免疫调节在特发性膜性肾病及足细胞损伤中的研究进展

特发性膜性肾病是一种常见的免疫介导的肾小球疾病，是成年人肾病综合征常见的病理类型之一，也是导致慢性肾脏病和终末期肾脏病的主要病因之一。足细胞是特发性膜性肾病蛋白尿发生的中心靶点，足细胞损伤是特发性膜性肾病进行性发展的重要因素，其中免疫复合物沉积及内环境发挥关键作用。本文对免疫调节在特发性膜性肾病及足细胞损伤中的发病机制进行综述。     

内镜诊断技术在早期胃癌诊断中的研究进展

我国是胃癌高发国家，发病率和病死率均较高。早期发现和诊断可以有效降低胃癌的病死率，从而改善患者的预后。而早期胃癌的发现和诊断高度依赖胃镜的筛查，但传统白光内镜对胃早癌的筛查有一定的局限性。随着科技的快速发展，越来越多新的内镜成像技术应运而生，本文将探讨近年来应用于临床的各种内镜技术在早期胃癌诊断中的应用价值。     

The effect of whole-body vibration exercise on postmenopausal women with osteoporosis: A protocol for systematic review and meta-analysis

Background:Osteoporosis (OP) is an age-related disease characterized by reduced bone mass and increased bone fragility. It is more common in older people and postmenopausal women. As a new type of exercise training for OP, whole-body vibration (WBV) exercise has been proved to have a good effect on postmenopausal women with OP. It can increase bone density and improve strength and balance in postmenopausal population, which has certain clinical value, but lacks evidence-based medicine evidence. This study aims to systematically study the effectiveness of WBV exercise on postmenopausal women with OP.Methods:The English databases (PubMed, Embase, Web of Science, The Cochrane Library) and Chinese databases (China National Knowledge Network, Wanfang, Weipu, China Biomedical Database) were searched by computer. From the establishment of the database to February 2021, the randomized controlled clinical studies on WBV exercise on postmenopausal women with OP were conducted. The quality of the included studies was independently extracted by 2 researchers and literature quality was evaluated. Meta-analysis of the included studies was performed using RevMan5.3 software.Results:In this study, the efficacy and safety of WBV exercise on postmenopausal women with OP were evaluated by lumbar spine bone density, femoral neck bone density, pain, incidence of falls, incidence of fractures, and quality of life scale score, etc.Conclusion:This study will provide reliable evidences for the clinical application of WBV exercise on postmenopausal women with OP.Ethics and dissemination:Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/WPYT9     

阿托伐他汀对ApoE基因敲除小鼠动脉粥样硬化病变中TRPC5表达的影响

目的:观察载脂蛋白E基因敲除(Apo E-/-)小鼠动脉粥样硬化斑块形成过程中血管平滑肌细胞瞬时受体电位通道5(TRPC5)蛋白的表达变化,以及阿托伐他汀药物干预对TRPC5的影响并探讨其作用机制。方法:将40只6周龄雄性Apo E-/-小鼠随机分为模型组和他汀干预组,高脂饲料喂养建立动脉粥样硬化模型。他汀干预组给予阿托伐他汀(20 mg·kg-1·d-1)灌胃,模型组给予等量生理盐水灌胃。20只同龄雄性野生型C57BL/6J小鼠给予普通饲料喂养作为正常对照组。各组小鼠分别喂养至20和30周龄,分别取10只取血并处死。取主动脉根部做石蜡切片行HE染色形态学观察,测量并计算斑块相对面积;免疫组织化学染色检测各组小鼠TRPC5蛋白表达变化。取胸腹段主动脉行实时荧光定量PCR,检测主动脉中TRPC5通道蛋白mRNA的表达水平。结果:与模型组相比,阿托伐他汀干预组的血脂明显下降,斑块总面积明显减小,TRPC5蛋白水平及mRNA含量明显下降;30周龄模型组的TRPC5蛋白表达稍高于20周龄模型组,但差异无统计学意义;30周干预组较20周干预组相比,TRPC5水平有降低趋势且差异有统计学意义。结论:阿托伐他汀可能通过下调TRPC5蛋白表达从而延缓动脉粥样硬化进程。     

谷氨酰胺对大鼠肠缺血再灌注损伤后闭合蛋白的保护作用

目的:探讨谷氨酰胺(Gln)对大鼠肠缺血再灌注损伤后闭合蛋白(occludin)的保护作用及其可能机制。方法:成年雄性Wistar大鼠30只随机分为假手术组(sham组)、缺血再灌注损伤组(I/R组)和谷氨酰胺预处理组(Gln组)。Gln组给予谷氨酰胺1 g·kg-1·d-1连续灌胃7 d。Sham组和I/R组以同等剂量生理盐水灌胃7d。Sham组仅分离肠系膜上动脉而根部不夹闭。I/R组和Gln组均用无损伤血管夹夹闭SMA根部30 min后放松血管夹形成再灌注损伤模型。各组大鼠均于制模后24 h采集静脉血和回肠标本。酶联免疫吸附试验检测血清中肿瘤坏死因子(TNF)-α、白细胞介素(IL)-10和IL-2水平。全自动生化仪检测超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽(GSH)和谷胱甘肽过氧化物酶(GSH-Px)水平。免疫组化及Western blotting法检测occludin蛋白的表达情况。结果:I/R组occludin蛋白表达明显低于正常对照组及谷氨酰胺处理组(P0.05);I/R组TNF-α和MDA水平均高于sham组和Gln组(P0.05)。I/R组血清的SOD活力、GSH、GSH-Px、IL-10和IL-2均低于sham组和Gln组(P0.05)。结论:谷氨酰胺对肠缺血再灌注损伤后的occludin蛋白具有保护作用,其机制可能与抑制炎症反应、抗氧化应激有关。     

Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Background: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes.

