马兜铃酸肾病大鼠肾损害及纤维化进展与相关因子表达的关系

目的探讨细胞因子网络失衡在马兜铃酸肾病(AAN)肾纤维化发生发展中的作用。方法雄性Wistar大鼠46只,SPF级,随机分为对照组(20只)和模型组(26只),模型组用含20mg/(kg.d)马兜铃酸(AA)的关木通浸膏灌胃,对照组用同体蒸馏水灌胃。于第4、8、12周处死动物,取肾组织行HE、PAS、Masson染色,病理学观察分析肾小管损伤和间质纤维化程度,免疫组化分析PCNA、VEGF、TGF-β1蛋白表达,RT-PCR分析VEGF、ET-1、BMP-7mRNA的表达。结果模型组大鼠在第4周即可见明显的肾小管间质损伤,并随时间延长而进行性加重,第12周小管间质形态结构紊乱严重,纤维化程度达31.36%;第4周时肾组织PCNA表达明显增高,第8周时呈下降趋势,第12周时在基底膜裸露的肾小管很少有PCNA阳性表达;在第4周TGF-β1、VEGF表达明显增高,随时间延长TGF-β1呈持续高表达,但VEGF阳性表达逐渐下降。RT-PCR检测发现模型组从第4周起VEGF、ET-1mRNA表达明显升高,第8、12周略有下降,但仍维持在较高水平,而BMP-7随着病变进展表达逐渐减少,第12周达最低水平。结论肾小管严重损伤及快速进展的早期纤维化是AAN的特征之一;肾小管上皮细胞的再生修复能力严重受损,促修复和抑纤维化因子表达不足,而致纤维化因子高表达,可能是AAN纤维化进展的重要原因。     

应用超声背向散射积分技术评价糖尿病大鼠肾脏纤维化

目的 检测不同病程糖尿病大鼠肾脏背向散射积分(IBS),同时观察纤维化指标,探讨IBS与肾脏纤维化的关系.方法 腹腔注射链尿佐菌素(65mg/kg)建立SD大鼠糖尿病模型,于第4、12、24周测定肾皮质和肾髓质的IBS％,Masson染色观察血管周围胶原面积(PVCA)、肾小球胶原沉积评分(GCDS)、肾小管间质病变评分(TIDS),肾脏胶原蛋白(CollagenI、CollagenⅢ)免疫组织化学染色.心肌光镜与透射电镜观察,并与同龄正常大鼠进行比较.结果 ①与对照组相比:糖尿病组肾皮质、肾髓质的IBS％明显增高(P＜0.05);糖尿病组肾脏纤维化指标PVCA、GCDS、TIDS、Collagen Ⅰ、CollagenⅢ的表达均明显增高(P＜0.05);②肾皮质与肾髓质IBS％与PVCA、GCDS、TIDS、CollagenⅠ、CollagenⅢ表达呈正相关(P＜0.05);③电镜发现糖尿病组肾小球毛细血管基底膜弥漫性增厚,间质胶原增生.结论 糖尿病大鼠存在明显的肾脏纤维化,通过监测IBS可以监测糖尿病大鼠肾脏组织纤维化的程度.     

大豆异黄酮对UUO大鼠肾间质ILK表达影响的研究

目的 观察单侧输尿管梗阻(UUO)大鼠肾小管间质中整合素连接激酶(integrin-linked kinase,ILK)的表达及大豆异黄酮对其的影响.方法 将36只雄性SD大鼠随机分为假手术组、对照组及异黄酮组,每组12只.对照组与异黄酮组大鼠均行左侧UUO手术,假手术组分离左侧输尿管后不结扎.术前3 d开始,异黄酮组用大豆异黄酮[200 mg/(kg·d)]饲喂,其余两组予等量普通饲料饲喂.术后第3、7、14 d分别处死各组中的4只大鼠,取左肾行HE和Masson染色,免疫组化方法 检测肾小管间质中TGF-β1、ILK和纤维连接蛋白(fibronectin,FN)的表达,并用计算机真彩色图像分析系统对其进行半定量分析.结果 对照组肾小管间质TGF-β1、ILK及FN高表达,与肾小管间质病变程度一致;ILK与TGF-β1、FN表达呈正相关.异黄酮组肾小管间质病变程度较同期对照组明显减轻(P＜0.01),TGF-β1、ILK 及FN的表达较同期对照组明显减少(P＜0.01),肾功能损害也较同期对照组明显减轻(P＜0.01).结论 UUO大鼠肾小管间质ILK高表达,ILK的表达强度与肾小管间质纤维化程度相一致,ILK可能参与TGF-β1介导的UUO大鼠肾小管间质纤维化过程;大豆异黄酮可能是通过抑制ILK的表达而实现抗肾小管间质纤维化作用,并保护肾功能.     

