Fractalkine在新月体肾炎患者肾组织中的表达及其意义

目的:研究新月体肾炎患者肾组织中Fractalkine的表达,分析其与新月体类型、间质中炎性细胞浸润程度、肾小管损伤程度之间的关系,以探讨其在新月体肾炎发生和发展中的作用。方法:新月体肾炎患者28例,应用免疫组织化学的方法分别观察伴细胞性、伴纤维细胞性和伴纤维性新月体中Fractalkine的表达。结果:在伴细胞性或伴纤维细胞性新月体的肾小球中Fractalkine表达增加,伴细胞性新月体的肾小球中Fractalkine的阳性细胞数较伴纤维细胞性新月体中的阳性细胞数增多,两者间差异有显著性(P<0.01)。表达于受损的肾小管上皮细胞胞质中的Fractalkine与肾小管损伤程度呈正相关(r=0.784,P<0.01),而与间质炎性细胞浸润程度无关(r=0.027,P>0.05)。结论:肾小球中的Fractalkine可能参与新月体形成的始动过程,肾小管中Fractalkine表达的意义还有待于进一步研究。     

41例新月体肾炎临床和病理分析

新月体肾炎病情凶险，临床多数表现高血压、蛋白尿、血尿、少尿，进行性贫血、急骤发展的肾功能不全[1，4]。近年来，随肾活俭的开展，特别是重症患者肾活检的例数增多，新月体肾炎的诊断率呈上升趋势。本文回顾了我科1982年～1996年6月，14年中经肾活俭确诊的41例特发性新月体肾炎，现就临床和病理进行分析。1资料与方法1．1病例选择41例均为住院患者。肾脏病理符合下列标准：①肾活检所取肾小球数≥10个；②新月体占所取肾小球总数50％以上；③新月体占肾小球囊表面积50％以上为半月或环状新月体；④构成新月体的细胞或组织＞3层。1．2病…     

超声引导下经皮肾活检的临床应用36例分析

目的探讨超声引导下经皮肾组织穿刺活检术对肾脏疾病的应用价值。方法对36例肾脏疾病患者在超声引导下经皮对肾脏进行穿刺,取出组织行病理检查。结果 36例共穿刺50针,穿出组织50条,长度1～2cm,穿刺成功率100%,其中系膜增生性肾小球肾炎23例,Ⅱ型狼疮性肾炎3例,Ⅲ型狼疮性肾炎2例,Ⅳ型狼疮性肾炎4例,新月体肾炎1例,系膜增生性肾小球肾炎伴局限性肾小球硬化3例。结论经皮肾组织穿刺活检术对了解肾脏疾病的病理类型,指导临床治疗及判断预后具有重要意义。     

p16^INK4a在原发性系膜增生性肾小球肾炎的表达及意义

目的：探讨原发性系膜增生性肾小球肾炎（MsPGN）细胞周期素依赖蛋白激酶抑制剂p16^INK4a在肾小球和肾小管间质的表达分布及意义。方法：采用非生物素免疫组化二步法检测36例MsPGN患者活检肾组织肾小球和肾小管间质p16^INK4a的表达水平。结果：正常对照组肾小球见极少p16^INK4a表达,肾小管间质少许表达,MsPGN组肾小球和小管间质p16^INK4a表达升高,两组比较,具有显著统计学差异（P〈0.01）。36例病例中15例硬化、新月体形成组肾小球上高表达,而非硬化、非新月体形成组肾小球部分表达,组间相比具有显著差异（P〈0.01）,而小管间质表达无统计学差异（P〉0.05）。结论：MsPGN组p16^INK4a高表达,主要表达于硬化肾小球、新月体形成肾小球,p16^INK4a参与了MsPGN的细胞周期调控。     

p16^INK4a在原发性系膜增生性肾小球肾炎的表达及意义

目的：探讨原发性系膜增生性肾小球肾炎（MsPGN）细胞周期素依赖蛋白激酶抑制剂p16^INK4a在肾小球和肾小管间质的表达分布及意义。方法：采用非生物素免疫组化二步法检测36例MsPGN患者活检肾组织肾小球和肾小管间质p16^INK4a的表达水平。结果：正常对照组肾小球见极少p16^INK4a表达,肾小管间质少许表达,MsPGN组肾小球和小管间质p16^INK4a表达升高,两组比较,具有显著统计学差异（P〈0.01）。36例病例中15例硬化、新月体形成组肾小球上高表达,而非硬化、非新月体形成组肾小球部分表达,组间相比具有显著差异（P〈0.01）,而小管间质表达无统计学差异（P〉0.05）。结论：MsPGN组p16^INK4a高表达,主要表达于硬化肾小球、新月体形成肾小球,p16^INK4a参与了MsPGN的细胞周期调控。     

急进性肾炎患者尿沉渣红细胞检测的临床意义

１对象与方法１．１观察对象１．１．１急进性肾炎１９例,男性６例,女性１３例,年龄１０～６４岁,平均３３．７４±１６．２３岁。符合下列标准：①原发性或继发性肾炎,②均经肾活检证实,活检所取肾小球＞１０个。新月体数占所取肾小球的５０％以上,新月体占肾小球囊表面积的５０％以上,为半月或环状新月体。按免疫病理学分为①抗肾抗体型,②免疫复合物型,③寡免疫复合物型。１．１．２对照组,均经肾活检证实为非新月体性肾炎１０例,男性 ３例,女性 ７例。年龄１３～４６岁,平均为２４．３±１２．２岁。其中ＩｇＡ肾病 ４例…     