Objective: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

Methods: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes.

Results: Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR)?=?0.460, 95% confidence interval (CI)?=?0.324–0.653, p?=?0 for myocardial infarction; OR?=?0.617, 95% CI?=?0.476–0.801, p?=?0 for composite of death/myocardial infarction/stroke; OR?=?0.406, 95% CI?=?0.247–0.666, p?=?0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms.

Conclusions: This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery.

• Key Messages

• Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery.

• We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

     

两种肺动脉压测量方法在急性中高危肺栓塞介入治疗中的临床价值对比研究

【摘要】 目的 比较超声心动图与肺动脉导管测量肺动脉收缩压（PASP）在急性中高危肺血栓栓塞症（PTE）血管内介入治疗中的临床价值。方法 回顾性分析2017年6月至2020年2月滨州市人民医院收治的31例急性PTE患者临床资料。其中中危21例,高危10例,均伴有下肢不同部位深静脉血栓形成。所有患者介入术前均接受经胸超声心动图和DSA下肺动脉导管直接测量PASP,并序贯接受临时腔静脉滤器置入、肺动脉吸栓及导管接触溶栓,回收滤器时肺动脉导管复测PASP,次日或出院前超声心动图复测PASP。采用Pearson线性相关分析描述超声心动图与肺动脉导管测量PASP值间相关性,配对t检验比较介入术前后两者测得PASP值变化。结果 31例患者介入术后肺栓塞症状均消失,25例血栓完全清除,6例大部分清除。平均溶栓时间（4.65±1.17） d,平均住院时间（10.55±1.89） d。治疗期间1例患者牙龈出血,未发生其他严重并发症。超声心动图测量与肺动脉导管实时直接测量PASP间具有显著相关性（术前r=0.99,P＜0.05;术后r=0.67,P＜0.05）。超声心动图、肺动脉导管测得介入术前后PASP值差异均有统计学意义（t=9.79,P＜0.05;t=11.64,P＜0.05）。术前肺动脉导管测压值高于超声心动图（t= 5.34,P＜0.05）,术后测压值低于超声心电图组（t=4.21,P＜0.05）。结论 介入治疗急性PTE患者效果显著。超声心动图与导管测量PASP值虽略有偏差,但有显著相关性。超声心动图无创测量PASP,可为介入治疗效果评估、预后分析、随访观察提供重要临床依据。     

骨髓间充质干细胞联合3D生物打印技术治疗骨缺损的研究进展

骨缺损一直以来都是临床治疗中的难题,目前主要是行自体骨或人工骨移植治疗。但自体骨取骨的损伤和人工骨资源有限且价格昂贵使得骨移植手术在临床广泛应用受到限制。近年来国内外学者对骨髓间充质干细胞诱导分化成骨的研究愈加重视,对其分离提取和定向分化的研究取得了长足的进步。骨髓间充质干细胞可向成骨细胞、软骨细胞等分化且不存在排斥反应及伦理问题,其结合3D生物打印技术修复骨缺损具有精准化和可控性的优势,是一种极具潜力和应用前景的新型骨缺损修复技术。文章对骨髓间充质干细胞的生物学特性、成骨诱导及结合载体支架治疗骨缺损的研究进行阐述,为今后在骨缺损的临床治疗中提供理论依据。     

miRNA-125b Signaling Ameliorates Liver Injury Against Obstructive Jaundice-Induced Excessive Fibrosis in Experimental Rats

PurposeMultiple pathways are involved in inducing liver fibrosis, which can damage the integrity of liver. Among them, miR-125b has been found to exert an activating action on hepatic stellate cells. Endoplasmic reticulum stress and autophagy lead to liver disorders. Here, we evaluated the therapeutic influence of miR-125b on the endoplasmic reticulum function in injured livers submitted to bile duct ligation.Materials and MethodsFor inducing injury, bile duct ligation was done on miR-125b transgenic rats (miR-125b-Tg) in wild type rats. The rat T-6 cells received transfection of miR-125b mimic and Tunicamycin. Protein expressions were observed by western blot analysis.ResultsCompared to wild type rats, liver-injured rats showed significant impairment of liver function as assessed by the total bilirubin levels. The miR-125b-Tg rats showed decrease in activity of aspartate transaminase and alanine transaminase. Liver tissues of miR-125b-Tg rats showed weaker fibrotic matrix formation. Upregulation of miR-125b decreased the bile duct ligation-mediated hepatic disturbances for the expressions of endoplasmic reticulum kinase, inositol-requiring kinase 1alpha, sXBP1, CHOP, LC3, p62, ULK, and caspase-3/-8/-9. T-6 cells transfected with miR-125b mimic and treated with Tunicamycin caused decrease in levels of cleaved caspase-3, sXBP1, CHOP, and LC3. The miR-125b signaling showed protective effect on the liver tissues subjected to injury and fibrosis histopathology.ConclusionThis study demonstrates a novel insight into the miR125b-mediated stabilization of endoplasmic reticulum integrity, which slows the progression of injury-induced hepatic deterioration.