重组人生长激素联合头孢曲松治疗新生儿败血症的临床研究

目的 探讨注射用重组人生长激素联合注射用头孢曲松钠治疗患儿新生儿败血症的临床疗效。方法 选取2018年5月—2021年1月许昌市中心医院收治的86例新生儿败血症患儿作为研究对象,根据随机数字表法将86例患儿分为对照组和治疗组,每组各43例。对照组患儿微泵静脉滴注注射用头孢曲松钠20 mg/kg,1次/d。治疗组在对照组治疗的基础上腹部肌注注射用重组人生长激素,剂量0.1 IU/kg,1次/2 d。两组患儿连续治疗8 d。观察两组患儿的临床疗效,比较两组患儿症状体征改善时间,以及血清中C反应蛋白（CRP）、白细胞介素-6（IL-6）、降钙素原（PCT）、CD4⁺/CD16⁺、CD3⁺、CD4⁺水平。结果 治疗后,治疗组的总有效率（95.35%）高于对照组（81.40%）,组间差异有显著性（P<0.05）。治疗后,治疗组的体温恢复时间、拒奶消失时间、住院时间均明显短于对照组（P<0.05）。治疗后,两组的血清CRP、IL-6、PCT水平明显降低（P<0.05）;且治疗组的血清CRP、IL-6、PCT水平低于对照组（P<0.05）。治疗后,治疗组的CD4⁺/CD16⁺较治疗前显著降低,CD3⁺、CD4⁺较治疗前显著升高（P<0.05）;治疗组患者的CD4⁺/CD16⁺明显低于对照组,CD3⁺、CD4⁺高于对照组（P<0.05）。结论 注射用重组人生长激素联合注射用头孢曲松钠可提高新生儿败血症的疗效,有助于改善临床症状,降低炎症反应,改善患儿的免疫功能,药物安全性良好。     

注射用黄芪多糖联合AP方案治疗晚期非小细胞肺癌的临床研究

目的 探讨注射用黄芪多糖联合AP方案治疗晚期非小细胞肺癌的有效性与安全性。方法 选择2020年1月—2021年12月天津市第五中心医院收治的124例晚期非小细胞肺癌患者,按随机数字表法将分为对照组和治疗组,每组各62例。对照组采取AP方案治疗,即第1天静脉滴注注射用培美曲塞二钠,500mg/m²溶于100mL生理盐水;滴注完30min后再静脉滴注注射用顺铂注射用顺铂,75mg/m²溶于500mL生理盐水。在对照组基础上,治疗组第1～14天静滴滴注注射用黄芪多糖,250mg加入500mL生理盐水,1次/d。所有患者均以21d为1个疗程,连续治疗4个疗程。观察两组患者临床疗效,比较治疗前后两组患者血清细胞角蛋白片段19（CYFRA21-1）、鳞状上皮细胞癌抗原（SCC-Ag）、癌胚抗原（CEA）、白细胞介素-8（IL-8）和转化生长因子-β1（TGF-β1）水平,FACT-L评分,及外周血CD3⁺、CD4⁺水平和CD4⁺/CD8⁺和不良反应。结果 治疗后,治疗组疾病控制率（DCR）比对照组（88.71%vs70.97%）、客观缓解率（ORR）比对照组（51.61%vs33.87%）均显著升高（P<0.05）。治疗后,两组血清肺癌标志物CYFRA21-1、SCC-Ag、CEA、IL-8和TGF-β1水平均显著低于治疗前（P<0.05）,且以治疗组的下降更显著（P<0.05）。治疗后,两组FACT-L中评分及其总分比治疗前均显著增加（P<0.05）,且以治疗组的升高更显著（P<0.05）。治疗后,对照组外周血CD3⁺、CD4⁺水平和CD4⁺/CD8⁺比值治疗前均显著下降,而治疗组治疗后CD3⁺、CD4⁺水平和CD4⁺/CD8⁺比值显著升高（P<0.05）;且治疗后治疗组患者外周血CD3⁺、CD4⁺水平和CD4⁺/CD8⁺比值高于对照组（P<0.05）。治疗组白细胞减少发生率（12.90%vs32.26%）、胃肠道反应发生率（12.90%vs29.03%）、血小板减少发生率（11.29%vs25.81%）均较对照组显著下降（P<0.05）。结论 注射用黄芪多糖对AP方案具有增效减毒的功效,有望成为晚期非小细胞肺癌治疗方案的重要组成部分。     

