肾病综合征患者尿TGFβ1检测的临床意义

目的　了解肾病综合征患者尿TGFβ1水平并评价其临床意义。方法　以 2 4例健康人为对照 ,对 4 3例接受激素标准疗程治疗的肾病综合征患者治疗前后尿的TGFβ1水平 ,用ELISA法检测。结果　 14例系膜增生性肾炎(MsPGN)和 7例局灶、节段性肾小球硬化 (FSGS)尿TGFβ1增高 (32 4 .4± 14 8.3vs 2 78.3± 12 3.6pg/ml,P <0 .0 1;5 2 5 .5±136 .4vs 2 78.3± 12 3.6pg/ml,P <0 .0 5 ) ,以FSGS增高最为明显。 14例MsPGN尿TGFβ1水平与 2 4h尿蛋白排泄量呈正相关 (r =0 .5 16 ,P <0 .0 5 ) ,7例FSGS尿TGFβ1水平与 2 4h尿蛋白排泄量、血清肌酐呈正相关 (r =0 .5 16 ,P <0 .0 5 ;r =0 .6 6 7,P <0 .0 5 )。 8例微小病变肾病 (MCD)、11例膜型肾病 (MD)和 3例膜增生性肾炎 (MPGN)尿TGFβ1水平与健康对照无明显差异 (P >0 .0 5 )。 2 9例激素敏感型的患者治疗后尿TGFβ1水平明显下调 (42 4 .0± 182 .4vs 2 79.6± 14 2 .6pg/ml,P <0 .0 1) ,15例激素抵抗型的患者治疗后尿TGFβ1水平无明显变化 (P >0 .0 5 )。但加用环磷酰胺冲击治疗病情缓解后 11例病情缓解 ,尿TGFβ1水平明显下调 (436 .3± 14 5 .9vs 2 89.3± 131.1pg/ml,P <0 .0 1)。结论　尿TGFβ1水平变化可作为反映肾病综合征病情、判断病理类型及评价激素治     

尿自然杀伤细胞检测在肾小球肾炎中的临床意义

目的 研究尿自然杀伤(NK)细胞含量与肾小球肾炎(GN)细胞增生程度的关系.方法 用流式细胞仪(FCM)测定54例GN患者尿NK细胞含量,将肾活检结果按照是否存在细胞新月体、毛细血管内增殖分为急性增殖组30例与非急性增殖组24例,比较2组患者尿NK细胞含量.结果 30例急性增生性肾炎患者尿NK细胞含量为(14.8±3.3)%;24例非急性增生性肾炎患者尿NK细胞含量为(21.6±2.9)%,急性增生性肾炎患者尿NK细胞含量明显低于非急性增生性肾炎组(P<0.05).结论 NK细胞含量降低可作为间接反映GN细胞活动程度指标之一.     

系膜增生性肾小球肾炎患者尿Ⅳ型胶原,层粘连蛋白水平的变化 …

目的探讨系膜增生性肾小球肾炎(MsPGN)患者尿Ⅳ型胶原(C-Ⅳ)、层粘连蛋白(LN)的变化及其与病理改变的关系和作用.方法采用放射免疫分析法对42例肾功能正常的轻、中度系膜增生及合并肾小管病变患者及78例正常人尿C-Ⅳ、LN水平进行检测.结果MsPGN患者尿C-Ⅳ、LN水平[(42.87±5.12)μ g/L,(92.34±29.18)ng/L]明显高于正常对照组[(10.83±1.65)μ g/L,(14.45±5.2)ng/L](P＜0.001);随着系膜增生程度的增加尿C-Ⅳ、LN水平递增,在伴有肾小管病变患者尿C-Ⅳ、LN水平增高最为明显.结论MsPGN存在胶原代谢的异常,尿C-Ⅳ、LN水平随肾脏病理损害的严重程度而增高,尿C-Ⅳ、LN可作为评估MsPGN肾功能的早期指标.     

