中性粒细胞明胶酶相关脂质运载蛋白对缺氧/复氧肾小管上皮HK-2细胞自噬作用的影响

摘要：目的：观察中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对缺氧/复氧肾小管上皮细胞HK-2自噬水平的影响,探讨NGAL在肾小管上皮细胞缺氧/复氧过程中发挥的作用。 方法：构建高表达NGAL的载体pcDNA3.1(-)/myc-His B-NGAL,并转染HK-2细胞。将HK-2细胞分为未转染组和转染组,每组再分为缺氧/复氧处理组和未处理组。用western blot法检测转染后NGAL蛋白表达水平和缺氧/复氧后细胞自噬微管相关蛋白轻链3-Ⅱ（LC-3-Ⅱ）表达水平,并用CellTiter Blue细胞活性检测系统检测细胞活力。 结果：成功构建高表达NGAL的载体pcDNA3.1(-)/myc-His B-NGAL,转染HK-2细胞后,细胞NGAL蛋白表达水平高于未转染组（t=8.959,P<0.05）。缺氧1 h/复氧24 h后,转染组细胞LC-3-Ⅱ表达水平高于未转染组（t=21.721,P<0.05）,而细胞活力低于未转染组（t=－6.238,P<0.05）。 结论：在HK-2细胞缺氧/复氧状态下,NGAL能增强细胞自噬水平,导致细胞损伤加重甚至死亡。     

腹腔镜去顶减压术治疗成人型多囊肾

目的评价腹腔镜下治疗成人型多囊肾的疗效。方法采用腹腔镜下经腹膜后行囊肿去顶减压术治疗多囊肾患者12例。结果12例手术成功,无并发症发生,发生肾功能不全的患者术后均有不同程度肾功能改善。结论腹膜后腹腔镜囊肿去顶术具有创伤小、患者恢复快、操作简便等优点,应作为首选术式。     

吸痰对组织氧代谢的影响

研究吸痰对组织氧代谢的影响。方法：观察１４例危重病人吸痰前,吸痰结束时及吸痰后５ｍｉｎ动脉血气和混合静脉血气的变化。结果：与吸痰前相比,吸痰结束时的动脉血氧分压、血氧饱和度,混合静脑海因氧分压,血氧饱和度均显著降低,吸痰结束后５ｍｉｎ,ＳｖＯ３仍未恢复正常。     

后腹腔镜去顶减压术治疗成人型多囊肾

目的 探讨后腹腔镜去顶减压术治疗成人型多囊肾的临床价值.方法 2001年1月～2004年10月,应用后腹腔镜去顶减压术治疗成人型多囊肾患者25例.结果 所有手术均获成功.平均手术时间150min,手术失血量30～150mL,术后肠道功能恢复时间12～24 h,下床活动时间24～48 h,术后平均住院时间6.5 d.随访10～54个月,20例腰痛患者中腰痛减轻13例;19例血压升高者中15例平均血压下降超过10 mmHg,其中11例血压下降至正常范围;血清Cr下降10μmol/L以上者6例,血清Cr一过性升高10μmol/L以上者2例.未发生严重并发症.结论 后腹腔镜去顶减压术治疗成人型多囊肾疗效确切,创伤小,恢复快,值得在临床上推广应用.     

郁金对低张性缺氧小鼠脑功能的影响

目的观察郁金对低张性缺氧小鼠脑功能的影响。方法利用常压密闭耐缺氧实验和断头实验复制小鼠急性缺氧模型，用郁金低、中、高剂量（10g／kg、20g／kg、40g／kg）连续灌胃6d。采用低张性缺氧模型观察各组小鼠存活时间；通过断头实验观察各组小鼠张口次数和喘吸时间；检测脑组织超氧化物岐化酶（SOD）活性和丙二醛（MDA）含量；镜下观察脑组织形态变化。结果郁金高、中剂量组小鼠急性缺氧条件下的存活时间显著延长（P〈0．001），各郁金剂量组小鼠断头喘息时间、断头后张口次数均增加（P〈0．05～0．001），脑组织SOD活性显著提高（P〈0．001），MDA含量明显下降（P〈0．01～0．001）；镜下可见模型组小鼠脑组织有明显的嗜神经现象、血管周围炎性水肿和脑膜下出血，而郁金治疗组小鼠脑组织除偶见脑膜血管扩张外未见其他异常。结论郁金对低张性缺氧小鼠脑组织有一定的保护作用。     