复方斑蝥胶囊联合TAC方案治疗三阴性乳腺癌的临床研究

目的 探讨复方斑蝥胶囊联合TAC方案治疗三阴性乳腺癌的疗效。方法 选取2020年4月—2023年3月在东台市中医院就诊的100例三阴性乳腺癌患者，根据随机数字表法将100例患者分为对照组（50例）和治疗组（50例）。对照组给予TAC方案治疗，第1天静脉注射多西他赛注射液75 mg/m²、静脉滴注注射用环磷酰胺600 mg/m²、静脉注射注射用盐酸表柔比星80 mg/m²。治疗组在对照组基础上口服复方斑蝥胶囊，3粒/次，2次/d。以21 d为1个化疗周期，两组在持续治疗6个周期后分析疗效。比较两组的临床疗效、生活质量、淋巴细胞相关指标、肿瘤标志物、血清指标和不良反应的情况。结果 治疗后，治疗组的总有效率（94.00%）高于对照组（80.00%），组间比较差异显著（P＜0.05）。治疗后，两组的乳腺癌生活质量量表（QLSBC）评分低于治疗前（P＜0.05），且治疗组QLSBC评分低于对照组（P＜0.05）。治疗后，治疗组的CD8⁺比治疗前小，LMR、CD4⁺、CD4⁺/CD8⁺比治疗前大（P＜0.05）；治疗组的CD8⁺比对照组小，LMR、CD4⁺、CD4⁺/CD8⁺比对照组大（P＜0.05）。治疗后，两组的血清糖蛋白抗原（CA153）、癌胚抗原（CEA）水平均比治疗前低（P＜0.05）；治疗组血清CA153、CEA水平比对照组低（P＜0.05）。治疗后，两组的血清脂联素（ADP）水平高于治疗前，血清白细胞介素-8（IL-8）水平低于治疗前（P＜0.05）；治疗组的血清ADP水平高于对照组，血清IL-8水平低于对照组（P＜0.05）。治疗期间，治疗组的不良反应发生率比对照组低，组间比较差异显著（P＜0.05）。结论 复方斑蝥胶囊联合TAC方案有助于提高三阴性乳腺癌的疗效，有助于改善患者的免疫功能和生活质量，降低肿瘤标志物的水平和药物不良反应的发生。     

复方苦参注射液对培美曲塞联合卡铂方案治疗非小细胞肺癌的有效性与安全性评价

目的 评价复方苦参注射液对培美曲塞联合卡铂方案治疗非小细胞肺癌有效性与安全性的提高作用。方法 纳入2016年1月—2017年9月收治的80例非小细胞肺癌患者作为研究对象,并回顾性分析临床病例资料。根据治疗方式的不同,分为观察组（n=42）与对照组（n=38）。对照组采用培美曲塞+卡铂治疗,观察组采用复方苦参注射液+培美曲塞+卡铂治疗。观察并比较2组患者的治疗效果。结果 治疗后,与对照组比较,观察组患者生活质量明显改善（P<0.05）; CD3⁺、CD4⁺、CD4⁺/CD8⁺显著升高（P<0.05）,而CD8⁺明显降低（P<0.05）;患者炎性指标（IL-6、IL-10、TNF-α）水平明显较低,近期治疗有效率与疾病控制率均较高（P<0.05）,且患者生存期明显延长,不良反应发生率更低（P<0.05）。结论 复方苦参注射液联合培美曲塞卡铂方案治疗非小细胞肺癌,能显著改善患者生活质量,提高其免疫功能,并降低机体炎性水平,治疗安全有效。     

