mice

The amount of dietary sodium intake regulates the renin angiotensin system (RAS) and blood pressure, both of which play critical roles in atherosclerosis. However, there are conflicting findings regarding the effects of dietary sodium intake on atherosclerosis. This study applied a broad range of dietary sodium concentrations to determine the concomitant effects of dietary sodium intake on the RAS, blood pressure, and atherosclerosis in mice. Eight-week-old male low-density lipoprotein receptor ?/? mice were fed a saturated fat-enriched diet containing selected sodium concentrations (Na 0.01%, 0.1%, or 2% w/w) for 12 weeks. Mice in these three groups were all hypercholesterolemic, although mice fed Na 0.01% and Na 0.1% had higher plasma cholesterol concentrations than mice fed Na 2%. Mice fed Na 0.01% had greater abundances of renal renin mRNA than those fed Na 0.1% and 2%. Plasma renin concentrations were higher in mice fed Na 0.01% (14.2±1.7 ng/ml/30 min) than those fed Na 0.1% or 2% (6.2±0.6 and 5.8±1.6 ng/ml per 30 min, respectively). However, systolic blood pressure at 12 weeks was higher in mice fed Na 2% (138±3 mm Hg) than those fed Na 0.01% and 0.1% (129±3 and 128±4 mmHg, respectively). In contrast, mice fed Na 0.01% (0.17±0.02 mm²) had larger atherosclerotic lesion areas in aortic roots than those fed Na 2% (0.09±0.01 mm²), whereas lesion areas in mice fed Na 0.1% (0.12±0.02 mm²) were intermediate between and not significantly different from those in Na 0.01% and Na 2% groups. In conclusion, while high dietary sodium intake led to higher systolic blood pressure, low dietary sodium intake augmented atherosclerosis in hypercholesterolemic mice.     

PGl2 analogue mitigates the progression rate of renal dysfunction improving renal blood flow without glomerular hyperfiltration in patients with chronic renal insufficiency.

Renal blood flow decreases with the progression of chronic glomerulonephritis (CGN). This disease induces medullary ischemia and further renal dysfunction in patients with chronic renal insufficiency (CRI). Prostacyclin (PGI2), with its vasodilative action, increases renal blood flow (RBF) without increasing glomerular filtration rate (GFR). We therefore examined the possibility that PGI2 would mitigate the progression of renal dysfunction by increasing RBF in patients with CRI. Sixteen patients with progressive renal insufficiency (serum creatinine: 2.14+/-0.89 mg/dl) due to CGN were prospectively chosen for this study. The blood pressure was already under control using calcium channel blockers before and during this study in nine hypertensive patients. In the first 6 months the patients received a low-protein (0.6 g/kg/day) and low-salt (5.0 g/day) diet. In the next 6 months they received 60 microg/day of PGI2 analogue (Beraprost sodium) orally. GFR was determined by 24-hour creatinine clearance, and effective renal plasma flow (ERPF) was determined by 99mTc-MAG3 scintigraphy. Glomerular capillary pressure, the resistance ratio of afferent and efferent arterioles (R(A)/R(E)), and the other hemodynamic parameters from Gomez's estimation equation were determined at the start of this study, just before the administration of Beraprost and at the end of the study. The levels of GFR and ERPF were 34.6+/-12.4 and 140.6+/-52.1 ml/min at the start of this study respectively, and decreased to 28.0+/- 12.0 and 115.6+/-45.3 ml/min after the first 6 months without Beraprost. The levels of GFR and ERPF stayed at 28.1+/-15.7 and 119.2+/-57.6 ml/min after the next 6 months with Beraprost in the same patients. R(A)/R(E) increased in the first 6 months from 7.9+/-3.6 to 10.8+/-8.6, but remained constant during 6 months of Beraprost administration, at 10.5+/-8.0. These data indicate that PGI2 analogue diminishes the vascular resistance of glomerular afferent and efferent arterioles regulating the decrease of renal blood flow without glomerular hyperfiltration, thus mitigating the progression rate of renal dysfunction.     

Hemodynamic effects of different preparations of stroma free hemolysates in the isolated perfused rat kidney

We have examined the effects of Stroma Free Hemolysate (SFH) solutions in the isolated perfused rat kidney. Three types of SFH, stored for 6 to 8 months at 4 degrees C, were tested: 1) unmodified, 2) glyoxalated and lightly cross linked and 3) pyridoxalated and polymerized. All three SFH solutions, added to the perfusate at a concentration of approximately 420 mg/100ml, increased renal vascular resistance (RVR) and reduced glomerular filtration rate (GFR). Unmodified, glyoxalated and lightly cross linked and pyridoxalated polymerized SFH resulted in a rise in RVR of 55%, 38% and 33% respectively and a fall in GFR of 42%, 57% and 83% respectively. In order to determine whether storage had altered the effect of SFH on renal function, one of the forms of SFH (glyoxalated and lightly cross linked) was studied only 4-6 weeks after preparation. While this preparation caused an increase in RVR of 41% it did not alter GFR; filtration fraction (FF) rose. However, after further storage of this preparation for 6-7 months, the solution resulted in a marked decrease in GFR of 47% as well as a rise in RVR of 23%. We conclude that three different SFH preparations resulted in marked vasoconstriction and reductions in GFR. These deleterious effects on renal hemodynamics were noted at a concentration of hemoglobin well below that necessary to effectively improve oxygen content. Storage of the SFH solutions may cause or contribute to their effects on renal function. SFH solutions intended for use as blood substitutes should be tested for vasoconstrictor activity.     

