补肾祛瘀活血汤治疗慢性肾小球肾炎患者的效果分析

目的　探讨补肾祛瘀活血汤对慢性肾小球肾炎患者肾功能及血脂的影响。方法　本研究为前瞻性研究。选取2019年7月至2021年7月临清市人民医院收治的96例慢性肾小球肾炎患者,按随机数字表法将其分为对照组和试验组,每组48例。对照组男25例,女23例,年龄（49.67±8.52）岁;试验组男26例,女22例,年龄（49.53±8.67）岁。两组均予以常规治疗,同时对照组给予氯沙坦治疗,试验组在对照组的基础上给予补肾祛瘀活血汤治疗,两组均连续治疗6个月。比较两组治疗后临床疗效,治疗前后肾功能、血脂指标水平,治疗期间不良反应情况。统计学方法采用独立样本t检验、配对t检验、χ²检验。结果　治疗后试验组临床总有效率与对照组相比升高［93.75%（45/48）比79.17%（38/48）］,两组比较差异有统计学意义（χ²=4.360,P=0.037）;治疗后试验组的血清肌酐（Scr）、尿素氮（BUN）、24 h尿蛋白定量（24 h UP）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平均低于对照组［（89.46±10.34）μmol/L比（125.35±14.18）μmol/L、（3.27±0.52）mmol/L比（6.58±0.75）mmol/L、（0.76±0.12）g/24 h比（1.45±0.27）g/24 h、（1.51±0.35）mmol/L比（2.13±0.37）mmol/L、（4.83±0.57）mmol/L比（6.76±0.75）mmol/L、（1.72±0.24）mmol/L比（3.15±0.45）mmol/L］,差异均有统计学意义（均P<0.001）;与治疗前比较,治疗后两组患者的肾小球滤过率（GFR）、血清高密度脂蛋白胆固醇（HDL-C）水平均升高,且试验组的GFR、HDL-C水平均高于对照组［（91.18±6.16）ml/（min·1.73 m²）比（75.35±9.74）ml/（min·1.73 m²）、（1.48±0.25）mmol/L比（1.16±0.23）mmol/L］,差异均有统计学意义（均P<0.001）。两组治疗期间均无严重不良反应出现。结论　补肾祛瘀活血汤治疗慢性肾小球肾炎,可有效缓解患者的临床症状,改善肾功能,调节血脂水平,且疗效显著。     

B超引导在脑外伤有创机械辅助通气患者肠内营养策略中的应用研究

目的　探讨B超引导在脑外伤有创机械辅助通气患者肠内营养（EN）策略中的应用。方法　选取2019年11月至2021年5月入住连州市人民医院重症医学科（ICU）的脑外伤有创机械通气患者共72例,随机数字表法分为参照组（36例）和试验组（36例）。参照组男24例,女12例,年龄（46.28±7.64）岁;试验组男26例,女10例,年龄（47.07±7.22）岁。两组患者均于入院后24～72 h内留置鼻胃管行EN治疗,参照组采用传统根据临床经验制定的EN方案,试验组采用改良的B超胃窦单切面法为指导制定有创呼吸机的EN方案。比较两组患者治疗前及治疗14 d后营养指标［血清总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）、血红蛋白（Hb）］,比较治疗后达到目标喂养量的时间、ICU停留时间、呼吸机使用时间,并统计EN相关并发症（返流、腹胀、腹泻、呼吸机相关肺炎、EN中断）的发生率。计量资料应用t检验,计数资料应用χ²检验或Fisher确切概率法。结果　治疗后,试验组血清TP、Alb、PA、Hb水平均优于参照组［（59.14±7.22）g/L比（55.65±7.19）g/L,（38.09±7.18）g/L比（34.16±7.53）g/L,（192.56±22.18）mg/L比（182.73±22.45）mg/L,（107.11±3.22）g/L比（105.28±3.47）g/L］（均P<0.05）。试验组患者达到目标喂养量的时间、ICU停留时间、呼吸机使用时间均较参照组明显缩短［（2.29±0.42）d比（3.68±0.47）d,（9.18±1.20）d比（11.25±1.23）d,（8.01±0.52）d比（10.17±0.55）d］（均P<0.001）。试验组腹胀、腹泻、呼吸机相关肺炎及EN中断发生率分别为5.56%（2/36）、5.56%（2/36）、2.78%（1/36）、8.33%（3/36）,均低于参照组的22.22%（8/36）、27.78%（10/36）、25.00%（9/36）、27.78%（10/36）,差异均有统计学意义（均P<0.05）。结论　应用以超声监测为导向的胃肠营养可有效降低脑外伤有创机械通气患者EN并发症的发生率、改善患者营养状态及预后相关指标,值得推广与应用。     