米诺环素治疗慢性牙周炎的临床疗效及其对外周血T细胞亚群、PD-1、PD-L1表达的影响

目的 探究米诺环素治疗慢性牙周炎的临床疗效及其对外周血T细胞亚群及程序性死亡分子-1（PD-1）、程序性死亡分子-1配体（PD-L1）表达的影响。方法 选择2015年1月-2017年1月在榆林市星元医院口腔科接受治疗的96例慢性牙周炎患者为研究对象。根据随机数字表法将患者分为对照组和观察组,每组各48例。对照组患者采用龈下刮治及根面平整进行治疗。观察组患者在对照组治疗的基础上在牙周袋底部缓慢注入盐酸米诺环素软膏,0.2 g/次,1次/周,边注射边后退。两组均治疗4周。观察两组患者的临床疗效,同时比较两组治疗前后的牙龈指数（GI）、菌斑指数（PLI）、牙槽骨吸收、附着丧失（CAL）以及牙周袋深度（PD）、C反应蛋白（CRP）、白细胞介素-10（IL-10）、龈沟出血指数（SBI）、外周血T淋巴细胞亚群和表面PD-1、PD-L1的表达情况。结果 治疗后,对照组患者临床总有效率为72.92%,显著低于观察组的91.67%（P<0.05）。治疗后,两组患者GI、PLI、PD、CAL和牙槽骨吸收等指标均显著降低（P<0.05）;且观察组以上各指标均显著低于对照组（P<0.05）。治疗后,两组患者龈沟液中CRP水平和SBI评分均显著降低,而龈沟液中IL-10水平显著升高（P<0.05）;且观察组龈沟液中CRP、IL-10水平和龈沟出血指数均优于对照组（P<0.05）。治疗后,两组患者外周血T淋巴细胞亚群中CD4⁺和CD4⁺/CD8⁺均显著降低,CD8⁺显著升高（P<0.05）;且观察组外周血T淋巴细胞亚群中CD4⁺和CD4⁺/CD8⁺均显著低于对照组,CD8⁺比例高于对照组（P<0.05）。治疗后,两组患者外周血CD4⁺和CD8⁺T淋巴细胞表面的PD-1和PD-L1表达水平均显著降低（P<0.05）;且观察组外周血CD4⁺和CD8⁺T淋巴细胞表面的PD-1和PD-L1表达水平均显著低于对照组（P<0.05）。结论 米诺环素治疗慢性牙周炎可有效改善患者各项牙周指标,改善牙周组织炎症反应抑制作用,在慢性牙周炎临床治疗中具有重要价值。     

丙种球蛋白联合阿糖腺苷对小儿病毒性脑炎患者血清丙二醛及超氧化物歧化酶水平的影响

目的 研究丙种球蛋白联合阿糖腺苷对小儿病毒性脑炎患者血清丙二醛及超氧化物歧化酶水平的影响。方法 选择2014年1月-2017年12月崇州市妇幼保健院的102例小儿病毒性脑炎患者,随机分为两组。对照组静脉滴注阿糖腺苷,每次7 mg,每天1次;观察组联合静脉注射丙种球蛋白,每天1 g/kg,均治疗5 d,对比两组疗效。结果 观察组的总有效率为92.16%,明显高于对照组的76.47%,差异有统计学意义（P<0.05）。观察组的呕吐消失时间、退热时间、头痛消失时间、意识清醒时间以及惊厥消失时间均显著短于对照组（P<0.05）。治疗后,两组患者的CD8⁺、CD4⁺、CD3⁺和CD4⁺/CD8⁺等细胞免疫功能指标均较治疗前显著升高（P<0.05）;且观察组CD3⁺、CD4⁺和CD4⁺/CD8⁺显著高于对照组（P<0.05）。治疗后,两组患者的血清丙二醛水平均显著降低,超氧化物歧化酶水平均显著升高（P<0.05）;且观察组显著优于对照组（P<0.05）。结论 丙种球蛋白联合阿糖腺苷可以显著改善小儿病毒性脑炎的症状,增强免疫功能,改善血清丙二醛及超氧化物歧化酶水平,减轻氧化应激反应,值得临床推荐。     