Cardiac adaptation to endurance exercise in rats

Endurance exercise is widely assumed to improve cardiac function in humans. This project has determined cardiac function following endurance exercise for 6 (n = 30) or 12 (n = 25) weeks in male Wistar rats (8 weeks old). The exercise protocol was 30 min/day at 0.8 km/h for 5 days/week with an endurance test on the 6th day by running at 1.2 km/h until exhaustion. Exercise endurance increased by 318% after 6 weeks and 609% after 12 weeks. Heart weight/kg body weight increased by 10.2% after 6 weeks and 24.1% after 12 weeks. Echocardiography after 12 weeks showed increases in left ventricular internal diameter in diastole (6.39 ± 0.32 to 7.90 ± 0.17 mm), systolic volume (49 ± 7 to 83 ± 11 μl) and cardiac output (75 ± 3 to 107 ± 8 ml/min) but not left wall thickness in diastole (1.74 ± 0.07 to 1.80 ± 0.06 mm). Isolated Langendorff hearts from trained rats displayed decreased left ventricular myocardial stiffness (22 ± 1.1 to 19.1 ± 0.3) and reduced purine efflux during pacing-induced workload increases. 31P-NMR spectroscopy in isolated hearts from trained rats showed decreased PCr and PCr/ATP ratios with increased creatine, AMP and ADP concentrations. Thus, this endurance exercise protocol resulted in physiological hypertrophy while maintaining or improving cardiac function. (Mol Cell Biochem 251: 51–59, 2003)     

Dynamics of Change in Total and Regional Body Composition After Gastric Bypass in Obese Patients

Little is known on patterns of change over time in body composition, especially lean body mass (LBM), during massive weight loss after Roux‐en‐Y gastric bypass (RYGB) in obese patients. We performed sequential measurements of total and regional body composition in patients after RYGB, and we compared a subsample of patients after surgery to a nonsurgical control group of similar age and body fatness. We used dual‐energy X‐ray absorptiometry (DXA) before and at 3, 6, and 12 months after RYGB in 42 obese women (before surgery: age 39.5 ± 11.6 years; BMI 44.6 ± 6.1 kg/m²; mean ± s.d.) and in 48 control obese women referred for nonsurgical weight management, before weight loss. During 1‐year follow‐up after RYGB, there was a continuous decrease in body weight (?36.0 ± 12.5 kg at 1 year), total fat mass (FM) (?26.0 ± 9.1 kg), as well as in trunk and appendicular FM. In contrast, the decrease in total LBM (?9.8 ± 4.8 kg at 1 year), as well as in trunk and appendicular LBM, plateaued after 3–6 months. Rates of loss in weight, FM, and LBM were highest during the first 3‐month period after RYGB (6.4 ± 1.8, 4.1 ± 1.7, and 2.3 ± 1.2 kg/month, respectively), then decreased continuously for FM but plateaued for LBM. There was no evidence of a decrease in total, trunk, or appendicular LBM in weight‐reduced subjects compared to the control group. In conclusion, follow‐up of these obese women revealed a differential pattern of change in FM and LBM after RYGB. Despite an important loss in LBM, especially during the 3–6 months of initial period, LBM appears to be spared thereafter.     

Gastric bypass surgery reduces plasma ceramide subspecies and improves insulin sensitivity in severely obese patients

Bariatric surgery is associated with near immediate remission of type 2 diabetes and hyperlipidemia. The mechanisms underlying restoration of normal glucose tolerance postoperatively are poorly understood. Herein, we examined the effect of Roux‐en‐Y gastric bypass surgery (RYGB) on weight loss, insulin sensitivity, plasma ceramides, proinflammatory markers, and cardiovascular risk factors before and at 3 and 6 months after surgery. Thirteen patients (10 female; age 48.5 ± 2.7 years; BMI, 47.4 ± 1.5 kg/m²) were included in the study, all of whom had undergone laparoscopic RYGB surgery. Insulin sensitivity, inflammatory mediators and fasting lipid profiles were measured at baseline, 3 and 6 months postoperatively, using enzymatic analysis. Plasma ceramide subspecies (C14:0, C16:0, C18:0, C18:1, C20:0, C24:0, and C24:1) were quantified using electrospray ionization tandem mass spectrometry after separation with HPLC. At 3 months postsurgery, body weight was reduced by 25%, fasting total cholesterol, triglycerides, low‐density lipoproteins, and free fatty acids were decreased, and insulin sensitivity was increased compared to presurgery values. These changes were all sustained at 6 months. In addition, total plasma ceramide levels decreased significantly postoperatively (9.3 ± 0.5 nmol/ml at baseline vs. 7.6 ± 0.4 at 3 months, and 7.3 ± 0.3 at 6 months, P < 0.05). At 6 months, the improvement in insulin sensitivity correlated with the change in total ceramide levels (r = ?0.68, P = 0.02), and with plasma tumor necrosis factor‐α (TNF‐α) (r = ?0.62, P = 0.04). We conclude that there is a potential role for ceramide lipids as mediators of the proinflammatory state and improved insulin sensitivity after gastric bypass surgery.     