球囊扩张治疗血液透析患者动静脉内瘘狭窄的围术期护理效果评价

目的　评价球囊扩张治疗血液透析患者动静脉内瘘狭窄的围术期护理效果。方法　选择2019年3月至2021年4月在广州市花都区人民医院行动静脉内瘘狭窄经皮腔内血管成形术（PTA）的64例维持性血液透析患者为研究对象，2019年3月至2020年3月行PTA治疗的32例患者作为对照组，2020年4月至2021年4月行PTA治疗的32例患者作为试验组。对照组男21例、女11例，年龄（59.72±13.22）岁；试验组男23例、女9例，年龄（58.41±14.16）岁。对照组患者采用常规护理方法，试验组患者在常规护理基础上采用更全面的围术期护理干预，随访6个月。观察两组患者PTA治疗前后的血管内径、血管自然血流量、穿刺针血流量及临床检验结果，统计两组患者并发症发生率及内瘘狭窄复发率。统计学方法采用独立样本t检验、配对t检验、χ²检验。结果　两组患者PTA治疗后的血管内径、血管内自然血流量、穿刺针血流量、血红蛋白、血白蛋白、尿素清除率、血磷均较手术前有改善，而且试验组改善均明显优于对照组，差异均有统计学意义（均P<0.05）。试验组患者透析并发症发生率为12.5%（4/32），明显低于对照组的37.5%（12/32），差异有统计学意义（χ²=5.333，P=0.021）；术后随访6个月，试验组患者无内瘘狭窄复发，对照组患者有6例（18.75%）内瘘狭窄复发，差异有统计学意义（P=0.024）。结论　对接受PTA治疗动静脉内瘘狭窄的血液透析患者进行围术期的护理干预，临床效果显著，值得推广。     

门诊协同护理联合认知重构干预对老年冠心病患者的效果分析

目的　探究门诊协同护理联合认知重构干预在减少老年冠心病患者再次入院中的应用。方法　选取2019年7月至2021年7月在无锡市第二人民医院门诊治疗后定期复查的老年冠心病患者82例,以奇偶分组法均分为参照组及试验组,每组41例。参照组男18例,女23例,年龄（69.07±5.62）岁;试验组男22例,女19例,年龄（69.31±5.47）岁。参照组行认知重构干预,试验组加用门诊协同护理。对两组疾病知识掌握、自我效能测定量表及西雅图心绞痛问卷生活质量数据进行测评。统计学方法采用独立样本t检验、配对t检验、χ²检验。结果　试验组疾病知识掌握率高于参照组［95.12%（39/41）比80.49%（33/41）］,差异有统计学意义（χ²=4.100,P=0.043）;干预后,试验组自我效能的自我护理技能评分［（36.21±2.82）分比（34.51±2.74）分］、自我责任感评分［（11.26±2.74）分比（9.52±2.65）分］、自我概念评分［（25.36±2.63）分比（23.52±2.84）分］及健康知识水平评分［（48.29±2.67）分比（46.56±2.58）分］均高于参照组,差异均有统计学意义（均P<0.05）;试验组生活质量的躯体活动评分［（24.89±2.59）分比（26.53±2.63）分］、躯体症状评分［（23.71±2.64）分比（25.46±2.84）分］、情绪困扰评分［（15.76±2.63）分比（17.45±2.88）分］及生活满意度评分［（14.66±2.56）分比（16.35±2.64）分］均低于参照组,差异均有统计学意义（均P<0.05）。试验组患者的再入院率低于参照组［2.44%（1/41）比14.63%（6/41）］,差异有统计学意义（χ²=3.905,P=0.048）。结论　门诊协同护理联合认知重构干预能够有效改善老年冠心病患者的疾病知识掌握程度,提高其自我效能及生活质量水平,降低患者的再入院率。     