重组人干扰素α-2b联合恩替卡韦对慢性乙型肝炎患者免疫功能的影响

目的 分析重组人干扰素α-2b联合恩替卡韦对慢性乙型肝炎患者免疫功能的影响。方法 选取2016年1月-2018年1月济源市人民医院收治的慢性乙型肝炎患者95例为研究对象,根据入院顺序随机将其分为对照组和观察组,对照组49例患者给予恩替卡韦进行治疗,观察组46例患者给予重组人干扰素α-2b联合恩替卡韦进行治疗,两组患者均治疗3个月。对比两组患者的临床疗效、免疫功能变化及不良反应情况。结果 观察组治疗总有效率为89.13%,对照组治疗总有效率为77.55%,观察组显著高于对照组（P<0.05）。治疗前,两组患者的CD4⁺、CD8⁺、CD4⁺/CD8⁺、C3、C4水平均无统计学差异;治疗后,对照组CD4⁺、CD8⁺、CD4⁺/CD8⁺水平与治疗前比较差异不显著;观察组患者的CD4⁺、CD4⁺/CD8⁺水平均显著升高,CD8⁺水平显著降低（P<0.05）;治疗后,两组C3、C4水平均显著高于治疗前（P<0.05）;且观察组患者的C3、C4水平均显著高于对照组（P<0.05）。观察组不良反应总发生率为23.91%,与对照组不良反应总发生率24.49%比较,差异无统计学差异。结论 重组人干扰素α-2b联合恩替卡韦治疗慢性乙型肝炎的效果显著,该方法可有效改善患者的免疫功能、且不良反应未增加,临床应用价值较高。     

加巴喷丁胶囊联合小计量泼尼松对带状疱疹神经痛患者免疫功能及疼痛物质的影响

目的 探讨加巴喷丁胶囊联合小剂量泼尼松治疗对带状疱疹患者清神经肽Y（NPY）、P物质（SP）及T细胞亚群的影响及近期临床疗效。方法 选择海南省人民医院2015年1月-2016年12月期间收治的带状疱疹患者128例,随机数表法分为对照组与观察组,每组各64例。其中对照组患者给予小剂量泼尼松治疗,观察组患者给予加巴喷丁胶囊联合小剂量泼尼松治疗。比较两组患者近期疗效,治疗前后患者视觉模拟尺评分（VAS）、T淋巴细胞亚群变化情况（CD3⁺和CD4⁺、CD8⁺、CD4⁺/CD8⁺）及NPY和SP水平。结果 经不同方案治疗后,观察组的总有效率为95.31%,对照组总有效率为85.94%,两组相比差异显著且具有统计意义（χ²=8.67,P < 0.05）。与治疗前相比,两组患者治疗后的VAS评分显著降低,同组治疗前后比较差异有统计学意义（P < 0.05）;治疗后,观察组VAS评分显著低于对照组,差异有统计学意义（P < 0.05）。与治疗前相比,两组患者治疗后T淋巴细胞亚群CD3⁺和CD4⁺、CD4⁺/CD8⁺明显增高,同组治疗前后比较差异有统计学意义（P < 0.05）;观察组治疗后T淋巴细胞亚群CD3⁺和CD4⁺、CD4⁺/CD8⁺较对照组增加更显著,差异有统计学意义（P < 0.05）。两组NPY和SP水平较治疗前均显著下降,同组治疗前后比较差异有统计学意义（P < 0.05）;治疗后,观察组NPY和SP水平均显著低于对照组,差异有统计学意义（P < 0.05）。结论 加巴喷丁胶囊联合小剂量泼尼松治疗对带状疱疹患者能够有效改善患者临床症状,缓轻患者的神经疼痛,改善患者机体免疫功能功能,降低外周血NPY、SP水平,值得临床推广和应用。     