Effects of dietary linoleic acid on blood pressure and renal function in subtotally nephrectomized rats

The effect of a high linoleic acid diet on blood pressure, renal function, and urinary prostaglandin excretion was studied in rats with decreased renal mass. Subtotally nephrectomized (5/6 nephrectomy) male rats received either a 15% linoleic acid (high linoleic acid, HLA) diet containing 20% safflower oil or a 0.28% linoleic acid (low linoleic acid, LLA) diet containing 20% coconut oil. Sham-operated rats were also placed on either HLA or LLA diet. The subtotal nephrectomized rats developed similar degrees of hypertension during the first 3 weeks after subtotal nephrectomy. However, 4 weeks after subtotal nephrectomy, the rats on HLA diet had significantly lower blood pressure than the rats on LLA diet [HLA 152 +/- 3 (mean +/- SE) mm Hg versus LLA 171 +/- 3 mm Hg]. This difference persisted until termination of the experiment at 7 weeks after subtotal nephrectomy (HLA 159 +/- 7 mm Hg versus LLA 192 +/- 6 mm Hg). The GFR measured 7 weeks after subtotal nephrectomy was significantly lower in both of the subtotally nephrectomized groups. However, the HLA subtotal nephrectomized rats had significantly higher GFR than the LLA-treated rats (HLA 0.23 +/- 0.05 ml/min 100 g versus LLA 0.12 +/- 0.02 ml/min/100 g, P less than 0.05). There was no difference in the GFR or blood pressure in the sham-operated rats treated with HLA or LLA diet. PGE2 excretion was lower in the two groups of subnephrectomized rats, but there was no difference between the HLA and LLA treated rats. Urinary 6-ketoPGF1 alpha was not decreased by subtotal nephrectomy and there was no difference between the dietary groups. However, TXB2 excretion was higher in the groups with subtotal nephrectomy, but there was no difference between the two dietary groups. In conclusion, the HLA diet attenuates the rise in blood pressure after subtotal nephrectomy in the rat and preserves renal function. There was no difference in urinary excretion of PGE2, 6-keto-PFG1 alpha, or thromboxane B2 between the two dietary groups.     

Adverse effects of pneumoperitoneum on renal function: involvement of the endothelin and nitric oxide systems

Increased intra-abdominal pressure (IAP) during laparoscopy adversely affects kidney function. The mechanism underlying this phenomenon is largely unknown. This study was designed to investigate the involvement of endothelin (ET)-1 and nitric oxide (NO) systems in IAP-induced renal dysfunction. Rats were subjected to IAP of 14 mmHg for 1 h, followed by a deflation for 60 min (recovery). Four additional groups were pretreated with 1) ABT-627, an ET(A) antagonist; 2) A-192621, an ET(B) antagonist; 3) nitroglycerine; and 4) N(G)-nitro-L-arginine methyl ester, a NO synthase inhibitor, before IAP. Urine flow rate (V), absolute Na+ excretion (U(Na)V), glomerular filtration rate (GFR), and renal plasma flow (RPF) were determined. Significant reductions in kidney function and hemodynamics were observed when IAP was applied. V decreased from 8.1 +/- 1.0 to 5.8 +/- 0.5 microl/min, U(Na)V from 1.08 +/- 0.31 to 0.43 +/- 0.10 microeq/min, GFR from 1.84 +/- 0.12 to 1.05 +/- 0.06 ml/min (-46.9 +/- 2.7% from baseline), and RPF from 8.62 +/- 0.87 to 3.82 +/- 0.16 ml/min (-54 +/- 3.5% from baseline). When the animals were pretreated with either ABT-627 or A-192621, given alone or combined, the adverse effects of IAP on GFR, RPF, V, and U(Na)V were significantly augmented. When the animals were pretreated with nitroglycerine, the adverse effects of pneumoperitoneum on GFR and RPF were substantially improved. In contrast, pretreatment with N(G)-nitro-L-arginine methyl ester remarkably aggravated pneumoperitoneum-induced renal dysfunction. In conclusion, decreased renal excretory function and hypofiltration are induced by increased IAP. These effects are related to impairment of renal hemodynamics and could be partially ameliorated by pretreatment with nitroglycerine and aggravated by NO and ET blockade.