IgA肾病肾小球系膜细胞P27与PCNA表达的意义

IgA肾病系肾小球系膜区以IgA占优势沉积为特征的一种免疫性肾小球疾病.发病机制仍未明确,近年来发现IgA1与肾小球系膜细胞(MC)结合是具有特异性和相当的亲和力,引发MC增殖的分泌因子.而MC的增殖受到周期调控蛋白的调控,本文根据肾活检常规病理检查,细胞周期调控蛋白P27Kip1(简称P27),增殖细胞核抗原(PCNA)的表达,治疗后近期疗效的结果,以期从细胞周期调控的角度来探讨MC增生状态与预后的关系.我们相信更好的理解调控肾小球系膜细胞增殖的机制必将能够导致新的诊断和治疗策略,因此能够帮助更好地控制增生性肾小球肾炎.     

关于世界卫生组织的肾疾病的组织学分类表

本表对日肾志21(4),105~111,1979,第1次会议所列的表的排列略加修正,余按第一次会议说明,未有变动。 表1肾小球的基本改变i。原发性肾小球疾病(肾小球肾炎和有关情况)2。周身疾病性肾小球肾炎 A微小肾小球异常狼疮性肾炎 B局灶/节段性损害(其他肾小球只伴有微小过敏性紫瘫性肾炎 异常)IgA肾病 C弥漫性肾小球肾炎GoodPasture氏综合征 a膜性肾小球肾炎(膜性肾病)周身性感染性肾小球损害 b增殖性肾小球肾炎败血症 系膜性增殖性肾小球肾炎感染性.合内膜炎 毛细血管内增殖性肾小球肾炎短路肾炎 系膜毛细血管性肾小球肾炎(膜增殖性肾梅毒性肾炎…     

肾小球肾炎患者活检标本中肾小管间质损害的意义

已知在原发性肾小球肾炎(GN)的肾活检标本尤其是含有硬化肾小球的标本中可以观察到肾小管间质损害(TIL),然而这类损害有时常被忽视或认为意义不大。作者对成人GN的常见类型作了回顾性研究,以评价TIL在估计GN的严重性和预后方面的意义。本研究包括IgA肾病(IgA-N)101例,IgA阴性的增殖性肾炎(PGN)31例,特发性膜性肾小球肾炎(IMGN)75例。平均随访时间为72个月。对上述病例的肾活检标本作了常规染色及检     

金水清对大鼠肾小球系膜细胞增殖及凋亡的影响

目的:通过观察中药复方金水清对大鼠肾小球系膜细胞(mesangial cells,MC)增殖及凋亡的影响,探讨其治疗小儿血尿的作用机制.方法:以噻唑蓝法检测MC的增殖,荧光显微镜下观察MC的凋亡形态,流式细胞仪检测细胞周期及凋亡.结果:在1 000～62.5 μg/L浓度范围内,金水清能抑制MC增殖,可使G0～G1期细胞增高,S、G2-M期细胞减少,且呈浓度依赖关系,并能明显诱导MC凋亡.结论:MC是金水清发挥作用的重要靶细胞,金水清可能通过:(1)减少细胞有丝分裂,干扰细胞周期,抑制系膜细胞的增殖及代谢活性;(2)诱导系膜细胞的凋亡等环节发挥抑制MC增殖的作用,从而减少炎性因子的合成与释放,减少细胞外基质的聚积,达到治疗小儿血尿,延缓慢性肾脏病理进程的目的.     

尿白细胞介素6对IgA肾病预后估价的意义

在日本,IgA肾病是最常见的原发性肾小球肾炎,组织学以系膜区IgA为特征,多为系膜增殖性肾小球肾炎。有研究发现白细胞介素6(IL-6)与系膜增殖性肾小球肾炎的发病机制密切相关。为探讨尿中IL-6的活性与IgA肾病预后之间的关系,作者测定了正常人和IgA肾病患者尿中IL-6的活性,并比较了IL-6与临床指标以及病理变化之间的关系。病人与方法:本研究包括20例正常人和32例IgA肾病患者(排除了系统性疾病和肾功能不全(Ccr>70ml/分)。根据肾活检系膜增殖的程度32例IgA肾病患者分为两组,Ⅰ组:24例,轻度系膜增殖;Ⅱ组:8例,中度系膜增殖(50%以上的肾小球有系膜增殖,肾小球局灶硬化和新月体形成在20%以上,间质纤维化和细胞浸润占皮质的30%以下)。32例IgA肾病患者有10例尿IL-6活性升高。这些病人随访10个月,Ⅱ组5例病人再次做肾活检。尿IL-6活性用IL-6鼠杂交克隆MH60,BSF_2测定。     

