FGF 23和Klotho蛋白水平在终末期肾病患者中与钙磷代谢及其伴发病的相关性

【摘要】 目的 探讨血清成纤维细胞生长因子23（FGF 23）和Klotho蛋白水平在终末期肾病（ESRD）患者中与钙磷代谢、动脉硬化、左室肥厚的相关性。方法 选取2015年1月～2016年4月在大连大学附属中山医院血液净化科进行血液透析（HD）的患者50例为血透组、腹膜透析（PD）患者50例为腹透组,并选取同期在本院体检的健康人群30例为健康对照组。通过整理资料、实验室检测、超声科检查比较不同透析方式对FGF 23和Kloth蛋白水平的影响、同时分析FGF 23和Kloth蛋白水平与钙磷代谢、动脉硬化及左室肥厚的相关性。结果 血透、腹透组FGF 23水平明显高于健康对照组,且血透组FGF 23水平也明显高于腹透组,差异有统计学意义（P＜005）;血透组、腹透组Klotho蛋白水平明显低于健康对照组,差异均有统计学意义（P＜005）,血透组与腹透组Klotho蛋白水平相近,差异无统计学意义（P＞005）;FGF 23水平与钙磷代谢呈正相关（r =05323、05178、05178,P＜005）、与继发性甲状旁腺功能亢进呈正相关（r =03038,P＜005）、与颈动脉硬化呈正相关（r =02987,P＜005）;Kloth蛋白与钙磷代谢呈负相关（r = 05103、 01105、 05264,P＜005）、与继发性甲状旁腺功能亢进呈正相关（r =03254,P＜005）。结论 ESRD透析患者中FGF 23存在高表达,而Klotho蛋白存在低表达,它们与HD、PD患者发生高磷血症、继发性甲状旁腺功能亢进、动脉硬化关系密切。     

慢性肾脏病3-4期糖尿病肾脏疾病患者进展到终末期肾病的危险因素分类树模型分析

【目的】分析糖尿病肾脏疾病（DKD）患者进展到终末期肾病（ESRD）的相关危险因素,筛查进展到ESRD的高风险人群,以早期预防。【方法】收集本院231例糖尿病肾脏疾病患者的临床资料,随访3年,据是否出现ESRD分为未进展到ESRD（133例）、ESRD组（98例）。使用分类树模型分析进展到ESRD相关危险因素,通过节点增益分析筛选进展到ESRD的高风险人群。【结果】从预测变量中筛选到4个重要解释变量：载脂蛋B（ApoB）、性别、糖尿病视网膜病变、收缩压;ApoB升高是DKD进展的重要的危险因素;ApoB＞1.14mmol/L的慢性肾脏病（CKD）3～4期DKD患者,3年进展到ESRD的概率是75.0%,如合并糖尿病视网膜病变,有79.7%的概率进展到ESRD。【结论】分类树模型能有效筛选并分析进展到ESRD危险因素,并识别高风险人群特征,有利于早期防治。     

5-aza-2’-deoxycytidine in the regulation of antioxidant enzymes in retinal endothelial cells and rat diabetic retina

AIM: To investigate the roles of a DNA methyltransferase (DNMT) inhibitor 5-aza-2’-deoxycytidine (5-aza-dC) in the regulation of antioxidant enzymes in diabetic retinopathy (DR) models. METHODS: DNMTs expressions and activity, and changes of two key antioxidant enzymes in DR, MnSOD (encoded by SOD2 gene) and glutathione S-transferase theta 1 (GSTT1), were quantified in the isolated human retinal endothelial cells (HRECs) exposed to high glucose (HG) with or without 5-aza-dC treatment. The downstream exacerbating factors including vascular endothelial growth factor (VEGF), intercellular adhesion molecule 1 (ICAM-1) and matrix metalloproteinase 2 (MMP2), which are implicated in the pathogenesis of DR and closely related to oxidative stress were also analyzed. The key parameters were confirmed in the retina from streptozotocin (STZ) diabetic rats. RESULTS: DNMTs expression and DNMT activity was induced in HRECs exposed to HG. Hyperglycemia decreased MnSOD and GSTT1 expression. 5-aza-dC administration effectively suppressed DNMTs expression and activity and reversed the MnSOD and GSTT1 expression under HG condition. VEGF, ICAM-1 and MMP2 induced by HG were also suppressed by 5-aza-dC treatment. Similar results were observed in the retina from STZ diabetic rats. CONCLUSION: Our findings suggest that DNA methylation may serves as one of the mechanisms of antioxidant defense system disruption in DR progression. Modulation of DNA methylation using pharmaceutic means such as DNMT inhibitors could help maintain redox homeostasis and prevent further progression of DR.     

