糖基化终产物对大鼠肾脏结缔组织生长因子的作用

目的探讨糖基化终产物(AGEs)对大鼠肾脏结缔组织生长因子(CTGF)表达及细胞外基质(ECM)合成的影响。方法将Wistar大鼠随机分成4组:正常对照组(Con)、单纯大鼠血清蛋白组(RSP)、糖化血清组(AGEs)和氨基胍组(AG)。尾静脉注射AGE-RSP6周后,采用RT-PCR、免疫组织化学和蛋白质印迹杂交等方法检测AGEs对大鼠肾皮质TGF-β1和CTGF的mRNA和蛋白质表达及ECM蛋白成分表达的影响。结果与Con及RSP组比较,AGEs组肾小球系膜细胞增生,ECM红染区增大。AGEs组大鼠肾皮质TGF-β1和CTGF的mRNA和蛋白质表达均明显上调(P<0.01);TGF-β1和CTGF免疫组化阳性表达部位主要位于肾小球;肾小球ECM蛋白成分胶原(Col)Ⅳ和纤连蛋白(FN)合成也增多(P<0.05)。AG组上述所有变化均减轻。结论AGEs能明显诱导大鼠肾皮质CTGFmRNA和蛋白质表达增强,并使ECM蛋白成分合成增多。AGEs可能通过诱导CTGF表达上调引起ECM合成增多。     

波生坦及依那普利对糖尿病肾病模型干预的对比研究

目的应用波生坦或依那普利对糖尿病肾病(DN)模型进行干预,比较两药疗效,并探讨其作用机制。方法Wistar大鼠摘除右肾后,静脉注射链脲菌素成DN模型,然后分成模型组、波生坦组、依那普利组。对照组为仅注射缓冲液。每组大鼠6只。20周时测量体重、血压、血糖及24h尿蛋白定量,处死大鼠,用PAS染色及Masson染色观察肾脏病理变化;用RT-PCR及免疫组化方法检测肾组织中Ⅰ型胶原(ColⅠ)、Ⅳ型胶原(ColⅣ)、转化生长因子-β1(TGF-β1)、结缔组织生长因子(CTGF)及骨形成蛋白-7(BMP-7)的mRNA及蛋白质表达。结果与对照组相比,糖尿病模型组大鼠血糖、平均动脉压、尿蛋白定量及肾重/体重比值均显著上升(P<0.05或0.01);肾小球系膜及基膜相对面积及肾间质纤维组织相对面积均显著扩大(P<0.01);肾组织内ColⅠ、ColⅣ、TGF-β1及CTGF的mRNA及蛋白质表达均显著上调(P<0.05或0.01),而BMP-7mRNA及蛋白质表达则下调(P<0.05或0.01)。波生坦或依那普利干预后,上述上调指标除血糖外都被显著抑制(P<0.05或0.01),而抑制的BMP-7表达却被上调(P<0.01)。两种药物之间比较,作用无显著性差异(P>0.05)。结论波生坦或依那普利对DN模型的干预效果相似,此疗效可能与下调肾组织TGF-β1及CTGF表达、及上调BMP-7表达相关。     

血管内皮生长因子抑制肾小管上皮间充质转化及其与结缔组织生长因子和PI3K-Akt信号通路的关系

目的　探讨血管内皮生长因子（VEGF）对转化生长因子β1（TGF-β1）诱导的肾小管上皮间充质转化（EMT）的作用,及其与结缔组织生长因子（CTGF）、PI3K-Akt信号通路的关系。 方法 （1）将体外培养的HK2细胞分为正常对照组、TGF-β1（5 μg/L,下同）组、VEGF组（100 μg/L,下同）、TGF-β1＋VEGF组。HK2细胞体外培养48 h,用免疫组化双染方法检测肾小管上皮细胞α平滑肌肌动蛋白（α-SMA）和E钙黏蛋白的表达。（2）将体外培养的HK2细胞分为正常对照组、TGF-β1组、VEGF组、TGF-β1＋VEGF组、PI3K-Akt信号通路阻断剂LY294002组（25 μmol/L,下同）、TGF-β1＋LY294002组、VEGF＋LY294002组、TGF-β1＋VEGF＋LY294002组。HK2细胞体外培养48 h,用Western印迹和RT-PCR方法检测α-SMA和CTGF的表达;用ELISA方法检测培养上清中纤连蛋白（FN）和I型胶原（ColⅠ）的表达。 结果 免疫组化结果显示,TGF-β1组α-SMA表达比正常对照组增强,而E钙黏蛋白表达减弱; TGF-β1＋VEGF组α-SMA表达比TGF-β1组显著减弱,而E钙黏蛋白表达增强。 TGF-β1组α-SMA、CTGF蛋白和 mRNA及FN、ColⅠ表达比正常对照组显著增强（均P < 0.05）;TGF-β1＋VEGF组α-SMA、CTGF蛋白和mRNA及FN、ColⅠ表达比TGF-β1组显著减弱（均P < 0.05）;TGF-β1＋VEGF＋LY294002组α-SMA、CTGF蛋白和 mRNA及FN、ColⅠ表达比TGF-β1＋VEGF组显著增强（均P < 0.05）。 结论　VEGF能抑制TGF-β1诱导的体外培养的HK2细胞发生EMT,其机制可能与VEGF下调HK2细胞CTGF表达及减少细胞外FN、ColⅠ合成有关。VEGF的这种作用可能部分通过PI3K-Akt信号转导通路实现,其确切机制有待进一步研究。     