各种肾脏疾病C_3b受体的意义

各类肾脏疾病病人以临床和病理学观察对C_3b受体分布状态进行了研究:慢性增殖性肾小球肾炎(CPGN)43例,急性链球菌感染后肾小球肾炎(AGN)9例,膜增殖性肾小球肾炎6例,膜性肾病(MN)2例。另外,6例系统性红斑狼疮,和2例急性肾功能衰竭(ARF)也研究了,6例健康肾作对照。结果如下:     

环孢素A在不同病理类型慢性肾小球疾病治疗中的应用进展

慢性肾小球疾病可分为原发性和继发性,原发性肾小球疾病中常见的病理类型包括以下5种：膜性肾病（membranous nephropathy,MN）、微小病变型肾病（minimal change glomerulonephropathy,MCD）、系膜增殖性肾小球肾炎（mesangial proliferative glomerulonephritis,MsPGN,包括IgA系膜增殖性肾小球肾炎和非IgA系膜增殖性肾小球肾炎）、局灶节段性肾小球硬化（focal segmental glomerular sclerosis,FSGS）和膜增殖性肾小球肾炎（membranoproliferative glomerulonephritis,MPGN）,常见的继发性肾小球疾病的病理类型有狼疮肾炎、过敏性紫癜性肾炎、乙型肝炎病毒相关性肾炎等.     

环孢素A在不同病理类型原发性肾病综合征治疗中的应用

肾病综合征可分为原发性和继发性,原发性肾病综合征中常见的病理类犁包括以下5种:微小病变(MCD)、膜性肾病(MN)、局灶节段硬化性肾小球肾炎(FSGS)、系膜增殖性肾小球肾炎(MsPGN)和膜增殖性肾小球肾炎(MPGN),较为常见的为前4种.MCD在小儿及老年人较为常见,MN多发于老年人,而MsPGN为我同较为常见的肾病综合征,FSGS对治疗反应不佳,通常预后较差,MPGN则较为少见.     

B型肝炎病毒和肾炎

关于一部分膜性肾炎和膜性增殖性肾炎,特别在小儿患者,由于B型肝炎表面抗原(HDsAg)的免疫复合体(IC)在肾小球内沉着与其发生机制有关的报告,从本世纪70年代开始已经相当的多。也有报告伴原发性混合性冷沉(淀)球蛋白血症的肾小球肾炎也与HBsAg的IC有关。最近,马来西亚大学病理学家Looi~#等报告,用荧光抗体间接法证明在47例狼疮性肾炎中43例肾小球基底膜或者肾小球系膜存在HBsAg。对照组非狼疮性肾小球肾炎201例中仅有8例肾小球内见到HBsAg,推断狼疮性肾炎的肾小球内的IC是以HBsAg的     

细胞周期调控蛋白在人类肾小球肾炎中肾小管及间质细胞的表达及其意义

目的 观察人类肾小球肾炎时肾小管－间质细胞的细胞周期调控蛋白的表达情况。方法 采用免疫组织化学技术，检测19例肾小球肾炎患者肾穿刺标本中细胞周期正性调控蛋白周期素D1（cyclin D1)，周期素A（cyclin A0，细胞周期负性调控蛋白p21^CIP1（p21)和增殖细胞核抗原（PCNA）的表达。结果 在人类肾小球肾炎中肾小管上皮细胞及间质细胞均见cyclin D1,cyclin A及p21的表达，并与PCNA呈正相关。小管的阳性表达以间质病变I级和Ⅱ级组显著，间质阳性细胞数与小管间质病变程度及患者尿NAG活性呈显著正相关。结论 人类肾小球肾炎时，细胞周期调控蛋白参与肾小管上皮细胞及间质细胞的增殖，参与肾间质纤维化的发展。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.