持续性非卧床腹膜透析患者腹膜炎发生的危险因素分析

目的探讨非卧床腹膜透析患者腹膜炎发生的危险因素。方法选取我院2017年1月至2018年12月收治的慢性肾衰竭持续性非卧床腹膜透析患者260例作为研究对象,采用一般情况调查问卷收集患者信息,统计记录腹膜炎发生情况,采用多因素logistic回归分析确定腹膜炎发生的影响因素。结果 260例患者中发生腹膜炎的73例,占28. 08%;多因素logistic回归分析显示腹膜炎发生的独立危险因素有高龄、低文化水平、合并糖尿病、透析时长、总蛋白(TP)水平下降、血钙(Ca)水平下降。结论我院慢性肾衰竭持续性非卧床腹膜透析患者相关性腹膜炎发生率为28. 08%,腹膜炎发生独立危险因素为高龄、低文化水平、伴有糖尿病、透析时间长、总蛋白水平下降、血钙水平下降,结合危险因素制定防范干预措施非常重要。     

Aortitis and periaortitis: The puzzling spectrum of inflammatory aortic diseases

Aortitis and periaortitis are inflammatory diseases of the aorta and its main branches; they differ in the extension of inflammation, which is confined to the aortic wall in aortitis, and spreads to the periaortic space in periaortitis. Aortitis is classified as non-infectious or infectious. Non-infectious aortitis represents a common feature of large-vessel vasculitides but can also be isolated or associated with other rheumatologic conditions. Periaortitis can be idiopathic or secondary to a wide array of etiologies such as drugs, infections, malignancies, and other proliferative diseases. Notably, both aortitis and periaortitis may arise in the context of IgG4-related disease, a recently characterised fibro-inflammatory systemic disease. Prompt recognition, correct diagnosis and appropriate treatment are essential in order to avoid life-threatening complications.     

Searching for prognostic biomarkers for small renal masses in the urinary proteome

Renal cell carcinoma (RCC) is frequently diagnosed incidentally as an early-stage small renal mass (SRM; pT1a, ≤4 cm). Overtreatment of patients with benign or clinically indolent SRMs is increasingly common and has resulted in a recent shift in treatment recommendations. There are currently no available biomarkers that can accurately predict clinical behavior. Therefore, we set out to identify early biomarkers of RCC progression. We employed a quantitative label-free liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) proteomics approach and targeted parallel-reaction monitoring to identify and validate early, noninvasive urinary biomarkers for RCC-SRMs. In total, we evaluated 115 urine samples, including 33 renal oncocytoma (≤4 cm) cases, 30 progressive and 26 nonprogressive clear cell RCC (ccRCC)-SRM cases, in addition to 26 healthy controls. We identified six proteins, which displayed significantly elevated expression in clear cell RCC-SRMs (ccRCC-SRMs) relative to healthy controls. Proteins C12ORF49 and EHD4 showed significantly elevated expression in ccRCC-SRMs compared to renal oncocytoma (≤4 cm). Additionally, proteins EPS8L2, CHMP2A, PDCD6IP, CNDP2 and CEACAM1 displayed significantly elevated expression in progressive relative to nonprogressive ccRCC-SRMs. A two-protein signature (EPS8L2 and CCT6A) showed significant discriminatory ability (areas under the curve: 0.81, 95% CI: 0.70–0.93) in distinguishing progressive from nonprogressive ccRCC-SRMs. Patients (Stage I–IV) with EPS8L2 and CCT6A mRNA alterations showed significantly shorter overall survival (p = 1.407 × 10⁻⁶) compared to patients with no alterations. Our in-depth proteomic analysis identified novel biomarkers for early-stage RCC-SRMs. Pretreatment characterization of urinary proteins may provide insight into early RCC progression and could potentially help assign patients to appropriate management strategies.     

