缺氧诱导因子-1α参与肝纤维化形成机制研究进展

目的 肝纤维化是一种由于反复肝损伤而导致肝组织细胞外基质过多沉积导致的疾病。缺氧损伤为肝损伤的一部分,缺氧诱导因子-1α(HIF-1α)是响应缺氧应激的关键转录因子,在肝纤维化组织和活化的肝星状细胞(HSC)表达显著增加。目前,通过对大量HIF-1α依赖性基因和信号通路的研究,确认这些基因及其通路的变化参与肝纤维化发展过程,并可能在肝纤维化发生发展过程中起关键作用。本文综述了HIF-1α相关的信号通路参与肝纤维化发展的相关机制,并对上游影响HIF-1α合成和降解的相关信号通路进行了阐述,为其作为新型治疗靶点的可能潜力提供依据。     

Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review

PurposeType B aortic dissection is a rare but life-threatening disease. Thoracic endovascular aortic repair (TEVAR) was widely used for Type B aortic dissection patients in the last decade due to the lower mortality and morbidity compared with open chest surgical repair (OCSR). AKI in type B aortic dissection is a well-recognized complication and indicates poor short-term and long-term outcome. The objective of this concise review was to identify the risk factors and the impact of AKI on type B aortic dissection patients.Methods and resultsA literature search was performed using PubMed, Embase, MEDLINE, and Cochrane Library with the search terms ‘type B aortic dissection’ and ‘acute kidney injury’ (AKI), and all English-language literatures published in print or available online from inception through August 2020 were thoroughly reviewed. Studies that reported relative AKI risks and outcomes in type B aortic dissection patient were included. Major mechanisms of AKI in type B aortic dissection included renal hypoperfusion, inflammation response, and the use of contrast medium. Type B aortic dissection patients with AKI significantly had increased hospital stay duration, need of renal replacement therapy, and 30-d and 1-year mortality.ConclusionsAKI in type B aortic dissection is a well-recognized complication and associated with poor short-term and long-term outcome. Early identification of high-risk patients, early diagnosis of AKI, stabilization of the hemodynamic parameters, avoidance of nephrotoxic drugs, and optimization of the use of contrast agents are the major strategies for the reduction of AKI in type B aortic dissection patients.     

Impact of overweight and obesity on US renal cell carcinoma incidence trends (1995-2018)

In the United States, renal cell carcinoma (RCC) incidence and the prevalence of obesity, an established risk factor for RCC, have been increasing for several decades. RCC is more common among older individuals. We sought to quantify the contribution of excess adiposity to the rising incidence of RCC among individuals 60 years or older. National Institutes of Health-American Association of Retired Persons Diet and Health Study data (n = 453 859 participants, enrolled in 1995-1996, age at enrollment 50-71 years) were used to estimate multivariable-adjusted hazard ratios (HRs) for RCC across body mass index categories and HRs associated with smoking. Population attributable fractions (PAFs) were calculated using estimated HRs and annual overweight/obesity prevalence from the National Health Interview Survey (1985-2008). PAF estimates were combined with RCC incidence from Surveillance, Epidemiology and End Results-13 to calculate annual percent changes in RCC incidence attributable (and unrelated) to overweight/obesity. We found that between 1995 and 2018, among individuals aged 60 years and older, PAF for overweight/obesity increased from 18% to 29% for all RCCs. In comparison, the PAF for smoking declined from 12% to 9%. RCC incidence increased 1.8% per year (95% confidence interval [CI] 1.5%-2.1%) overall, while RCC incidence attributable to overweight/obesity increased 3.8% per year (95%CI 3.5%-4.2%) and RCC incidence unrelated to overweight/obesity increased 1.2% per year (95% CI 0.9%-1.4%). In conclusion, overweight/obesity appears to have contributed importantly to the rising incidence of RCC in the United States since the mid-1990s. Public health interventions focused on reducing overweight and obesity could help substantially in curbing this trend.     