胸腺肽联合GP方案治疗非小细胞肺癌的临床研究

目的 观察胸腺肽联合GP方案治疗非小细胞肺癌的疗效及对免疫功能和血管内皮生长因子（VEGF）表达水平的影响。方法 选取2017年4月-2019年6月期间安康市中医医院收治的80名非小细胞肺癌患者作为研究对象,采用随机数字表法分为对照组和观察组,每组40例。对照组在第1天、第8天静脉滴注注射用盐酸吉西他滨,1.0 g/m²,1次/d,第1~3天静脉滴注注射用顺铂,25 mg/m²,1次/d。观察组在对照组的基础上口服胸腺肽肠溶片,15 mg,2次/d。21 d为1个周期,两组均治疗2个周期。观察两组患者的近期临床疗效,比较两组患者的KPS评分、免疫功能指标和血管内皮生长因子（VEGF）水平。结果 治疗后,对照组客观有效率（ORR）为47.50%,观察组为57.50%,两组差异无统计学差异。治疗后,观察组患者KPS评分优于对照组,两组比较差异具有统计学意义（P<0.05）。治疗后,两组患者的CD4⁺、CD8⁺、CD4⁺/CD8⁺及NK细胞的比例与治疗前有统计学差异（P<0.05）;治疗后,观察组患者CD4⁺、CD8⁺、CD4⁺/CD8⁺及NK细胞比例均优于对照组,差异具有统计学（P<0.05）。治疗后,两组VEGF水平均显著降低（P<0.05）;与对照组相比,观察组下降更为显著（P<0.05）。结论 胸腺肽肠溶片联合GP方案用于非小细胞肺癌的临床治疗,提高了患者的生存质量和免疫功能,降低了血清VEGF水平。     

川芎嗪联合阿奇霉素对红霉素耐药性大叶肺炎患儿的疗效及细胞因子的影响

目的 考察川芎嗪联合阿奇霉素对红霉素耐药性大叶肺炎患儿的疗效及细胞因子的影响。方法 选择180例红霉素耐药大叶性肺炎患儿为研究对象,随机分为阿奇霉素组和联合组,每组90例。阿奇霉素组给予静脉滴注10 mg/kg的注射用阿奇霉素,连用3～5 d,患儿体温恢复,且外周血白细胞恢复后,给予口服10 mg/kg的阿奇霉素干混悬剂,1次/d,连续治疗10 d。联合组在此基础上给予静脉滴注40 mg的盐酸川芎嗪注射液,1次/d,连续治疗10 d。观察比较两组的疗效、免疫球蛋白水平及炎性因子水平。结果 治疗后,阿基霉素组的有效率为77.78%,联合组为87.78%,两组有效率有显著差异（P<0.05）。治疗前,两组患儿CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺水平均无显著差异;治疗后,两组患儿CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均显著升高,CD8⁺水平显著降低,同组治疗前后比较差异有统计学意义（P<0.05）;其中联合组患儿CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均显著高于对照组,CD8⁺水平显著低于对照组,组间差异均有统计学意义（P<0.05）。治疗前,两组患儿IL-6、IL-8、IL-10水平均无显著性差异;治疗后,两组患者IL-6、IL-8、IL-10水平均显著降低,同组治疗前后比较差异有统计学意义（P<0.05）;其中联合组显著低于对照组,组间差异有统计学意义（P<0.05）。结论 川芎嗪联合阿奇霉素对红霉素耐药大叶肺炎患儿有较好的疗效,其治疗作用的发挥与调节机体免疫环境有关,能增加免疫力,减轻炎症反应,从而促进患儿的康复。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.