基于ACE-Star循证模式的快速康复护理在输尿管软镜钬激光碎石术患者中的应用

目的　探讨基于ACE-Star循证模式的快速康复护理在输尿管软镜钬激光碎石术患者中的应用效果。方法　选取2018年3月至2022年3月广州医科大学附属广州市第八人民医院收治的输尿管软镜钬激光碎石术患者94例,依据随机数字表法分为研究组与对照组,每组47例。研究组男24例、女23例,年龄（40.05±12.21）岁;对照组男26例、女21例,年龄（39.67±11.78）岁。对照组采取常规护理,研究组在对照组基础上采取基于ACE-Star循证模式的快速康复护理。分析两组术后康复情况、并发症发生率、术后疼痛程度、护理满意度。统计学方法采用独立样本t检验、χ²检验。结果　研究组首次排便时间为（14.79±5.35）h、首次排气时间为（7.28±2.84）h、首次下床活动时间为（3.11±1.05）h、住院时间为（7.53±1.71）d,均短于对照组的（25.28±7.75）h、（12.68±4.04）h、（5.15±1.29）h、（9.28±1.59）d,两组比较差异均有统计学意义（均P<0.001）;研究组并发症发生率低于对照组［4.26%（2/47）比17.02%（8/47）］,两组比较差异有统计学意义（χ²=4.029,P=0.045）;术后不同时间段研究组的视觉模拟评分法评分均低于对照组（均P<0.05）;研究组患者的护理满意度高于对照组［93.62%（44/47）比78.72%（37/47）］,两组比较差异有统计学意义（χ²=4.374,P=0.036）。结论　采取基于ACE-Star循证模式的快速康复护理对输尿管软镜钬激光碎石术患者实施干预,可减轻术后疼痛程度,降低并发症发生率,利于缩短术后康复进程,且患者满意度较高。     

PEWS联合分级护理模式在急诊高热惊厥患儿中的应用观察

目的　分析儿童早期预警评分（PEWS）联合分级护理模式在急诊高热惊厥患儿中的应用效果。方法　选取2020年5月至2021年7月汝州市人民医院收治的高热惊厥患儿126例为研究对象，按护理方式不同分为参照组和研究组，各63例。参照组男40例、女23例，年龄（30.06±4.32）个月，给予常规急诊护理；研究组男42例、女21例，年龄（29.48±4.28）个月，在参照组基础上给予PEWS联合分级护理。对比两组护理效果、急救情况、并发症及家属护理满意度。计量资料采用t检验，计数资料采用χ²检验，等级资料采用U检验。结果　研究组护理总有效率为98.41%（62/63），高于参照组87.30%（55/63），差异有统计学意义（χ²=5.863，P=0.016）。研究组住院时间、急救时间、体温恢复时间、惊厥消失时间分别为（4.32±1.05）d、（32.18±5.26）min、（1.87±0.42）d、（4.12±1.02）min，均短于参照组的（5.14±1.08）d、（43.25±5.14）min、（2.38±0.48）d、（5.84±1.04）min，差异均有统计学意义（均P<0.05）。研究组并发症发生率为3.17%（2/63），低于参照组14.29%（9/63），差异有统计学意义（χ²=6.952，P=0.008）。研究组常规护理、预检分诊、基础指导、健康宣教评分分别为（19.79±3.84）分、（20.84±3.08）分、（20.55±3.16）分、（21.27±2.85）分，均高于参照组的（16.28±3.57）分、（17.12±3.14）分、（16.39±3.22）分、（18.16±2.76）分，差异均有统计学意义（均P<0.05）。结论　应用PEWS联合分级护理模式应用于急诊高热惊厥患儿，能促进患儿恢复，缩短急救时间与住院时间，降低并发症发生风险，提高家属护理满意度。     