改进Seldinger法经皮穿刺腹膜透析置管术在终末期肾病患者中的应用

目的:探讨改进Seldinger法经皮穿刺腹膜透析置管术在终末期肾病患者中的应用效果。方法:选取2019年12月~2020年12月于本院进行腹膜透析置管术的终末期肾病患者61例,随机分为观察组(31例)和对照组(30例),对照组患者采用常规开腹手术置管,观察组采用改进Seldinger法置管,比较两组患者完成置管手术的相关指标(手术时间、术后排气时间、切口长度、住院时间),术后3d、1个月患者并发症发生情况。结果:较对照组,观察组手术时间、术后排气时间均更短,腹部切口长度更短(P<0.05),两组患者住院时间比较(P>0.05),观察组穿刺成功率明显高于对照组(100.00%,80.00%,χ²=6.88,P=0.01)。较对照组,观察组患者术后3d并发症发生率明显低于对照组(22.58%,50.00%,χ²=4.97,P=0.03),观察组患者术后1个月并发症发生率明显低于对照组(19.35%,53.33%,χ²=7.05,P=0.01)。结论:对终末期肾病患者运用改进Seldinger法经皮穿刺腹膜透析置管术进行置管可有效缩短手术时间和术后排气时间,创口较小,患者术后早期、远期并发症较少,临床应用效果较好。     

Liver fibrosis scores and risk of liver-related mortality in young adults with chronic hepatitis B: A cohort study

The predictive role of noninvasive liver fibrosis scores on liver-related mortality in patients with chronic hepatitis B below 40 years of age remains unclarified. We examined the association of liver fibrosis scores with liver-related mortality in young (<40 years) and older adults with hepatitis B virus (HBV) infection. A cohort study was performed in 21,360 HBsAg-positive Korean adults without liver cirrhosis or liver cancer at baseline who were followed up for up to 18 years. The liver fibrosis scores were determined using the fibrosis-4 score (FIB-4) and aspartate transaminase to platelet ratio index (APRI). Patients’ vital status and cause of death were ascertained through the National Death Records. During a median follow-up of 10.2 years, 283 liver-related deaths were identified (liver-related mortality, 127.4/10⁵ person-years). The liver fibrosis scores were significantly associated with increased risks of liver-related mortality; this association did not differ by age group (<40 vs. ≥40 years). The multivariable-adjusted hazard ratios with 95% confidence intervals for liver-related mortality comparing intermediate and high to low FIB-4 scores were 4.23 (1.99–9.00), and 15.16 (5.18–44.38), respectively, among individuals under 40, and 4.46 (3.03–6.56) and 22.47 (15.11–33.41), respectively, among older individuals. These associations were similar in analyses using APRI. In this cohort of HBsAg-positive individuals, the liver fibrosis scores were associated with increased risks of liver-related mortality in young and older adults. The liver fibrosis scores have a role in predicting liver mortality, even in young adults with HBV.     

A reappraisal of pediatric abdominal surface anatomy

Surface anatomy is fundamental to clinical and surgical practices. As the surface anatomy varies with age, the purpose of this study is to provide age-standardized surface markings for the abdomen in children. A total of 155 abdominal computed tomography scans of healthy children aged 0–18 years were categorized into six groups, and the surface anatomy of the major vascular structures, solid viscera, and anatomical planes in the abdomen was analyzed. The vertebral levels of the celiac trunk, superior mesenteric artery, and hepatic portal vein formation were higher in the youngest age group, whereas the levels of the inferior mesenteric artery, formation of the inferior vena cava, and renal arteries did not differ with age. The right kidney lay between T12 and L3 and the left at T11-L3; however, both kidneys were in lower positions in younger children. The spleen was most commonly located between the 8th and 11th ribs except in toddlers. In all age groups, the hepatic portal vein formation was within the transpyloric plane and the aortic bifurcation was above the supracristal plane. In vivo reassessment of the surface anatomy enables the substantial variability of surface landmarks to be highlighted. This study demonstrates that taking account of age-related variations will increase the accuracy and therefore the clinical relevance of surface anatomy.     

大黄素治疗代谢相关脂肪性肝病的作用机制研究进展

代谢相关脂肪性肝病既往称为非酒精性脂肪肝，与肥胖、糖尿病、高脂血症等关系密切，还明显增加心血管死亡的风险。大黄素是大黄、何首乌中主要的活性成分，具有多种生物学功能。大黄素可通过降低肝细胞脂质沉积、抑制肝脏炎症反应、抗胰岛素抵抗、抑制肝纤维化、抗氧化应激反应等多种途径对代谢相关脂肪性肝病发挥治疗作用。总结了大黄素治疗代谢相关脂肪性肝病的作用机制，为代谢相关脂肪性肝病的治疗提供参考。