预充氧对减少吸痰导致组织缺氧的临床观察

为研究预充氧对吸痰导致组织缺氧的影响,在非预充氧和预充氧条件下,观察１４ 例危重患者吸痰前、吸痰结束时、吸痰后５ 分钟动脉血气和混合静脉血气的变化。结果：与吸痰前相比,非预充氧组吸痰结束时的动脉血氧分压（ＰａＯ２） 、动脉血氧饱和度（ＳａＯ２）、混合静脉血氧分压（ＰｖＯ２）、混合静脉血氧饱和度（ＳｖＯ２） 均显著降低（ Ｐ＜０．０５）,吸痰结束后５ 分钟,ＳｖＯ２ 仍未恢复正常。如给予预充氧,吸痰结束时无低氧血症,组织缺氧较轻,虽然ＰａＯ２ 、ＳａＯ２ 、ＰｖＯ２ 、ＳｖＯ２ 亦低于吸痰前水平,但明显高于非预充氧组吸痰结束时的水平。吸痰结束后５ 分钟,组织缺氧完全纠正。结论：预充氧可以预防吸痰导致的低氧血症和组织缺氧。     

多排CT对肾结石并肾盂恶性肿瘤的诊断价值

[目的]探讨肾结石并肾盂恶性肿瘤的CT诊断和漏诊原因.[方法]回顾性分析经手术病理证实的9例肾结石并肾盂恶性肿瘤的CT资料,重点观察肾结石并肾盂恶性肿瘤的发生部位、病理类型、有无转移、合并症及与周围组织关系.[结果]9例肾结石并肾盂恶性肿瘤患者5例为肾盂移行细胞癌,3例为肾盂鳞癌,1例腺癌;5例有腹膜后淋巴结转移,鳞癌、移行细胞癌各1例,累及肾被膜及邻近脂肪组织及肝、肾上腺等多处转移;7例合并肾盂、输尿管炎症或肾盂积脓,3例合并肾盂炎性肉芽增生,移行细胞癌2例和鳞癌1例误诊为肾结石并积水感染,确诊率66.7(6/9),误诊率33.3%(3/9).[结论]多排CT对肾结石并肾盂恶性肿瘤诊断价值较高,但合并其他病变时易导致漏诊.     

雷帕霉素对肾移植患者术后肾功能的影响

目的探讨国产雷帕霉素(rapamycin,RPM)联合环孢菌素A(cyclosporineA,CsA)、激素(steroid,ST)对肾移植患者术后肾功能的影响。方法本实验为随机开放、与硫唑嘌呤(azathioprine,AZA)平行对照的多中心Ⅱ期临床研究,观察期24周;172例首次接受同种异体肾移植的患者术后72小时内随机平均分配进入两组:RPM组,应用RPM、CsA和ST;AZA组,应用AZA、CsA和ST。对术后24周内的肾功能指标[肌酐(SCr)、尿素氮(BUN)、尿酸(UA)以及肾功能首次恢复时间]和相关的不良事件进行客观评价。结果与AZA组术后肾功能首次恢复时间(23.63±39.24)天相比,RPM组术后肾功能首次恢复时间(17.05±36.31)天更早。术后24周,RPM组和AZA组的SCr分别为(93.75±26.40)μmol/Lvs(102.39±44.61)μmol/L,P=0.145;BUN分别为(6.16±1.68)mmol/Lvs(7.05±1.56)mmol/L,P=0.001;UA分别为(329.09±76.25)mmol/Lvs(360.06±74.82)mmol/L,P=0.013,各项肾功能试验室指标RPM组均低于AZA组。发生肾功能相关的不良事件,RPM组7例(8.14%),AZA组18例(20.93%),其中高尿酸血症AZA组多于RPM组(17例,19.77%vs3例,3.49%),P=0.001。结论RPM、CsA和Pred联合应用于同种肾移植,更有利于术后移植肾功能的恢复,且无肾毒性。     

肾蒂阻断低温下肾实质切开取石术治疗复杂性肾结石

[目的]探讨肾蒂阻断低温下肾实质切开取石术治疗复杂性肾结石的疗效.[方法]对42例复杂性肾内型肾盂结石患者,采用原位低温阻断肾动静脉,Brdel线或放射状切开肾实质取出结石.[结果]38例（90.5%）一次取净结石,4例（9.5%）有小结石残留,经体外冲击波碎石（ESWL）后痊愈.肾蒂阻断30～100 min.术后无严重并发症.肾功能无明显损害.[结论]原位低温阻断肾蒂肾实质切开取石术是治疗复杂性肾结石安全、有效的方法.     

Hypoechoic normal renal sinus and renal pelvis tumors: sonographic differentiation.

