小儿遗尿症指南和专家共识质量评价

背景 小儿遗尿症是儿科常见病之一,有效的小儿遗尿症诊疗指南有助于症状的规范化控制和缓解,而制定高质量的临床实践指南是提高小儿遗尿症诊疗水平的重要方式。目的 基于AGREEⅡ和RIGHT工具,评价2010年以来国内外发布的小儿遗尿症指南和专家共识的质量,以期为临床实践及后续指南的制订提供参考。方法 检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库和PubMed(补充检索医脉通、世界卫生组织以及英国国家临床示范研究所等数据库)2010-01-01至2022-01-31公开发表的小儿遗尿症相关的诊疗指南和专家共识。采用AGREEⅡ和RIGHT工具评价纳入文献的方法学和报告质量。根据AGREE Ⅱ工具评价结果,将各指南/共识推荐等级评定为“推荐(A级)”“更新后推荐(B级)”和“不推荐(C级)”。使用组内相关系数(ICC)进行一致性评价。结果 纳入8部指南和5部专家共识。共形成推荐意见185条,其中44条为诊断评估方面的意见,140条为治疗方面的推荐意见,1条为随访推荐意见。AGREEⅡ工具评价结果显示,范围和目的、参与人员、严谨性、清晰性、应用性和独立性6个领域的总得分(报...     

脓毒症患者外周血单核细胞miR-147b的表达及其与病情严重程度和预后的关系

目的 探讨脓毒症患者外周血单核细胞miR-147b的表达水平及其与病情严重程度及预后的相关性。方法 选择2019年1月至2021年6月于安徽医科大学第一附属医院就诊的46例脓毒症患者(脓毒症组)和50例普通感染患者(普通感染组)作为研究对象。查阅患者病历,记录年龄、性别、感染部位等一般资料。采用酶联免疫吸附试验试剂盒检测研究对象血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(C-reactive protein, CRP)的浓度。计算序贯性器官衰竭评分(sequential organ failure score, SOFA)和急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health scoreⅡ,APACHEⅡ)。观察或随访脓毒症患者的28 d预后情况,分为生存组和死亡组。应用逆转录聚合酶链反应测定外周血单核细胞中miR-147b的表达水平。结果 脓毒症组和普通感染组的年龄、性别、感染部位分布比较差异无统计学意义(P>0.05)。脓毒症组患者的TNF-α、CRP水平、SOFA评分和A...     

Role of angiotensin in the salt-hypertension of rats

Summary Hypertension was induced in uninephrectomized rats by NaCl 0.9% drinking and deoxycorticosterone acetate (DOCA) administration for 6 weeks. Plasma renin activity was markedly reduced but not suppressed. Renal renin concentration and total renal renin content were moderately reduced. Intravenous injection of 0.2 ml of antiangiotensin plasma resulted in transitory hypotension both in salt and DOCA-treated rats, and in normotensive control rats. It is concluded that angiotensin participates in the maintenance of blood pressure in salthypertensive rats as well as in normal animals.This work was supported by grant 67-00-517 from D.G.R.S.T. (Délégation Générale à la Recherche Scientifique et Technique). The authors wish to thank Miss colette Innocenzi and Miss Sonia Culot for technical assistance.     

血管紧张素转换酶2基因转染对人内皮细胞MIF表达的影响

目的：探讨重组血管紧张素转换酶2（ACE2）基因转染对体外培养的人血管内皮细胞中由血管紧张素（Ang）II诱导的巨噬细胞移动抑制因子（MIF）表达的影响。方法:克隆和构建含人ACE2基因全长的重组质粒（pACE2），并将之转染入人血管内皮细胞中。分别采用实时定量PCR和Western印迹技术检测转染细胞中的MIF mRNA与蛋白表达情况。结果: Ang Ⅱ（100 nmol/L）和Ang IV（100 nmol/L）刺激后均可诱导人血管内皮细胞中MIF mRNA及蛋白表达增加（P<0.01）。pACE2基因转染可明显抑制内皮细胞中由Ang II和Ang IV诱导的MIF mRNA和蛋白表达（P<0.05）。结论: ACE2基因过表达可明显抑制人内皮细胞中炎症介质MIF的表达，提示ACE2基因具有一定的抗炎症效应。通过调节ACE2基因的活性和表达，很可能为炎症相关疾病如动脉粥样硬化治疗提供新的策略。     

