Association of glomerular hyperfiltration with serum chemokine levels and metabolic features in prepubertal children with overweight/obesity

Background and aimsGlomerular hyperfiltration (GH) is proposed as one of the earliest events in obesity (OB)-associated renal disease. Children with GH and type-1 diabetes showed increased chemokine levels. Chemokine associations with glomerular filtration rate (GFR) and metabolic features in prepubertal children with overweight (OW)/OB are unknown.Methods and resultsCross-sectional study. 75 prepubertal children (aged: 9.0 ± 1.7 years) with OW/OB were studied. Clinical and metabolic characteristics (including non-esterified fatty acids, NEFA) and GFR (combined Zappitelli equation) were assessed. GH was defined as GFR >135 ml/min.1.73 m². Serum levels of regulated on activation, normal T cell expressed and secreted (RANTES)/CCL5, interleukin-8 (IL-8)/CXCL8 and monokine-induced by interferon-γ (MIG)/CXCL9 were measured by ELISA. Age- and sex-adjusted correlations and differences were tested. 48% of the cohort was female and 13% were OW, 54% OB and 33% severe OB. Prepubertal children with GH showed lower z-BMI (−12%), NEFA (−26%) and uric acid (−22%) than those without GH (all p < 0.05). Similarly to high sensitivity C-reactive protein (hsCRP), there were no differences in serum chemokines between children with GH or not (all p > 0.05). Adjusted correlations were significant for RANTES and z-BMI (r = 0.26; p < 0.05) and for MIG with z-BMI (r = −0.26; p < 0.05) and with NEFA (r = 0.27; p < 0.05).ConclusionGH was not associated with higher chemokine levels in prepubertal children with OW/OB. Decreased rather than elevated GFR values were correlated with obesity and worse metabolic profiles. Chemokines levels in children with severe OB suggest a regulation of the immune response. Follow-up studies are needed to address the clinical implications of these findings.     

妊娠期肝内胆汁淤积症产妇胎儿肺损伤的相关性分析

目的:探讨妊娠期肝内胆汁淤积症(ICP)孕妇胎儿肺损伤与血清总胆汁酸(TBA)水平的相关性。方法:随机抽选50例在该院剖宫产分娩的ICP孕妇为观察组,同时抽选50例正常孕妇作为对照组。比较两组各检测指标差异及分析其相关性。结果:1观察组新生儿窒息、呼吸窘迫等肺损伤病症发生率44%、20%显著多于对照组14%、0%,差异有统计学意义(P<0.05);2观察组母体血清及新生儿脐带血清TBA明显高于对照组,差异有统计学意义(P<0.05),观察组新生儿脐带血清TBA与母体血清TBA呈正相关(P<0.05);3观察组胎儿肺主动脉末期流速(S/D)、阻力指数(RI)、搏动指数(PI)均高于对照组,差异有统计学意义(P<0.05),而板层小体(LB)、肺面积/体重比低于对照组,差异有统计学意义(P<0.05);4观察组胎儿动脉血氧饱和度(SO2)、氧分压(PO2)、酸碱度(PH)低于对照组,差异有统计学意义(P<0.05);5观察组新生儿脐带血清TBA与胎儿肺主动脉S/D、RI呈正相关,与肺面积/体重比、LB呈负相关(P<0.05);胎儿肺面积/体重比、LB与PO2、PH呈正相关,与二氧化碳分压(PCO2)呈负相关;而RI、S/D与PO2、PH呈负相关,与PCO2呈正相关。结论:ICP产妇血清TBA及新生儿脐带血清TBA浓度升高,ICP产妇胎儿存在肺损伤与TBA升高有关,胎儿肺主动脉RI、肺面积/体重比对于早期发现肺损伤具有一定临床意义。     

MSCT对肾脏嗜酸细胞腺瘤和透明细胞癌的鉴别诊断价值

目的:探讨多层螺旋CT(Multi-slice spiral computed tomography,MSCT)四期扫描对肾脏嗜酸细胞腺瘤(Renal oncocytoma,RO)和透明细胞癌(Clear-cell renal cell carcinomas,ccRCC)的鉴别诊断价值。方法:搜集因肾脏占位行肾脏CT平扫和三期增强扫描患者79例共80枚瘤灶,经术后病理证实RO 29例,ccRCC 50例,并回顾性分析两组病例的影像表现,采用SPSS 19.0软件对肿瘤CT值、校正CT值、皮质期与实质期CT差值及增强廓清率进行独立样本t检验分析。采用Fisher确切概率法对肿瘤部位、形态、平扫特点、强化程度、强化方式、皮质期与实质期强化CT值差异、节段增强反转等征象进行统计分析。结果:RO和ccRCC皮质期CT值、皮质期校正CT值、皮质期与实质期CT差值和增强廓清率差异有统计学意义(P<0.05),平扫、实质期、排泄期CT值校正CT值差异均无统计学意义(P>0.05)。中央星状低密度影、强化程度、强化均匀度、轮辐状强化、皮质期与实质期强化CT值差异及节段增强反转等征象差异有统计学意义(P<0.05),部位、形态、钙化,病灶周边絮状和条索状影等征象差异无统计学意义(P>0.05)。结论:在MSCT多期扫描表现中,皮质期CT值、皮质期校正CT值、皮质期与实质期CT差值和增强廓清率、中央星状低密度影、强化程度、强化均匀度、轮辐状强化、皮质期与实质期强化CT值差异及节段增强反转等征象对于RO、ccRCC二者的鉴别具有重要价值。     