基于加速康复外科理念的护理干预对脑胶质瘤患者术后康复及预后的影响

目的　探讨基于加速康复外科（ERAS）理念的护理干预对脑胶质瘤患者术后康复及预后的影响。方法　选择2020年5月至2021年8月于南阳市第二人民医院接受外科手术治疗的脑胶质瘤患者82例进行前瞻性研究。按随机数字表法分为两组,各41例。对照组男18例,女23例,年龄（50.93±4.89）岁;观察组男19例,女22例,年龄（51.24±5.37）岁。对照组实施常规护理,观察组实施基于ERAS理念的护理,干预至患者出院。比较两组患者术后康复情况、健康状况、日常生活能力及并发症发生情况。统计学方法采用t检验、χ²检验。结果　观察组患者术后首次排便时间、首次下床时间、拔尿管时间、疼痛持续时间及住院时间均短于对照组［（2.36±0.65）d比（3.44±1.03）d、（1.32±0.55）d比（2.09±0.73）d、（7.47±1.05）h比（24.88±2.19）h、（1.97±0.30）d比（3.09±1.14）d、（5.65±0.73）d比（7.76±1.22）d］,差异均有统计学意义（t=5.678、5.394、45.900、6.084、9.503,均P<0.001）。术前,两组Karnofsky功能状态（KPS）评分、改良Barthel指数（MBI）评分比较,差异均无统计学意义（均P>0.05）;术后1周,两组KPS、MBI评分均高于术前,差异均有统计学意义（均P<0.001）;术后1周,观察组KPS评分、MBI评分均高于对照组［（62.31±7.56）分比（53.82±6.45）分、（71.65±10.39）分比（60.78±7.20）分］,差异均有统计学意义（t=5.470、5.506,均P<0.001）。观察组并发症总发生率低于对照组［4.88%（2/41）比19.51%（8/41）］,差异有统计学意义（χ²=4.100,P=0.043）。结论　基于ERAS理念的护理干预利于减少脑胶质瘤患者术后并发症的发生,促进患者康复,改善预后。     

经支气管镜清除肺曲霉菌球术治疗的患者特点及护理对策

目的　探讨经支气管镜清除肺曲霉菌球治疗患者特点及对策。方法　本研究为回顾性研究，选取2018年11月至2020年12月广州市胸科医院经支气管镜清除肺曲霉菌球治疗患者52例作为治疗组，其中男46例、女6例，年龄（47.00±13.48）岁；另选取同期支气管镜普通诊疗操作患者52例作为对照组，男44例、女8例，年龄（48.00±16.28）岁。比较两组患者心率、血氧饱和度、血压、操作时间以及出血差异。计量资料采用独立样本t检验，计数资料采用χ²检验。结果　治疗组心率、操作时间分别为（112.0±6.46）次/min、（39.95±8.32）min，均高于对照组的（100.0±9.11）次/min、（8.83±2.46）min，血氧饱和度为（96.0±0.69）%，低于对照组（98.0±1.11）%，差异均有统计学意义（均P<0.05）；两组气管镜操作患者收缩压和舒张压比较，差异均无统计学意义（均P>0.05）。治疗组镜检出血发生率为48.08%（25/52），高于对照组0.00%（0/52），两组比较差异有统计学意义（χ²=32.911，P<0.001）。结论　经支气管镜清除肺曲霉菌球治疗的患者更加紧张，发生低氧血症、出血的风险高；采用术前、术中及术后护理对策，控制高危因素，把握治疗时机是预防严重并发症的关键。     