血管紧张素Ⅱ受体1和受体2在小鼠肾脏发育中的表达

目的观察小鼠肾脏发育中血管紧张素Ⅱ受体1(AngiotensinⅡreceptor type1,AT_1)和受体2 (AT_2)的表达特征,探讨小鼠肾脏发育过程中AT_1和AT_2的作用及相互关系。方法应用免疫组织化学技术、免疫印迹法(Western blot)并结合体视学方法检测胚龄12、14、15、16、18d及生后日龄1、3d小鼠肾脏发育中AT_1和AT_2的表达。结果AT_1和AT_2均首先出现在输尿管芽,然后出现在肾小管,生后表达逐渐减弱。早期肾小体内AT_2丰富表达,随着肾小体的成熟表达量逐渐降低。结论在小鼠肾脏发育中,AT_1可能与输尿管芽分支不断延长以及肾小管的增殖密切相关,AT_2可能与输尿管芽和肾小体的相互诱导相关。     

菊藤胶囊对应激大鼠血压、血浆血管紧张素Ⅱ和血液流变学的影响

目的观察中药复方菊藤胶囊对慢性应激性高血压大鼠血压、血浆血管紧张素Ⅱ（AngⅡ）及血液流变学的影响。方法大鼠随机分为6组（每组7只）：应激＋蒸馏水组（model），应激＋菊藤胶囊高剂量组（JT—H），应激＋菊藤胶囊中剂量组（JT—M），应激＋菊藤胶囊低剂量组（JT—L），应激＋卡托普利组（captopril），正常对照组（control）；除正常对照组外，其余5组均采用低频低压交流电间断电击法。电击大鼠足底28d，制作应激性高血压模型，同时各组均加入不同的干预。后应用经尾动脉测量血压和心率，酶联免疫吸附法（ELISA）检测大鼠血浆血管紧张素Ⅱ，血液流变学和细胞流变学的各项指标。观察比较菊藤胶囊不同剂量组、卡托普利组对应激致大鼠血压及相关指标的影响。结果与正常对照组相比，模型组大鼠血压和血浆血管紧张素Ⅱ含量明显升高（P〈0．01）。全血黏度、血浆黏度、纤维蛋白原及红细胞聚集指数均明显升高（P〈0．05），红细胞变形指数无变化。与模型组相比，菊藤胶囊高、中组均能抑制应激大鼠的血压及血浆血管紧张素Ⅱ含量的升高（P〈0．01），菊藤胶囊高剂量能明显改善应激大鼠的血液流变性（P〈0．05），低剂量组应激大鼠的血液流变学无明显改变（P〉0．05）。结论菊藤胶囊能够降低应激性高血压大鼠的血压，其机理可能是通过降低血浆中血管紧张素Ⅱ的含量和改善血液流变和细胞流变性实现的。     

心肌肥厚大鼠心肌组织中5-羟色胺及血管紧张素-Ⅱ含量的变化

目的：观察大鼠发生心肌肥厚时心肌组织中5-羟色胺（5-HT）及血管紧张素-Ⅱ（Ang-Ⅱ）含量的变化，探讨5-HT、Ang-Ⅱ与心肌肥厚发生的关系。方法：采用腹主动脉缩窄法建立压力超负荷心肌肥厚模型；腹腔注射甲状腺素法建立体液性心肌肥厚模型；荧光分光光度法和放射免疫分析法测定5-HT及Ang-Ⅱ含量。结果：大鼠腹主动脉缩窄后8周，心肌肥厚明显，分别于主动脉缩窄后4-8周内处死动物，发现心肌肥厚程度逐渐加重；心肌组中5-HT及Ang-Ⅱ含量也逐渐增加，并与肥厚程度呈正相关。腹腔注射甲状腺素2周后出现心肌肥厚，4周时症状加剧；于2、3、4周时处死动物，发现肥厚心肌组织中5-HT和Ang-Ⅱ含量均显著增加。结论：提示5-HT与心肌肥厚的形成有关，二者之间的相互关系尚待进一步研究。     