金雀异黄素对5/6肾切除鼠肾脏的保护作用

目的：探讨金雀异黄素对5/6肾切除鼠肾脏的保护作用。方法：将5/6肾切除鼠分为金雀异黄素组（Gen）和对照组（Con）,同时设假手术组（Sham）为正常对照。检测各组术前、术后第4、8周各组尿蛋白、血肌酐、尿素氮、血白蛋白、总蛋白等指标,观察第8周肾组织的病理改变情况,采用Rajj半定量方法值评估肾小球硬化指数。应用免疫组化方法检测肾组织中纤维连接蛋白（FN）和Ⅳ型胶原（ColⅣ）原沉积情况。分别采用RT-PCR法和WesternBlot法检测肾组织中转化生长因子-β1（TGF-β1）mRNA转录以及蛋白质表达情况。结果：与对照组相比,金雀异黄素组尿蛋白排泄量明显减少,血肌酐、尿素氮水平下降（P〈0.01）。肾小球硬化程度减轻,肾小球内FN和ColⅣ沉积显著减少。TGF-β1mRNA及其蛋白质表达明显减弱（P〈0.05）。结论：金雀异黄素对5/6肾切除鼠肾脏病变有部分保护作用,其机制可能与其减少细胞外基质（ECM）蓄积、抑制TGF-β1的表达有关。     

姜黄素对TGF-β1诱导人肾小管上皮细胞转分化及分泌细胞外基质成分的影响

目的：通过研究姜黄素（curcumin,Cur）对转化生长因子-β1（TGF-β1）诱导人肾小管上皮细胞（HK-2）转分化及分泌细胞外基质（ECM）成分的影响,探讨姜黄素在防治肾小管-间质纤维化方面可能的作用机制。方法：应用不同浓度Cur处理经TGF-β1诱导活化的HK-2细胞,通过显微镜观察细胞形态改变,免疫组化技术检测α-平滑肌肌动蛋白（α-SMA）和E-钙黏蛋白（E-cadherin）的表达;应用酶联免疫吸附法（ELISA）检测细胞培养上清Ⅰ型胶原（ColⅠ）、Ⅲ型胶原（ColⅢ）和纤连蛋白（FN）的分泌。结果：（1）正常HK-2细胞表达E-cadherin,不表达α-SMA,经TGF-β1刺激后细胞表型发生转变,E-cadherin的表达明显减弱,α-SMA表达明显增强;（2）不同浓度Cur组与单纯TGF-β1刺激组相比α-SMA的表达有所减弱,而E-cadherin的表达增强;（3）不同浓度Cur抑制了ColⅠ、ColⅢ和FN的分泌,与单纯TGF-β1刺激组相比有统计学差异（P〈0.05）。结论：姜黄素能抑制TGF-β1诱导人肾小管上皮细胞转分化及细胞外基质成分ColⅠ、ColⅢ和FN的合成,在一定程度上具有防治肾小管-间质纤维化的作用。     