清肺化痰汤通过抑制JAK2/STAT3通路上调CFTR的表达治疗COPD

目的:探索清肺化痰汤对慢性阻塞性肺疾病(COPD)的治疗作用及其机制研究。方法:应用烟雾吸入联合脂多糖(LPS)灌肺复合素的方法,建立COPD大鼠模型,造模成功后将大鼠随机分为6组,分别为正常组,COPD模型组,清肺化痰汤低、中、高剂量组和氨溴索组。造模28 d后开始给药,清肺化痰汤低、中、高剂量7.5,15,30 g·kg~(-1),氨溴索35 mg·kg~(-1),连续给药14 d。免疫组化和实时荧光定量聚合酶链式反应(Real-time PCR)检测肺组织囊性纤维化跨膜转导调节因子(CFTR)蛋白和mRNA的表达。应用LPS诱导NCI-H292细胞建立黏液高分泌模型,实验分为8组,分别为空白组,LPS组,LPS+10%胎牛血清,LPS+生理血清,LPS+5%含药血清,LPS+10%含药血清,LPS+20%含药血清,LPS+AG490组。免疫荧光、蛋白免疫印迹法(Western blot)和Real-time PCR观察LPS刺激后的NCI-H292细胞中CFTR蛋白和mRNA的表达,Western blot检测LPS刺激后的NCI-H292细胞中Janus激酶2/信号转导与转录激活因子3(JAK2/STAT3)信号通路表达。结果:正常组大鼠肺组织管腔周围有大量棕褐色颗粒,COPD表达升高,与正常组比较,模型组大鼠肺组织管腔周围的棕褐色颗粒极少,COPD表达较低。与正常组比较,COPD模型组大鼠肺组织中CFTR mRNA和蛋白表达明显降低(P0.05);与模型组比较,清肺化痰汤低、中、高剂量组明显升高大鼠肺组织CFTR mRNA和蛋白表达水平(P0.05)。与空白组比较,LPS组NCI-H292细胞CFTR mRNA和蛋白表达显著降低(P0.01),p-JAK2,p-STAT3蛋白表达明显升高(P0.05);与模型组比较,清肺化痰汤5%,10%,20%含药血清组明显升高CFTR mRNA和蛋白表达,明显降低p-JAK2,p-STAT3蛋白表达(P0.05,P0.01)。结论:清肺化痰汤通过抑制JAK2/STAT3通路来上调CFTR治疗COPD。     

血清铁蛋白诊断慢性肝病显著纤维化和肝硬化的临床价值

目的探讨血清铁蛋白在慢性肝病显著纤维化和肝硬化中的诊断价值。方法收集来我院诊疗的122例慢性肝病患者资料,均进行肝组织病理学检查,检测患者的肝纤维化4项、肝功能以及血清铁蛋白的水平,以肝穿刺的病理结果作为依据,比较血清铁蛋白与肝纤维化4项、血常规等指标对显著肝纤维化和肝硬化诊断价值的优劣,并采用Logistic回归分析探讨相关影响因素。结果血清铁蛋白、肝纤维化四项指标水平均与肝纤维化程度呈正相关,均随着肝纤维化分期增加而增加,并且在肝硬化时期最高(P<0.05)。对纤维化或肝硬化的可能影响因素进行单因素分析,结果发现血小板透明质酸、层黏蛋白、Ⅳ型胶原、Ⅲ型前胶原、血清铁蛋白等因素与显著纤维化有关;而白细胞计数、血小板、白蛋白、层黏蛋白、Ⅳ型胶原、Ⅲ型前胶原、血清铁蛋白等因素与肝硬化有关。ROC曲线分析血清铁蛋白对显著纤维化的诊断效能,曲线下面积为0.816(0.803~0.910),血清铁蛋白在截点值为138.17 ng/mL时,敏感度为82.0%,特异度为91.2%。ROC曲线分析血清铁蛋白对肝硬化的诊断效能,曲线下面积(AUC)为0.827(0.817~0.846),血清铁蛋白在截点值为160.25 ng/mL时,敏感度为82.4%,特异度为91.5%。结论血清铁蛋白、肝纤维化四项与慢性肝病显著纤维化和肝硬化程度有关,且以上方式简便、创伤性小、可重复性较强,对检测肝纤维化以及肝硬化程度具有良好的提示作用。     

Tumor-to-tumor metastases: Latent renal cell carcinoma discovered after elective surgical resection of a convexity meningioma

BackgroundTumor-to-tumor metastases are extremely rarely reported lesions, which usually involve an indolent lesion hosting a more aggressive neoplasm. We present an unusual initial manifestation of a previously unknown clear cell renal cell carcinoma as a tumor-to-tumor metastasis in a typical meningothelial meningioma.Case reportA 73-year old patient with transient left slight monoparesis was addressed to our Neurosurgical Department after being evaluated by his general practitioner and passing a cerebral MRI which revealed a right frontotemporal mass attached to the meninge. At presentation, no deficits were identified; therefore an elective surgery was proposed. Histological analysis revealed a typical meningothelial meningioma containing a metastatic clear cell renal cell carcinoma. Additional thoraco-abdominal computer tomography identified a 6 cm diameter lesion within the right kidney with radiological features highly suggestive of a primary clear cell renal cell carcinoma.ConclusionOur case highlights the need for a specialized neuropathological approach to clinical and imagistic indolent meningiomas, as they may require important differential diagnosis that can highly impact the treatment and follow-up of brain tumor patients.     