Action of ANG II and ANP on colon epithelial cells

The interaction of angiotensin II (ANG II) and atrial natriuretic peptide (ANP) on intracellular pH (pH_i) and calcium ([Ca²⁺]_i) was investigated in T84 cells (a permanent cell line derived from human colon epithelium) using the fluorescent stains BCECF/AM and Fluo 4/AM, respectively. pH_i recovery rate mediated by the Na⁺/H⁺ exchanger (NHE) was examined following an NH₄Cl pulse. Under control conditions pH_i recovered at 0.114±0.005 pH units/min (n=35). ANG II (10^–12 or 10^–9 M) increased this value, whilst ANG II (10^–7 M) decreased it. These effects of ANG II were impaired by simultaneous addition of 1 M or 25 M HOE-694, indicating that the stimulatory and inhibitory effects of ANG II on pH_i recovery are mediated in part via the NHE1 and NHE2 isoforms. ANG II increased [Ca²⁺]_i concentration-dependently. ANP (10^–6 M) or dimethyl-BAPTA/AM (50 M) blocked the effects of ANG II on [Ca²⁺]_i and on the rate of pH_i recovery. Thapsigargin (10^–5 M) enhanced the effect of ANG II on [Ca²⁺]_i and reversed its stimulatory effect on the rate of pH_i recovery to an inhibitory one. External Ca²⁺-free solution did not affect the effects of ANG II on these parameters. These data suggest that the [Ca²⁺]_i increase induced by ANG II is dependent on intracellular calcium stores. They are compatible with the demonstration of two sites on the C-terminal of the Na⁺/H⁺ exchanger, one stimulating Na⁺/H⁺ activity by increases of [Ca²⁺]_i in the lower range (at 10^–12 or 10^–9 M ANG II) and the other inhibiting this activity at high [Ca²⁺]_i levels (at 10^–7 M ANG II). ANP or dimethyl-BAPTA/AM, by impairing the pathway mediating the increase in [Ca²⁺]_i, block both the stimulatory and inhibitory effects of ANG II.     

血管紧张素II对巨噬细胞(THP-1细胞)凝集素样氧化低密度脂蛋白受体表达的影响

目的:研究AngII对人单核/巨噬细胞(THP-1细胞)凝集素样氧化低密度脂蛋白受体(LOX-1)蛋白表达和基因转录的影响,从细胞蛋白、分子水平探讨AngII和巨噬细胞LOX-1相互之间的关系,以进一步了解两者在动脉粥样硬化中的地位。方法:将不同浓度AngII(1×10^-9-1×10^-5mol/L)与经0.1μmol/L佛波酯(PMA)诱导分化后的THP-1细胞共孵育24h,以及将1×10^-6mol/L浓度的AngII与诱导分化后的THP-1细胞作用不同时间0、3、6、12、24、48h后,用细胞酶联免疫法和半定量RT-PCR分别检测LOX-1蛋白和mRNA表达的情况。结果:未经诱导的THP-1细胞不表达LOX-1mRNA;而经PMA诱导后,THP-1细胞停止增殖,由单核细胞分化成为巨噬细胞,并表达LOX-1mRNA。不同浓度的AngII作用诱导分化后的THP-1细胞24h,细胞LOX-1蛋白和mRNA的表达呈浓度依赖性显著增加。同一浓度的AngII作用THP-1细胞,可呈时间依赖性诱导LOX-1蛋白和mRNA表达,其趋势是3h左右开始增加,24h左右至最高峰,之后逐渐减低。结论:经PMA诱导分化后的THP-1细胞表达LOX-1;AngII能明显增强分化后的THP-1细胞表达LOX-1蛋白和mRNA,并呈浓度和时间依赖性。AngII这种作用可能是促进动脉粥样硬化发生、发展的机制之一。     

Anti-AT1R autoantibodies and prediction of the severity of Covid-19

The stimulation of AT1R (Angiotensin II Receptor Type 1) by Angiotensin II has, in addition to the effects on the renin-angiotensin system, also pro-inflammatory effects through stimulation of ADAM17 and subsequent production of INF-gamma and Interleukin-6. This pro-inflammatory action stimulate the cytokine storm that characterizes the most severe forms of SARS-CoV-2 infection. We studied the effect of AT1Rab on the AT1R on 74 subjects with SARS-CoV-2 infection with respiratory symptoms requiring hospitalization. We divided the patients into 2 groups: 34 with moderate and 40 with severe symptoms that required ICU admission. Hospitalized subjects showed a 50% reduction in the frequency of AT1Rab compared to healthy reference population. Of the ICU patients, 33/40 (82.5%) were AT1Rab negative and 16/33 of them (48.5%) died. All 7 patients positive for AT1Rab survived. These preliminary data seem to indicate a protective role played by AT1R autoantibodies on inflammatory activation in SARS-CoV-2 infection pathology.