黄芩素对高糖诱导近端肾小管上皮细胞外基质及转化生长因子β1表达的影响

目的 探讨黄苓素对高糖诱导近端肾小管上皮细胞高度表达细胞外基质(ECM)及转化生长因子β1(TGF-β1)的干预作用。方法 LLC-PK1细胞分为(1)正常对照组(NG);(2)高糖组(HG);(3)HG+蛋白激酶抑制剂(PKCI)组(10μmol/L chelerythrine chloride);(4)HG+黄芩素组(50μmol/L);(5)HG+黄芩素组(100μmol/L);(6)HG+黄芩素组(200μmol/L)。检测各组PKC活性,并采用原位杂交法和细胞免疫化学技术(ABC法)分别检测细胞胶原(Col)Ⅳ、纤连蛋白(FN)及TGF-β1mRNA和蛋白的表达。结果 在高糖培养基中加入黄芩素100μmol/L及200μmol/L后可显著抑制细胞膜PKC活性(P<0.01),分别使细胞膜PKC活性下降42%、68%;200μmol/L黄芩素能使高糖组细胞ColⅣ、FN及TGF-β1 mRNA表达均显著下降,分别达55%、51%、46%,并显著抑制TGF-β1蛋白表达达51%(P<0.05)。结论 黄芩素可通过抑制细胞PKC活性而阻止高糖诱导近端小管细胞过度表达ECM及TGF-β1。     

尿转化生长因子-β1及Ⅳ型胶原与肾内微癥积的相关性研究

目的:通过无创检测方法早期发现肾内微型癥积.方法:对98例肾活检的患者进行中医辨证分型:检测血/尿TGF-β1、尿ColⅣ、Scr、Ccr、24 h尿蛋白排泄;时肾组织运用CMIAS计算机病理图像分析系统作半定量测定;观察尿TGF一岛、ColIV水平,与肾硬化程度、中医辨证间的相关性.结果:(1)肾病患者尿TGF-β1、ColⅣ明显高于健康人(P<0.01).(2)尿TGF-β1、COlⅣ与肾小球基质基底膜面密度、肾间质纤维化程度、间质浸润细胞数呈正相关(P<0.05),与尿ColⅣ呈负相关(P<0.05).随着硬化程度加重尿TGF-β1、ColⅣ水平逐级增高.(3)尿TGF-β1、COlⅣ分别与Scr正相关,与Ccr负相关(P<0.01);与血TGF-β1、24 h尿蛋白定量无关.(4)在轻度肾硬化组,Scr和Ccr尚正常时尿TGF-β1、ColⅣ已高于正常组(P<0.01),尿ColⅣ敏感程度要高于尿TGF-β1和Ccr.(5)98例肾脏病患者的中医辨证以脾肾气虚型为主,占66.3%,以传统"四诊"辩为兼瘀血证者仅占8例(8.16%),肾硬化均属于重度,肾功能已减退,尿TGF-βColⅣ水平显著高于无瘀血证者.结论:尿TGF-β1、ColⅣ能早于Scr和Ccr的异常反映肾硬化及硬化程度.不受血TGF-β1和24 h尿蛋白定量的影响,可以作为监测肾硬化及其进展的一项无创性早期标志性指标,以尿ColⅣ更为敏感;同时揭示肾微癥积的病因为正虚邪郁,中医传统的宏观辨证加上微观辨证可明显提高辨证的准确性,尿TGF-β1、ColⅣ可以作为中医微观辨证的一项量化指标早期诊断肾内微癥积,监测病情的动态变化,指导早期应用消癥散积中药防治肾硬化.     

高糖通过血清和糖皮质激素诱导的蛋白激酶1通路促进人近端肾小管上皮细胞合成纤连蛋白

目的 研究血清和糖皮质激素诱导的蛋白激酶1(SGK1)在高糖诱导人近端肾小 管上皮细胞(HKC)产生纤连蛋白(FN)中的作用,探讨SGK1在糖尿病肾病(DN)肾小管间质纤 维化中的作用机制。方法 将带有SGK1显性激活型突变体质粒(pIRES2-EGFP-S422DSGK1 mutant, SD)和带有SGK1显性失活型突变体质粒(pIRES2-EGFP-K127NSNSGK1 mutant,KN)分别瞬时转染 HKC;同时,设空质粒(pIRES2-EGFP,FP)转染组和未转染组(NT)为对照。分别用正常糖(NG, 5.5 mnlol／L D-葡萄糖)和高糖(HG,25 mmol/L D-葡萄糖)刺激8 h后,采用RT-PCR和Western 印迹来观察SGK1和FN的mRNA及蛋白的表达。结果 正常葡萄糖环境下转染SD和KN后, HKC合成的FN mRNA和蛋白的表达没有显著性改变。高糖环境下,转染SD的HKC与其它组 比较,其SGK1mRNA表达显著性增高(P<0.01),SGK1蛋白过度活化(P<0.01),其FN mRNA和 蛋白的表达显著增加(P<0.01)。转染KN的HKC与其它高糖组HKC比较,其活化的SGK1蛋 白显著减少(P<0.01),其合成FN mRNA和蛋白亦显著减少(P<0.01)。结论 高糖诱导HKC 的FN mRNA和蛋白的表达增加是依赖于SCK1的表达与活化,提示在DN中,高糖能通过SGK1 介导的信号通路来诱导人近端肾小管上皮细胞过度合成FN,促进肾小管间质纤维化。     