金雀异黄素对肾小管间质纤维化模型大鼠肾组织DDR1、bFGF表达的影响

目的探讨DDR1在肾小管损伤及间质纤维化过程中的表达以及金雀异黄素在肾小管损伤及间质纤维化过程中对肾脏的保护作用及可能机制。方法采用单侧输尿管结扎致肾间质纤维化大鼠模型,将45只大鼠随机分为三组：假手术组、模型组、金雀异黄素干预组,分别于术后7d、14d、21d每组各处死5只大鼠,收集血清测定尿素氮（BUN）、血肌酐（Scr）水平,结扎侧肾组织行HE染色观察肾脏病理变化,Masson染色分析肾间质纤维化程度,免疫组化半定量检测各组大鼠肾组织DDR1、bFGF的表达。结果模型组DDR1、bFGF表达及肾间质纤维化程度明显高于假手术组,BUN、Scr水平显著升高（P〈0.01）;金雀异黄素干预组DDR1、bFGF表达及肾间质纤维化程度较模型组明显降低（P〈0.01或0.05）,部分时间段BUN、Scr水平有所下降（P〈0.05）。结论金雀异黄素可能通过降低DDR1及bFGF的表达而减轻肾小管损伤及间质纤维化程度。     

IgA肾病肾血管纤溶酶原激活物抑制物-1和基质金属蛋白酶-9的表达及其意义

为探讨免疫球蛋白A肾病(IgA肾病)患者肾血管壁纤溶酶原激活物抑制物1(PAI1)、基质金属蛋白酶9(MMP9)、金属蛋白酶组织抑制物1(TIMP1)和α平滑肌肌动蛋白(αSMA)的表达及意义,采用免疫组织化学技术检测38例IgA肾病肾组织血管壁的PAI1、MMP9、αSMA和TIMP1的蛋白表达。结果显示,αSMA主要表达于平滑肌细胞;PAI1表达与αSMA类似;MMP9在平滑肌细胞和内皮细胞均表达;TIMP1仅在血管壁内膜的内皮细胞微弱表达。在IgA肾病LeeⅣ～Ⅴ级组,肾血管壁的PAI1、MMP9和αSMA表达显著高于LeeⅠ～Ⅲ级组(P<001)。直线相关分析显示,肾血管的PAI1、MMP9和αSMA表达与肾小管间质的纤维化和炎细胞浸润呈正相关(P<001)。提示PAI1可能参与介导了IgA肾病肾血管壁细胞外基质的积聚过程,MMP9则可能促进血管的平滑肌细胞迁移和内膜增生。     

维生素D3促进大鼠胃癌血管新生机制的研究

为探讨维生素D3促进大鼠胃癌血管新生的机制,取Wistar大鼠12只作为空白对照(Ⅰ组),饲常规饲料;另将120只经饮水摄入N-甲基-N′-亚硝基-N-亚硝基胍(MNNG,150mg/L)4周制作大鼠胃癌模型,之后均分为3组Ⅱ组为对照(MNNG),饲常规饲料;Ⅲ、Ⅳ组分别饲以1,25-二羟基维生素D3添加饲料(2.5μg/kg和5.0μg/kg).于实验16、32周处死动物,处死前行活体心血管内墨汁灌注.进行血管内皮细胞生长因子(VEGF)免疫组织化学染色和微血管密度测定.结果显示,实验16周Ⅳ组VEGF表达和微血管密度明显高于MNNG组(P＜0.05),至实验32周达到更为显著水平(P＜0.01);VEGF表达与微血管密度密切相关(r=0.604,P＜0.01).提示VEGF表达增强可能是1,25(OH)2D3促进大鼠胃癌血管新生的机制之一.     