不同时间段血乳酸水平对脓毒症院内死亡的预测价值比较：基于重症监护医学信息数据库

目的比较不同时间段的血乳酸水平对脓毒症院内死亡的预测价值,以期为临床上合理选用血乳酸提供一定的研究证据。 方法基于重症监护医学信息数据库,纳入3 299例脓毒症患者。根据患者院内死亡情况,将3 299例脓毒症患者分为院内存活组（2 445例）和院内死亡组（854例）。比较两组患者的性别比、监护室类型、简化急性生理学评分Ⅱ（SAPSⅡ）、序贯器官衰竭估计（SOFA）评分、入院24 h内血乳酸的最大值[血乳酸（24 h,max）]及最小值[血乳酸（24 h,min）]及24 ~ 48 h血乳酸的最大值[血乳酸（48 h,max）]及最小值[血乳酸（48 h,min）]。采用Logistic回归分析及受试者工作特征（ROC）曲线分析影响脓毒症患者院内死亡的相关因素,并用Z检验比较曲线下面积（AUC）。 结果院内存活组患者的血乳酸（24 h,max）[3.0（1.8,4.8）mmol/L vs. 3.6（2.1,6.3）mmol/L]、血乳酸（24 h,min）[1.5（1.1,2.2）mmol/L vs. 1.8（1.3,2.9）mmol/L]、血乳酸（48 h,max）[1.5（1.1,2.3）mmol/L vs. 2.5（1.5,4.4）mmol/L]、血乳酸（48 h,min）[1.3（1.0,1.8）mmol/L vs. 1.9（1.3,3.2）mmol/L]、SAPSⅡ评分[44（35,54）分vs. 48（37,59）分]及SOFA评分[6（4,9）分vs. 8（5,11）分]均较院内死亡组显著降低（H = 7.350、9.535、13.473、12.720、6.734、8.033,P均< 0.001）。将上述指标纳入Logistic回归分析,结果显示,血乳酸（24 h,max）[比值比（OR）= 1.099,95%置信区间（CI）（1.069,1.130）]、血乳酸（24 h,min）[OR = 1.300,95%CI（1.220,1.385）]、血乳酸（48 h,max）[OR = 1.330,95%CI（1.271,1.391）]、血乳酸（48 h,min）[OR = 1.558,95%CI（1.451,1.673）]、SAPSⅡ评分[OR = 1.014,95%CI（1.008,1.020）]和SOFA评分[OR = 1.084,95%CI（1.059,1.110）]均为影响脓毒症患者院内死亡的危险因素（P均< 0.001）。ROC曲线分析结果显示,血乳酸（24 h,max）[AUC = 0.574,95%CI（0.551,0.597）]、血乳酸（24 h,min）[AUC = 0.614,95%CI（0.591,0.636）]、血乳酸（48 h,max）[AUC = 0.693,95%CI（0.672,0.715）]、血乳酸（48 h,min）[AUC = 0.689,95%CI（0.668,0.710）]、SAPSⅡ评分[AUC = 0.577,95%CI（0.555,0.600）]及SOFA评分[AUC = 0.592,95%CI（0.569,0.614）]对脓毒症患者院内死亡均具有预测价值（P均< 0.001）,且血乳酸（48 h,max）和血乳酸（48 h,min）的AUC均显著高于血乳酸（24 h,max）（Z = 7.310、7.064,P均< 0.001）和血乳酸（24 h,min）（Z = 5.078、4.821,P均< 0.001）、SAPSⅡ评分（Z = 7.126、6.880,P均< 0.001）和SOFA评分（Z = 6.204、5.959,P均< 0.001）。 结论入院24 ~ 48 h的血乳酸水平对脓毒症患者院内死亡可能具有更好的预测价值。     

原有信息系统基础上架构无线临床信息系统

叙述在医院原有信息系统基础上构建一个完整的无线临床信息系统。无线信息系统架构在医院HIS上,通过中间件为医院现有的以及今后可能增加的多种信息管理系统提供全面的数据交互平台。软件系统采用Web Service技术提供信息服务,前后台系统之间的交互采用SOAP(Simple Object Access Protocol)协议,网络结构采用"WS(无线交换机) APort(智能天线)"方式,以无线网络为依托,用手持数据终端及应用条形码实现将网络信息点延伸到临床以及移动着的医护人员身边。     

Influenza as an issue on the agenda of policy makers and government representatives What can we do? What do we need?

