Registered at the UMIN (University Hospital Medical Information Network) Clinical Trials Registry with study number UMIN000008343.

BackgroundThe study aim was, for the first time, to conduct a multicenter randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgA nephropathy (IgAN).MethodsPatients with biopsy-proven IgAN, proteinuria and low serum creatinine were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were urinary protein excretion and the disappearance of proteinuria and/or hematuria.ResultsDuring 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria (odds ratio 2.98, 95% CI 1.01–8.83, P = 0.049), but did not identify an independent factor in achieving the disappearance of hematuria or clinical remission.ConclusionsThe results indicate tonsillectomy combined with steroid pulse therapy has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Although the antiproteinuric effect was significantly greater in combined therapy, the difference was marginal, and its impact on the renal functional outcome remains to be clarified.

No abstract

Highly efficient and site-specific gene transfer can be achieved by applying a few pulses of nanosecond pulsed LISWs to rat skin in vivo.

A tyrosine kinase adaptor protein containing pleckstrin homology and SH2 domains (APS) is rapidly and strongly tyrosine phosphorylated by insulin receptor kinase upon insulin stimulation. The function of APS in insulin signaling has heretofore remained unknown. APS-deficient (APS ؊/؊ ) mice were used to investigate its function in vivo. The blood glucose-lowering effect of insulin, as assessed by the intraperitoneal insulin tolerance test, was increased in APS ؊/؊ mice. Plasma insulin levels during fasting and in the intraperitoneal glucose tolerance test were lower in APS ؊/؊ mice. APS ؊/؊ mice showed an increase in the whole-body glucose infusion rate as assessed by the hyperinsulinemic-euglycemic clamp test. These findings indicated that APS ؊/؊ mice exhibited increased sensitivity to insulin. However, overexpression of wild-type or dominant-negative APS in 3T3L1 adipocytes did not affect insulin receptor numbers, phosphorylations of insulin receptor, insulin receptor substrate-1, or Akt and mitogen-activated protein kinase. The glucose uptake and GLUT4 translocation were not affected by insulin stimulation in these cells. Nevertheless, the insulin-stimulated glucose transport in isolated adipocytes of APS ؊/؊ mice was increased over that of APS ؉/؉ mice. APS ؊/؊ mice also showed increased serum levels of leptin and adiponectin, which might explain the increased insulin sensitivity of adipocytes. Diabetes 52: [2657][2658][2659][2660][2661][2662][2663][2664][2665] 2003 I nsulin signaling begins with the binding of insulin to its receptor present on the cell surface, and activation of the insulin receptor tyrosine kinase results in tyrosine phosphorylation of a number of intracellular substrates. These molecules, including the insulin receptor substrate (IRS) family (1), src homology and collagen (2), Gab1 (3), and Grb10 (4), act as adaptor molecules that link between the insulin receptor and downstream signaling effectors. Adaptor protein containing a pleckstrin homology and SH2 domain (APS) is also one of the substrates that tyrosine phosphorylated by insulin receptor kinase (5,6).APS was first described to interact with an oncogenic mutant of the tyrosine kinase receptor c-Kit (7), and APS was isolated by the two-hybrid system using the cytoplasmic domain of the human insulin receptor as bait (5,6). APS (66.5 kDa) forms an adaptor protein family together with Lnk (8,9) and SH2-B (SH2-B␣, SH2-B␤, SH2-B␥, and SH2-B␦) (10 -13), whose members share a homologous NH 2 -terminal region with proline-rich stretches, pleckstrin homology and SH2 domains, and a conserved COOHterminal tyrosine phosphorylation site. It has been demonstrated that some members of this adaptor protein family act as modulators of signaling through various tyrosine kinase receptors. Lnk plays a role in regulating production of B-cell precursors and hematopoietic progenitor cells (8,14). SH2-B is an important signaling molecule in the insulin-like growth factor I (IGF-1) mediated reproductive pathway (13).APS is highly expressed in insulin-r...