结缔组织生长因子在关木通相关肾小管间质肾病肾间质纤维化中的作用

目的 通过观察关木通相关肾小管间质肾病(GMT-TIN)肾小管间质内纤维化相关生长因子表达及细胞外基质(ECM)沉积的特点,探讨其纤维化病变发生与发展的有关环节。方法 22例GMT-TIN患者根据病理特点分为急性组8例、慢性轻型组8例和慢性重型组6例,对其纤维化程度进行半定量分析。应用免疫组化SP法观察肾活检组织标本中,肾小管间质内α-平滑肌肌动蛋白(α-SMA)、纤连蛋白(FN)、IV型胶原、结缔组织生长因子(CTGF)和转化生长因子 β1(TGF-β1)的表达情况。分析上述指标之间以及与纤维化病变之间的相关关系。结果 (1)各组肾小管间质内均检测到高表达的α-SMA、FN和IV型胶原,随病变慢性化加重3者表达均明显增强,并与肾间质纤维化程度正相关(P<0.01)。(2)各组肾间质内均出现CTGF及TGF-β1表达,2者间显著正相关(r=O.771,P<0.0001),但在时相上存在一定差异。(3)肾间质内CTGF表达分别与FN及IV型胶原沉积正相关(r=0.6855和0.5964,P<0.01)、与纤维化病变程度正相关(r=0.4941,P<0.05)。结论(1)GMT-TIN肾间质内CTGF的高表达、CTGF与ECM沉积以及纤维化病变的相关性,提示其在GMT-TIN肾间质纤维化病变中起重要作用。(2)CTGF与TGF-β1的相关关系及2者表达时相的差异,进一步支持CTGF可能作为TGF-β1的下游效应因子在纤维化病变     

苦参碱调控Snail2表达水平抑制转化生长因子β1诱导的人腹膜间皮细胞上皮间充质转分化

目的 研究苦参碱对转化生长因子β1(TGF-β1)诱导腹膜间皮细胞上皮间充质转分化(EMT)后转录因子Snail2的影响.方法 采用TGF-β1刺激人腹膜间皮细胞并同时予不同浓度苦参碱干预处理,实验分为空白对照组、TGF-β1(5 ng/ml)诱导组、TGF-β1+0.4 mg/ml苦参碱干预组、TGF-β1+0.6 mg/ml苦参碱干预组、TGF-β1+0.8 mg/ml苦参碱干预组和TGF-β1+1.0 mg/ml苦参碱干预组.实时荧光定量PCR和Western印迹检测Snail2、上皮标志分子E钙黏蛋白(E-cadherin)和间质标志分子α平滑肌肌动蛋白(α-SMA)、纤维连接蛋白(FN)、胶原Ⅲ(ColⅢ)的表达,Western印迹检测Smad2、Smad3和细胞外调节蛋白激酶1/2(ERK1/2)的蛋白磷酸化水平.结果 TGF-β1(5 ng/ml)刺激能上调人腹膜间皮细胞Snail2、α-SMA、FN和ColⅢmRNA和蛋白的表达水平,上调Smad2、Smad3和ERK1/2的蛋白磷酸化水平,下调E-cadherinmRNA和蛋白的表达水平;苦参碱(0.4、0.6、0.8、1.0 mg/ml)干预处理后能下调Snail2和α-SMA、FN和ColⅢmRNA和蛋白的表达水平以及ERK1/2的蛋白磷酸化水平,上调E-cadherin mRNA和蛋白的表达水平.结论 TGF-β1能诱导人腹膜间皮细胞EMT,苦参碱可能通过ERK1/2信号通路下调Snail2的表达水平来抑制TGF-β1诱导的人腹膜间皮细胞EMT.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。