OBJECTIVE: To evaluate the sonographic findings of an unusually hypoechoic renal sinus that mimics a tumor in the renal pelvis or renal sinus. METHODS: Sonographic scans of 7 patients with an unusually hypoechoic portion in the renal sinus were reviewed retrospectively. Computed tomography, excretory urography, or both confirmed all sinuses as normal. Five consecutive cases of renal pelvis tumors, which were detected on sonography initially in same period, were also reviewed to determine the differences between the 2 conditions. All cases were transitional cell carcinomas of the renal calyces. The images were analyzed for location, shape, margin, presence of posterior sonic attenuation, and associated findings such as caliectasis. RESULTS: Sonographic findings noted in patients with hypoechoic normal renal sinuses were irregular and poorly defined margins (n = 7), a central and symmetric location in the renal sinus (n = 6), the presence of posterior sonic attenuation with nonvisualization of the posterior border of the lesion (n = 7), an unaffected peripheral hyperechoic renal sinus (n = 7), and traversing hilar vessels in the lesion on color Doppler sonography (n = 7). In contrast, renal pelvis tumors had a relatively well-defined margin (n = 4), an eccentric location in the renal sinus (n = 2), a partially or completely obliterated hyperechoic renal sinus (n = 2), a visible posterior margin (n = 5), no posterior shadowing (n = 5), vessel displacement by the mass on color Doppler sonography (n = 5), and associated caliectasis (n = 1). CONCLUSIONS: By being familiar with the sonographic characteristics of a hypoechoic renal sinus, it can be differentiated from renal pelvis tumors, and unnecessary diagnostic workups can be avoided.     

Is mild normobaric hypoxia a risk factor for venous thromboembolism?

Summary.  Background : Modern air travel entails a cabin altitude between 1520 and 2440 m (5000–8000 ft) and thus exposure to mild hypoxia. There is debate as to whether hypoxia is causally related to venous thromboembolism (VTE) occurring during or after travel. One study suggested that a short period of hypobaric hypoxia causes activation of coagulation. Objectives : To test the hypothesis that hypoxia alone (normobaric hypoxia) causes activation of coagulation, possibly through endothelial cell activation. Methods : Six healthy male volunteers were exposed for 3 h, while seated, on two separate occasions to (i) dry air (control) and (ii) hypoxic gas mixture (12.8% O₂ in N₂, equivalent to breathing air at 3660 m [12000 ft]). Results : There were no differences in hemostatic or endothelial markers between control and hypoxic groups, but platelet and leukocyte counts increased and were significantly higher in the hypoxic group. There were increases in fibrinogen and von Willebrand factor, as well as rheological changes, but these were not significantly different between control and hypoxic groups. Conclusions : This small study does not support the previous suggestion that hypoxia causes activation of coagulation, and suggests that immobility-induced rheological changes may be more significant in the etiology of VTE occurring during or after travel.     

50例支气管肺炎患儿心肌酶谱的检测观察

目的:观察支气管肺炎患儿心肌酶谱改变并探讨缺氧和心肌损害的关系。方法:检测了50例无心力衰竭表现的支气管肺炎患儿的经皮血氧饱和度(TcSO_2)、心肌酶谱及心电图。结果:支气管肺炎患儿有不同程度的心肌酶升高,TcSO_2≤94％的肺炎组患儿和TcSO_2>94％的肺炎组患儿心肌酶CK、CK-MB、LDH、LDH_1、HBDH的值有显著性差异,前者显著高于后者(P<0.05)。结论:支气管肺炎患儿即使未出现心力衰竭表现,心肌也已遭受损害,且缺氧严重的患儿心肌损害的程度更重。因此积极治疗小儿支气管肺炎的同时,应及早使用心肌保护药物。     

慢性缺氧大鼠膈肌细胞骨架蛋白表达变化与膈肌收缩特性相关性分析

目的探讨慢性缺氧膈肌被动收缩特性与细胞骨架结构及基因表达的关系。方法用慢性间断缺氧方法制备慢性缺氧动物模型,测定膈肌条的应力-应变关系,免疫组化和RT-PCR方法检测膈肌细胞骨架蛋白titin,nebulin的表达。结果(1)慢性缺氧组膈肌肌肉僵硬度常数下降,初始弹性常数升高,与对照组相比差异有显著性意义(P<0.05);(2)慢性缺氧膈肌细胞titin,nebulin表达显著减少,与对照组相比差异有显著性意义(P<0.05);(3)相关分析显示,膈肌细胞骨架蛋白表达的变化与膈肌肌肉僵硬度常数变化相关。结论慢性缺氧大鼠膈肌细胞titin和nebulin表达下调,并可能与膈肌被动张力改变有关。     

The role of miRNA-210 in pre-eclampsia development

MicroRNAs (miRNAs) are a class of small non-coding, single-stranded RNAs (ribonucleic acids) that play important roles in many vital processes through their impact on gene expression. One such miRNA, miR210, represents a hypoxia-induced cellular miRNA group that hold a variety of functions. This review article highlights the importance of miR-210 in the development of pre-eclampsia.