3种配准方式下肺癌图像引导放射治疗摆位误差的比较

目的研究滑轨CT不同配准方式对肺癌大分割调强放疗摆位误差的影响。方法选取2016年10月至2017年10月在安徽医科大学第一附属医院放疗科就诊的肺癌患者24例,每周行滑轨CT扫描所得图像与原计划图像行灰度、骨性、手动3种模式在线配准,得出X、Y、Z轴3个方向平移误差,并进行统计分析。结果灰度配准、骨性配准和手动配准方式测量的X、Y、Z轴摆位误差分别为(0. 21±0. 16)、(0. 29±0. 15)、(0. 37±0. 22) cm,(0. 27±0. 16)、(0. 35±0. 25)、(0. 29±0. 19) cm,(0. 18±0. 12)、(0. 28±0. 16)、(0. 23±0. 14) cm,结果显示Y轴平移误差最大,其次为X轴,Z轴最小,且3组数据的差异有统计学意义(P <0. 05)。其中灰度模式在X、Y、Z轴上平移误差较骨性模式均缩小,灰度模式在X、Z轴上平移误差较手动模式有所缩小,差异有统计学意义(P <0. 05)。结论肺癌患者行图像引导大分割调强放疗时,应用滑轨CT中的灰度模式可缩小摆位误差。     

利用1＋3模式改进医院成本核算

针对全成本核算过程中收入数据统计存在的问题，运用1＋3质量管理模式进行持续改进，通过分析查找根本原因，完善服务流程，建立相关制度，提高执行科室归并的准确性，以此更加准确反映各科室的收入情况，保证全成本核算的质量。     

A dynamic system for delivering controlled bromine and chlorine vapor exposures to weanling swine skin

Context: Assessing the hazards of accidental exposure to toxic industrial chemical (TIC) vapors and evaluating therapeutic compounds or treatment regimens require the development of appropriate animal models.

Objective: The objective of this project was to develop an exposure system for delivering controlled vapor concentrations of TICs to the skin of anesthetized weanling pigs. Injury levels targeted for study were superficial dermal (SD) and deep dermal (DD) skin lesions as defined histopathologically.

Materials and methods: The exposure system was capable of simultaneously delivering chlorine or bromine vapor to four, 3-cm diameter exposure cups placed over skin between the axillary and inguinal areas of the ventral abdomen. Vapor concentrations were generated by mixing saturated bromine or chlorine vapor with either dried dilution air or nitrogen.

Results: Bromine exposure concentrations ranged from 6.5?×?10^?4 to 1.03?g/L, and exposure durations ranged from 1 to 45?min. A 7-min skin exposure to bromine vapors at 0.59?g/L was sufficient to produce SD injuries, while a 17-min exposure produced a DD injury. Chlorine exposure concentrations ranged from 1.0 to 2.9?g/L (saturated vapor concentration) for exposures ranging from 3 to 90?min. Saturated chlorine vapor challenges for up to 30?min did not induce significant dermal injuries, whereas saturated chlorine vapor with wetted material on the skin surface for 30–60?min induced SD injuries. DD chlorine injuries could not be induced with this system.

Conclusion: The vapor exposure system described in this study provides a means for safely regulating, quantifying and delivering TIC vapors to the skin of weanling swine as a model to evaluate therapeutic treatments.     

Artificial neural network for modeling the elastic modulus of electrospun polycaprolactone/gelatin scaffolds

Scaffolds for tissue engineering (TE) require the consideration of multiple aspects, including polymeric composition and the structure and mechanical properties of the scaffolds, in order to mimic the native extracellular matrix of the tissue. Electrospun fibers are frequently utilized in TE due to their tunable physical, chemical, and mechanical properties and porosity. The mechanical properties of electrospun scaffolds made from specific polymers are highly dependent on the processing parameters, which can therefore be tuned for particular applications. Fiber diameter and orientation along with polymeric composition are the major factors that determine the elastic modulus of electrospun nano- and microfibers. Here we have developed a neural network model to investigate the simultaneous effects of composition, fiber diameter and fiber orientation of electrospun polycaprolactone/gelatin mats on the elastic modulus of the scaffolds under ambient and simulated physiological conditions. The model generated might assist bioengineers to fabricate electrospun scaffolds with defined fiber diameters, orientations and constituents, thereby replicating the mechanical properties of the native target tissue.