lncRNA UCA1在肾透明细胞癌中的表达与临床特征及预后的关系

目的:研究长链非编码RNA（lncRNA）尿路上皮癌胚抗原1（UCA1）在肾透明细胞癌（KIRC）患者癌组织及癌旁正常组织中的表达水平，探讨其与患者临床特征及预后的关系。方法:选取2009年2月至2013年2月在本院诊治并保存完整的KIRC患者癌组织标本56例为KIRC组，同时另取患者配对癌旁正常肾组织（距肿瘤边缘＞5 cm）作为对照组，通过实时荧光定量逆转录聚合酶链反应(qRT-PCR)法检测lncRNA UCA1表达水平，分析lncRNA UCA1表达水平与患者临床特征及预后生存的关系。结果:KIRC患者肾癌组织中lncRNA UCA1表达水平显著高于对照组（P＜0.05）。lncRNA UCA1表达水平与TNM分期、Robson分期和组织分化程度有关（P＜0.05）。lncRNA UCA1高表达组的5年生存率显著低于lncRNA UCA1低表达组（P＜0.05）。lncRNA UCA1高表达是影响KIRC患者不良预后发生的独立危险因素（P＜0.05）。结论:lncRNA UCA1在KIRC患者肾癌组织中高表达，与TNM分期、Robson分期和组织分化程度有关，是影响KIRC患者不良预后发生的独立危险因素。     

《伤寒论》六经辨证与肾性水肿

肾性水肿临床可见于原发性或继发性肾脏疾病。仲景继承《内经》理论,著《伤寒杂病论》并开创六经辨证理论体系,对现代肾性水肿临床治疗具有重要的指导意义。该体系囊括了经络脏腑、气血津液、体质禀赋等理论基础。根据六经辨证理论体系,以太阳、阳明、少阳、太阴、少阴、厥阴六经理论为基础,结合各经辨证要点,将《伤寒论》六经辨证引入肾性水肿的临床诊疗。拓展六经辨证理论在肾性水肿临床治疗中的实际应用。     

Polycystic kidney disease and other genetic kidney disorders

Cystic kidney diseases encompass a range of genetic disorders in which the primary cilia of the cells are affected and thereby cysts form as a result. There are an increasing range of cystic renal diseases recognized due to the advances in genomics. The most common genetic kidney condition is autosomal dominant polycystic kidney disease (ADPKD). ADPKD leads to renal failure in adulthood. In children, hypertension is common and if treated, may slow down renal decline. The most common cystic kidney disease causing renal failure in children is autosomal recessive polycystic kidney disease (ARPKD). ARPKD also affects the liver. These conditions often have extra-renal features which also need to be addressed. Until recently, treatments were mainly supportive but now it is possible to slow down development of cyst formation and renal decline in ADPKD. This raises hope for treatment for other cystic renal conditions as more genes are identified and underlying mechanisms defined.     

腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤的临床应用

目的对比研究腹腔镜下外生性肾血管平滑肌脂肪瘤"蘑菇状"剜除与标准肾部分切除术的安全性及有效性，为肾血管平滑肌脂肪瘤腹腔镜下"蘑菇状"剜除术术式的建立提供临床依据。 方法选取海南医学院第二附属医院与解放军总医院2018年1月至2019年5月期间，接受腹腔镜手术的肾血管平滑肌脂肪瘤患者53例，其中25例沿肿瘤假包膜行"蘑菇状"剜除术(A组)、28例行肾部分切除术(B组)。比较两组手术患者的肾动脉阻断时间、手术时间、术中出血量、术后24 h血红蛋白、术后eGFR(estimated glomerular filtration rate,估计肾小球率过滤)的变化、术后住院时间和术后肿瘤复发率。 结果53例手术无术中转开放，无死亡病例。肾动脉阻断时间：A组(11.9±2.2)min、B组(21.5±6.5) min(P<0.001)。手术时间：A组(87.9±24.8)min、B组(114.3±38.9) min(P<0.001)。术中出血量：A组20 ml(20～40)ml、B组50 ml(50～100)ml(P<0.001)。术后24 h血红蛋白变化：A组(7.4±4.3) g/L、B组(12.4±8.8) g/L(P＝0.013)。术后24 h eGFR变化：A组(6.2±7.2 )ml(min·1.73 m²)，B组(12.7±12.8)ml(min·1.73 m²)(P＝0.027)。术后6个月eGFR变化：A组(1.5±3.7)ml(min·1.73 m²)、B组(6.5±5.6)ml(min·1.73 m²)(P<0.001)。术后住院时间：A组4.0 d(3～4)d、B组4.5 d(3～6)d(P＝0.023)。术后随访两组术后肿瘤均无复发。 结论采用腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤在肾动脉阻断时间、术中出血量、术后24 h血红蛋白、术后eGFR变化、术后住院时间等方面均优于传统肾部分切除术，两组术后肿瘤均无复发；该方法安全、有效，适于临床推广。