院前救护中加强院前急救护理管理的应用效果分析

目的　探讨加强院前急救护理管理在院前救护中的应用效果。方法　选取深圳市急救中心2020年10月至2021年5月304例院前急救患者资料进行回顾性研究,随机数字表法分为观察组和对照组,每组152例。观察组男80例、女72例,年龄（38.49±2.47）岁;对照组男78例、女74例,年龄（39.28±2.64）岁。对照组采取常规院前急救护理管理,观察组采取加强院前急救护理管理。对比两组急救所需时间、病死率以及护理满意度。统计学方法采用独立样本t检验、χ²检验。结果　观察组转移回院时间、达到患者处时间、出车反应时间均低于对照组［（6.28±2.12）min比（12.26±2.84）min、（7.64±2.18）min比（13.51±3.51）min、（2.12±0.57）min比（3.20±0.68）min］,两组比较差异均有统计学意义（t=5.201、4.632、5.102,P=0.016、0.013、0.024）;观察组病死率显著低于对照组［5.92%（9/152）比27.63%（42/152）］（χ²=25.657,P<0.001）;观察组护理满意度高于对照组［98.68%（150/152）比75.66%（115/152）］（χ²=36.033,P<0.001）。结论　通过加强院前急救护理管理可有效缩短急救所需时间,降低病死率,提升家属的护理满意度。     

排石汤对肾结石手术治疗患者的疗效研究

目的　观察肾结石手术患者术后应用排石汤辅助治疗的效果。方法　以南阳医学高等专科学校第一附属医院2021年4月至2022年4月期间接受手术治疗的110例肾结石患者为研究对象,经抽签法将其分为对照组和研究组,各55例。对照组男30例、女25例,年龄（55.23±2.26）岁,术后予以常规西药辅助排石;研究组男32例、女23例,年龄（55.19±2.47）岁,术后予以口服排石汤辅助治疗。比较两组的残留结石排出时间、结石清除时间、肾功能指标、炎症因子指标及术后并发症发生情况。采用独立样本t检验、χ²检验。结果　研究组残留结石排出时间、结石清除时间分别为（4.14±0.23）d、（7.05±0.16）d,均短于对照组的（5.95±0.56）d、（8.82±0.72）d,结石清除率为92.73%（51/55）,高于对照组的81.82%（45/55）,差异均有统计学意义（均P<0.05）。研究组血清肌酐（SCr）、血清尿素氮（BUN）、血清尿酸（UA）、白细胞介素-6（IL-6）、降钙素原（PCT）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平分别为（72.35±5.18）μmol/L、（4.17±0.25）mmol/L、（271.45±10.36）μmol/L、（125.45±5.28）ng/L、（0.32±0.11）μg/L、（7.13±0.25）mg/L、（1.22±0.35）μg/L,均低于对照组的（77.44±5.84）μmol/L、（5.88±0.62）mmol/L、（299.71±10.49）μmol/L、（140.36±5.37）ng/L、（0.67±0.36）μg/L、（9.44±0.37）mg/L、（2.71±0.26）μg/L,肾小球滤过率（EGFR）为（92.24±5.15）ml/min,高于对照组的（83.14±5.26）ml/min,差异均有统计学意义（均P<0.05）。研究组术后并发症发生率为9.09%（5/55）,低于对照组20.00%（11/55）,差异有统计学意义（P<0.05）。结论　在肾结石患者术后通过相应药物辅助可促进残留结石排出,相较于西药来说,中药排石汤对加快患者结石排出、清除,增强肾功能并缓解炎性反应均有积极意义,排石汤的促排石效果好,可避免患者术后发生相关并发症,可更好适应患者临床需求。     

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.     

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。     

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.     

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.