Influenza vaccinations and antiviral drugs are the foundation of epidemic and pandemic preparedness, but only close collaboration between public health authorities and industry can achieve the necessary production levels and ensure the smooth distribution necessary to protect European citizens from this public health scourge. To focus the minds of all public health stakeholders, ESWI has translated these simple facts into clear achievable goals: it recommends that EU governments vaccinate one-third of their populations by 2010 and stockpile antiviral drugs for 20% of their citizens while promoting public-private partnerships. The scientific justification behind this objective is easily understood namely that while the annual flu shot protects against three viral strains,the pandemic vaccine will focus on only the one highly lethal virus. As a result if countries succeed in meeting the target to vaccine one-third of the EU-25 population with a trivalent vaccine, sufficient monovalent pandemic vaccine could be produced to vaccinate almost the entire EU-25 population at least once. Achieving these objectives would go far to containing the pandemic and ensuring necessary treatment to avoid needless deaths and social and economic disruption. It would also signal that influenza preparedness had become part of the European mindset. Relying on the technique of force-field analysis organised by professional facilitators the session asked government representatives and policy makers to identify existing factors that either provide support for the objectives or hinder progress.     

同种异体肾移植患者B型钠尿肽水平的临床观察

目的：探讨同种异体肾移植患者和发生急性排斥反应时血浆B型钠尿肽（BNP）水平及其临床意义。方法：采用免疫夹心化学发光法检测17例首次肾移植患者术前1d、术后第1天、第2天、第3天、1周、2周和3个月血BNP浓度。17例健康体检者作对照。结果：肾移植患者术前1d血BNP浓度显著高于健康对照组（P〈0．01）。肾移植术后血BNP浓度呈下降趋势（χ^2=14．25，P=0．027）。13例没有发生急性排斥反应的患者血BNP浓度术后1周和3个月与肾移植术前比较差异有显著性（P〈0．05）；4例发生急性排斥反应患者，发生急性排斥反应当天的血BNP浓度显著增高，加强抗排斥治疗后很快下降。结论：肾移植成功后可以降低血BNP水平，但发生急性排斥反应时血BNP浓度显著增高。因此，血BNP浓度可作为早期诊断移植肾急性排斥反应发生的敏感指标。     

Visualizing inflammation activity in rheumatoid arthritis with Tc-99 m Anti-CD4-mAb fragment scintigraphy

PurposeT-cell-located CD4 antigen represents one of the therapeutic targets in rheumatoid arthritis (RA). However, up to now there is no established imaging tool to visualize this target in vivo. The aim of our study was to assess the safety and tolerability of a technetium-99 m labelled murine anti-human CD4 IgG1-Fab fragment ([^99mTc]-anti-CD4-Fab, [^99mTc]-EP1645) in patients with active synovitis due to RA, and to evaluate its potential as a marker of disease activity.MethodsIn the present phase I proof of principle study five patients with RA were examined. Planar scans of the whole body, hands, and feet were taken 30 min up to 24 h after application of 550 ± 150 MBq [^99mTc]-anti-CD4-Fab, followed by visual analyses, comparison with clinical data in 68 joints per patient and semiquantitative analysis of hand and wrist joints.ResultsNeither infusion related adverse events nor adverse events during follow up were observed. No increase in human anti-murine antibody titres was seen. All patients had positive scans in almost 70% of clinically affected joints. Positive scans were also found in 8% of joints without evidence of swelling or tenderness.ConclusionScintigraphy with [^99mTc]-anti-CD4-Fab is a promising technique for evaluation of inflammatory activity in patients with RA, pre-therapeutical evaluation of CD4 status and therapy control. Tracer uptake in clinically inconspicuous joints strongly indicates diagnostic potential of [^99mTc]-anti-CD4-Fab. Whether this technique is eligible as a prognostic factor in RA needs to be analysed in further studies as well as the pathophysiological background of clinically affected joints lacking tracer uptake.     

Age-related changes in the meibomian gland

The purpose of this study was to characterize the age-related changes of the mouse meibomian gland. Eyelids from adult C57Bl/6 mice at 2, 6, 12 and 24 months of age were stained with specific antibodies against peroxisome proliferator activated receptor gamma (PPARγ) to identify differentiating meibocytes, Oil Red O (ORO) to identify lipid, Ki67 nuclear antigen to identify cycling cells, B-lymphocyte-induced maturation protein-1 (Blimp1) to identify potential stem cells and CD45 to identify immune cells. Meibomian glands from younger mice (2 and 6 months) showed cytoplasmic and perinuclear staining with anti-PPARγ antibodies with abundant ORO staining of small, intracellular lipid droplets. Meibomian glands from older mice (12 and 24 months) showed only nuclear PPARγ localization with less ORO staining and significantly reduced acinar tissue (p < 0.04). Acini of older mice also showed significantly reduced (p < 0.004) numbers of Ki67 stained nuclei. While Blimp1 appeared to diffusely stain the superficial ductal epithelium, isolated cells were occasionally stained within the meibomian gland duct and acini of older mice that also stained with CD45 antibodies, suggesting the presence of infiltrating plasmacytoid cells. These findings suggest that there is altered PPARγ receptor signaling in older mice that may underlie changes in cell cycle entry/proliferation, lipid synthesis and gland atrophy during aging. These results are consistent with the hypothesis that mouse meibomian glands undergo age-related changes similar to those identified in humans and may be used as a model for age-related meibomian gland dysfunction.