尿沉渣中Podocalyxin的检测在肾小球疾病中的应用研究

目的探讨尿沉渣中Podocalyxin（PCX）的检测在肾小球疾病中的应用价值。方法用免疫比浊法检测晨尿中的PCX含量。标本来自患有不同肾小球疾病的患者（81例）及作为对照组的未患肾小球疾病的体检者（61例）。患者按肾小球疾病的不同分成两组：肾小球患有炎症（60例），包括5种疾病类型（IgA肾病25例，紫癜性肾炎17例，狼疮性肾炎6例，膜性增生性肾小球肾炎5例，链球菌性肾小球肾炎7例）；肾小球未患有炎症（21例），包括3种疾病类型（膜性肾病5例，微小痛变肾病综合征和局灶节段性肾小球硬化16例）。结果①患者的尿沉渣中PCX含量（44．1&#177;36．6ng／ml，n=81）明显高于不患病体检者尿沉渣中的PCX含量（4．31&#177;2．97ng／ml，Y／=61）；且肾小球患有炎症的患者PCX含量（55．3&#177;36．3ng／ml，n=60）明显高于肾小球未惠有炎症的患者PCX含量（12．2&#177;4．9ng／ml，n=21）。②尿蛋白的含量明显与肾小球患有炎症的患者尿沉渣中PCX含量相关（r=0．53，P〈0．001），而与肾小球未患有炎症的患者尿沉渣中PCX含量不相关。③肾小球患有炎症的患者中，急性期的PCX含量明显高于慢性期的PCX含量（P〈0．01）。结论用免疫比浊法检测尿沉渣中的PCX含量是评估急性肾小球损伤严重性的可靠的实验室指标。     

尿TGF-β1检测在诊断慢性肾炎中的临床应用

目的 研究慢性肾炎患者尿转化生长因子β1(TGF-β1)水平的变化及临床意义。方法 以22例健康者作为正常对照组(Norm),与40例慢性肾脏疾病患者尿TGF-β1水平作比较,利用逆转录聚合酶链反应(RT-PCR)和酶联免疫吸附试验(ELISA)的方法检测尿TGF-β1水平。结果 与正常对照组(31.53±11.59 ng/mmol.Cr)相比较,16例系膜增生性肾炎(MPG)患者(76.44±24.29 ng/mmol.Cr),14例局灶性肾小球硬化症(FGS)患者(65.07±20.59 ng/mmol.Cr)和10例IgA肾炎(IgA N)患者的尿TGF-β1水平(67.01±21.95 ng/mmol.Cr)明显增高,且差异均有统计学意义(P<0.01)。结论 尿TGF-β1水平变化可作为反映慢性肾炎的病情、判断病理类型及疾病诊断和疗效观察的重要指标。     

2型糖尿病合并肾损害177例临床病理分析

目的分析2型糖尿病(T2DM)合并肾损害的临床病理特点,探讨肾穿刺活检在诊断T2DM合并肾损害时的重要性。方法回顾性分析177例T2DM合并肾损害患者的临床资料及肾穿刺活检的病理资料。结果 177例2型糖尿病合并肾损害患者占同期全部肾穿刺活检患者的6.7%(177/2653),其中女性56例,男性121例。患者年龄24~76岁,平均年龄53.4岁。病理诊断糖尿病肾病(DN)62例,非糖尿病肾病(NDRD)106例,DN合并NDRD 9例。62例DN中,I型DN 2例,IIa型5例,IIb型8例,Ⅲ型41例,Ⅳ型6例。106例NDRD中,Ig A肾病27例,膜性肾病24例,系膜增生性肾小球肾炎21例,高血压肾损伤7例,肾小管间质性炎6例,局灶节段性肾小球硬化症(FSGS)和局灶增生硬化性肾小球肾炎各5例,ANCA相关性血管炎性肾损伤4例,增生硬化性肾小球肾炎3例,淀粉样变性肾病、膜增生性肾小球肾炎、过敏性紫癜性肾炎和新月体性肾小球肾炎各1例。9例DN合并NDRD中,Ⅲ型DN+Ig A肾病、IIa型DN+膜性肾病和Ⅲ型DN+局灶增生性肾小球肾炎各2例,Ⅲ型DN+系膜增生性肾小球肾炎、Ⅲ型DN+ANCA相关性血管炎性肾损伤和IIb型DN+Ⅳ型狼疮性肾炎各1例。结论 T2DM合并肾损害可以是DN也可以是NDRD,还可以是DN合并NDRD,不同的病理类型在临床治疗和预后上有很大的差异。肾穿刺活检可以从组织学上明确诊断,为治疗和判断预后提供依据。     

289例中晚期肿瘤病人外周血T淋巴细胞表型分析

目的 :分析中晚期肿瘤病人外周血T淋巴细胞亚群测定值的特点 ,探讨其影响因素及临床意义。方法 :采用流式细胞术检测 2 89例中晚期肿瘤病人外周血T淋巴细胞亚群水平。结果 :2 89例中晚期肿瘤病人外周血T淋巴细胞亚群测得值分别为CD3+ 细胞 5 9 0 7± 14 2 8,CD4 + 2 4 70± 10 70 ,CD8+ 33 4 5± 12 72 ,CD4 /CD80 89± 0 5 6。除性别对CD3表达的影响具有统计学意义外 (P =0 0 0 3) ,其余指标不受患者性别及年龄的影响 (P >0 0 5 )。结论 :中晚期肿瘤患者普遍存在T淋巴细胞介导的细胞免疫功能下降。     