62例移植肾穿刺活组织检查的病理及临床分析

目的：探讨肾移植后肾损害的病理及可能的相关因素，评价移植肾穿刺活组织检查(肾活检)的诊断价值。方法：回顾性分析62例移植肾肾活检的病理及临床资料。结果：62例中发生总性排斥反应24例(39％)，慢性移植性肾病21例(34％)，加速排斥反应1例，IgA肾病5例(8％)，系膜增生性肾炎样改变3例(5％)，新月体肾炎2例，膜性肾病1例，环抱素中毒1例，肾结核1例，急性肾小管坏死1例，慢性排斥反应、慢性肾小球肾炎各1例。排斥反应病例肾移植术前的人类白细胞抗原配型和群体反应性抗体明显差于非排斥反应病例，巨细胞病毒感染发生率较高。移植肾穿刺活检未发生明显的不良反应。结论：移植肾肾活检安全可靠，对于肾移植术后发生肾损害的病因诊断具有很高的价值。     

急性肾功能衰竭患者经皮肾穿刺活检的临床意义

目的研究急性肾功能衰竭（ARF）患者的病理类型及病因分布，评价肾活检在肾脏病诊治中的作用与临床意义。方法对30例ARF患者具有肾穿刺活检适应证的病例，在B超介入定位下行经皮肾穿刺活检，并作光镜、免疫病理检查及结合临床特点进行分析。结果30例ARF患者肾穿刺均能成功取得肾小球，标本合格率为96．7％。病理分析显示：硬化性肾炎2例（6．67％）；原发性肾小球肾炎17例（56．67％），其中IgA肾病3例，肾小球轻微病变5例，膜性肾病2例，局灶节段性硬化性肾炎2例，毛细血管内增生性肾炎2例，新月体肾炎3例；继发性肾小球肾炎8例（26．62％），其中狼疮性肾炎6例，过敏性紫癜肾炎2例：另外，急性肾小管坏死2例（6．67％）；急性间质性肾炎1例（3．33％）。并发症主要有肉眼血尿2例，肾周血肿1例，未发生误穿其他脏器、感染及严重大出血等并发症。结论对急性肾功能衰竭患者行肾活检是可行的，有助于明确病因及病理类型，对指导治疗及判断预后均有非常重要的作用。     

超声引导下经皮不同方式肾组织活检的临床应用

目的 B型超声引导下对30例肾脏疾病患者进行经皮,肾组织穿刺活检的经验.方法采用东芝240 A型超声仪和穿刺探头,选择右肾下极穿刺.利用同步负压活检装置及组织切割针进行肾穿刺.分别送光镜、电镜及免疫组化检查.结果 30例患者,利用同步负压活检装置进行肾穿18例,利用组织切割针进行肾穿12例,取材率100%.并取出组织物35条,共检出肾小球306个.送病理学检查.结果为肾小球疾病者28例,肾小管疾病者2例.在肾小球疾病中,原发者24例,包括弥漫系膜增生性肾小球肾炎19例,IgA肾病4例,新月体肾小球肾炎1例,继发性者4例,即狼疮性肾炎4例.结论经皮肾穿刺活检,对了解肾脏疾病的病理类型、指导临床治疗、判断疾病预后具有十分重要的意义.     

成纤维细胞特异性蛋白-1在急性肾小管坏死病变中的表达及临床意义

目的检测成纤维细胞特异性蛋白-1(FSP-1)在急性肾小管坏死(ATN)病变肾组织及尿沉渣中的表达,并分析其临床意义。方法收集ATN患者10例,新月体肾炎2例为阳性对照,正常肾组织3例为阴性对照,采用免疫组化和免疫荧光法检测FSP-1、CD68(巨噬细胞标志物)在肾组织中的表达,并观察ATN患者尿沉渣涂片中FSP-1的表达。收集6例健康志愿者的晨尿标本作为阴性对照。结果正常肾组织肾间质小血管偶见FSP-1表达,CD68染色阴性。阳性对照新月体肾炎患者肾小球细胞性新月体及纤维细胞性新月体中FSP-1呈散在阳性分布,肾小管间质中亦可见FSP-1阳性细胞。ATN患者肾组织FSP-1阳性细胞位于损伤、再生的肾小管周围及肾小管管腔中,部分肾小管上皮细胞也见FSP-1阳性表达。肾组织病变严重的ATN患者肾脏及尿沉渣涂片中FSP-1阳性细胞明显增多。尿沉渣FSP-1阳性细胞数与肾脏FSP-1阳性细胞数呈正相关(r=0.793,P=0.006)。FSP-1与CD68的阳性表达部位不重叠。健康志愿者的尿沉渣涂片中未见FSP-1阳性细胞表达。结论 ATN患者肾组织中可见FSP-1阳性细胞的浸润及FSP-1在肾小管上皮的表达,与尿沉渣FSP-1阳性细胞数呈正相关,FSP-1有望成为反映肾小管急性损伤的生物学标志物。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.