KEY MESSAGE

• miR-210 is a promising biomarker for monitoring pregnancy with pre-eclampsia. Overexpression of miR-210 had a negative impact on the process of cell migration and trophoblast invasion.

     

Does Nutrition Counseling Affect Glycosylated Hemoglobin and Estimated Glomerular Filtration Rate in Patients With Diabetes and Stage 3 Chronic Kidney Disease?

This study evaluated glycosylated hemoglobin (HbA_1c) and estimated glomerular filtration rate (eGFR) for adult patients with diabetes and stage 3 chronic kidney disease after disease and nutrition counseling interventions were performed. A retrospective electronic medical record audit was used (n = 88) during a 12-month period. Use of the paired samples t test at 3 and at 6 months after the initial counseling visit reflected a statistically significant improvement in the HbA_1c at 3 and at 6 months (mean outcome, 0.000; P < .05), and the eGFR at 6 months (mean outcome, 0030; P < .05). These outcomes support implementation by advanced practitioners.     

肾细胞DNA合成刺激因子的实验和临床研究

采用大鼠原代肾皮质细胞体外培养和３Ｈ－ＴｄＲ掺入法检测１０例肾综合征出血热（ＨＦＲＳ）患者和１０例正常献血员血清。结果显示：患者血清可显著提高原代肾皮质细胞ＤＮＡ中３Ｈ－ＴｄＲ掺入量，提示ＨＦＲＳ患者血清中可能存在某种促肾生长物质。同时利用本室制备的肾细胞ＤＮＡ合成刺激因子（ＲＤＳＳＦ）治疗ＨＦＲＳ４３例，并与２２例ＨＦＲＳ对照比较，治疗组尿素氮、血肌酐下降和尿蛋白消失优于对照组。     

氧疗对模拟急性高原缺氧兔脑线粒体氧化呼吸功能的影响

[目的]探讨不同浓度氧疗对急性高原缺氧兔线粒体氧化呼吸功能的影响。[方法]模拟4500m海拔高原建立急性缺氧模型,将28只新西兰大白兔分为5组,A组为正常对照组,B组、C组、D组置于低压舱内,分别给予体积百分比为25%、30%、35%的氧氮混合气体持续吸入10h、5h、3h,E组（缺氧对照组）直接暴露于低压舱内,电镜观察脑线粒体形态学改变,应用差速离心法提取脑皮质线粒体,Clark氧电极法测定线粒体呼吸功能。[结果]B组、C组与E组比较,Ⅲ态呼吸（ST3）、呼吸控制率（RCR）、氧化磷酸化效率（OPR）显著提高,差异有统计学意义（P〈0.01）;B组Ⅳ态呼吸（ST4）较C组、D组显著降低,差异有统计学意义（P〈0.01）,D组ST3、ST4、OPR较E组显著提高,差异有统计学意义（P〈0.01）,其中B组影响最明显,接近正常水平。[结论]当吸氧总量相同时,对于脑线粒体氧化呼吸功能的保护作用,采用25%浓度的氧疗效果优于30%、35%浓度的氧疗。     

后腹腔镜下肾盂旁囊肿切除术

目的 探讨腹腔镜技术经腹膜后途径治疗肾盂旁囊肿的临床应用.方法 后腹腔镜下肾盂旁囊肿切除术10例(11侧),囊肿最大直径4.5～9.5 cm,平均6.5 cm.术中行囊肿内无水酒精注射,囊肿切除后用带蒂脂肪填塞肾窦内残腔.结果 9例(10侧)手术成功,1例(1侧)因囊肿暴露不理想改开放手术.手术时闻55～170 min,平均98 min.术中出血30～150 mL,平均65 mL.术后2、3 d拔除切口引流管.住院4～8 d,平均5.6d,术后病理均为良性囊肿壁组织.10例均获随访,7～37个月,平均18.5个月.症状均解除,无囊肿复发及并发症.结论 后腹腔镜技术治疗肾盂旁囊肿具有微创、痛苦小、恢复快等优点,但操作技巧要求高.随着技术的成熟,可成为替代开放手术的新方法.