小儿肾小球疾患血清可溶性白细胞介素-2受体的改变

本用双抗体夹心ELISA法检测52例肾小球疾患患儿血清可溶性白细胞介素-2受体（SIL-2R)浓度,并以20例正常儿作对照。结果发现27例肾病综合征的SIL-2R浓度为396．27±195．79(x±s,μ／ml)．12例急性肾小球肾炎为548.33±199．82．13例过敏性紫癜肾炎为377．69±156．70,均高于20例正常儿对照组227．5±161．04。经t检验各肾小球疾患组与正常对照组P<0.1或P<0．05有显差异,说明在肾小球疾患活动期T淋巴细胞被激活。     

阵发性睡眠性血红蛋白尿症患者外周血T淋巴细胞亚群及活化分子表达的研究

目的　探讨阵发性睡眠性血红蛋白尿症 (PNH)患者T淋巴细胞的功能及活化状态与PNH临床的关系。方法　应用流式细胞术及免疫磁珠分选术 ,测定了 18例PNH患者外周血单个核细胞 (PBMNC)及CD59+ 和CD59-PBMNC中CD3 + 、CD4+ 及CD8+ 细胞表型 ,并测定了新诊断的未经治疗的 6例PNH患者外周血中NK细胞及CD4+ CD2 8+ /CD4+ 、CD8+ CD2 8+ /CD8+ 、CD4+ HLR DR+ /CD4+ 、CD8+HLR DR+ /CD8+ 及CD8+ CD3 8+ /CD8+ 淋巴细胞表面分子表达比值。结果　PNH患者PBMNC中CD3 +CD8+ /CD3 + CD4+ 细胞比值增加 ,为 1.2 2± 0 .5 1,对照组为 0 .86± 0 .2 7,两者比较 ,差异有显著性 (P <0 .0 5 )。分选后PNH患者CD59-PBMNC中CD3 + CD8+ /CD3 + CD4+ 细胞比值增加 ,为 2 .31± 1.5 6 ,CD59+PBMNC为 0 .6 2± 0 .2 7,两者比较 ,差异有统计学意义 (P <0 .0 1)。CD3 + CD8+ /CD3 + CD4+ 细胞比值与骨髓衰竭 (BMF)的级差相关分析呈正相关。PNH患者CD4+ CD2 8+ /CD4+ 细胞比值明显减少 ,为 0 .5 2±0 .11(对照为 1.0 0± 0 .0 6 ) ,而CD8+ HLR DR+ /CD8+ 增加 ,为 0 .4 5± 0 .2 6 (对照为 0 .10± 0 .0 6 )。结论　PNH患者CD3 + CD8+ /CD3 + CD4+ 细胞比值增加 ,病变表型细胞更易发生在CD8+ 细胞群中。CD4+ 细胞中CD2 8+ 辅助刺激因     

肾康胶囊对急性肾小球肾炎治疗作用的临床研究

目的 :观察自行组方研制的肾康胶囊治疗急性肾小球肾炎的临床疗效。方法 :将 38例肾病专科门诊急性肾小球肾炎患者随机分两组 ,对照组给予青霉素 80× 10 4 U肌肉注射 ,每日 2次 ,连用 2周 ;有水肿、高血压者给予利尿、降压等对症治疗。肾康胶囊组在青霉素、对症治疗基础上加服肾康胶囊 (由茯苓、泽泻、茅根、蝼蛄、鳖甲、肾炎草、生大黄等组成 ) ,每次 5粒 ,每日 3次。两组疗程均为 2周 ,疗程结束后观察两组患者用药前后的体质量、平均动脉压、2 4 h尿蛋白定量、1h尿红细胞排泄率、血尿素氮、血清肌酐、钾和钠的变化 ;2 4 h尿蛋白定量及 1h尿红细胞排泄率随访 6周。结果 :肾康胶囊能显著减轻急性肾小球肾炎患者 2 4 h尿蛋白定量〔用药 2周后由 (2 6 7± 16 2 ) m g/ 2 4 h降到 (14 8± 110 ) mg/ 2 4 h,P<0 .0 5〕及 1h尿红细胞排泄率〔用药 2周后由(46± 7)× 10 4 / h降到 (11± 6 )× 10 4 / h,P<0 .0 5 ;用药 6周肾康胶囊组 (5± 3)× 10 4 / h,对照组 (13± 8)× 10 4 / h,P<0 .0 5〕。且使用过程中无不良反应。结论 :急性肾小球肾炎加用肾康胶囊协助治疗可阻止其蛋白尿及血尿的迁延     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.