维生素D3促进大鼠胃癌血管新生机制的研究

为探讨维生素D3促进大鼠胃癌血管新生的机制,取Wistar大鼠12只作为空白对照(Ⅰ组),饲常规饲料;另将120只经饮水摄入N-甲基-N′-亚硝基-N-亚硝基胍(MNNG,150mg/L)4周制作大鼠胃癌模型,之后均分为3组:Ⅱ组为对照(MNNG),饲常规饲料;Ⅲ、Ⅳ组分别饲以1,25-二羟基维生素D3添加饲料(2.5μg/kg和5.0μg/kg).于实验16、32周处死动物,处死前行活体心血管内墨汁灌注.进行血管内皮细胞生长因子(VEGF)免疫组织化学染色和微血管密度测定.结果显示,实验16周Ⅳ组VEGF表达和微血管密度明显高于MNNG组(P＜0.05),至实验32周达到更为显著水平(P＜0.01);VEGF表达与微血管密度密切相关(r=0.604,P＜0.01).提示VEGF表达增强可能是1,25(OH)2D3促进大鼠胃癌血管新生的机制之一.     

实验性慢性肾缺血中肾小管-间质细胞表型转化的规律及意义

目的 :研究Goldblatt肾动脉狭窄 (RAS)大鼠模型中慢性缺血肾脏肾小管 -间质细胞表型转化的规律及意义。方法 :制备RAS大鼠模型 ,用免疫组化方法观察α -平滑肌肌动蛋白 (α -SMA)、波型蛋白 (Vimentin)、转化生长因子 β1 (TGF - β1 )在肾小管间质中的表达变化规律及其与肾小管间质损伤的关系。结果 :RAS术后α-SMA、Vimentin、TGF - β1 在肾小管间质中的表达均增高 ;α -SMA及Vimentin的表达同肾间质纤维化的程度均为正相关 (r =0 .82 3,P <0 .0 1 ;r=0 .785 ,P <0 .0 1 )。结论 :肾小管-间质细胞表型转化是促进缺血后肾间质纤维化发展的重要因素 ,α -SMA及Vimentin可能是判断慢性缺血性肾间质纤维化的早期指标     

维甲酸对单侧输尿管梗阻大鼠肾组织趋化因子表达及炎症反应的影响

目的探讨不同浓度维甲酸对单侧输尿管梗阻(UUO)大鼠肾组织趋化因子表达及肾组织炎症反应的影响。方法 135只SD大鼠随机分为假手术组、UUO组和维甲酸治疗组,每组45只。假手术组行左输尿管游离,不结扎;UUO组和维甲酸治疗组行左侧输尿管结扎。维甲酸治疗组术后每天分别给予不同剂量(5、10、20mg/kg)全反式维甲酸(ATRA)皮下注射,假手术组和UUO组注射同体积二甲亚砜花生油溶剂。于术后第3、7、14天观察各组肾小管损害、肾间质炎性细胞浸润程度,免疫组化和RT-PCR法观察病变肾组织趋化因子RANTES、CCR5、MCP-1、MIP-1α和TGF-β1表达情况。结果假手术组大鼠肾组织无明显病理改变,肾组织RANTES、CCR5、MCP-1及MIP-1α无明显表达。随着梗阻时间延长,UUO组大鼠肾间质炎性细胞浸润和肾小管损害逐渐加重(P0.05),肾组织趋化因子表达进行性增加(P0.01)。与UUO组相比,维甲酸治疗组肾间质炎性细胞浸润和肾小管损害程度显著减轻(P0.05),肾组织趋化因子表达显著降低(P0.01),但不同剂量维甲酸治疗组肾组织趋化因子的表达无明显差异。结论维甲酸能减少UUO大鼠肾间质炎性细胞浸润,减轻肾小管损害,抑制趋化因子表达,从而减轻肾脏炎症反应和纤维化。     

环孢菌素A致大鼠肾小管间质细胞凋亡及Losartan、Enalapril的保护作用

以低盐饮食 (钠含量 0 .0 5 % )饲养大鼠 7天后随机分成①对照组 ,②CsA处理组 ,③CsA +盐酸维拉帕米处理组 ,④CsA +Losartan处理组 ,⑤CsA +Enalapril处理组。CsA皮下注射剂量为 15mg/ (kg·d) ,连续 4周。用TUNEL法检测凋亡细胞 ,免疫组化方法观察增殖细胞核抗原 (PCNA)、Fas抗原表达。结果发现CsA处理后大鼠肾小管间质凋亡细胞较对照组明显增加 ,增殖细胞也有代偿性增加 ,肾小管上皮细胞Fas抗原表达增多。与CsA处理组相比 ,Losartan、Enalapril处理组肾小管间质细胞凋亡和Fas抗原表达明显减少。结果提示CsA可促进肾小管间质细胞凋亡 ,导致肾小管间质纤维化 ,Fas可能是介导肾小管细胞凋亡的重要介质。Losartan、Enalapril对CsA所致的肾小管间质细胞凋亡有保护作用。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）