Anosmin-1蛋白通过成纤维生长因子1型受体激活ERK1/2信号通路增强嗅鞘细胞的迁移

目的探究Anosmin-1蛋白对嗅鞘细胞迁移的影响及对成纤维生长因子(FGF)1型受体和ERK1/2信号通路的影响。方法选择SPF级成年雌性SD大鼠40只,7～10周龄,体重250～300 g。提取大鼠嗅球的嗅鞘细胞并纯化,纯化后细胞培养7 d后,采用随机数字表法将所有细胞平均分为四组:对照组(C组),FGF 1型受体激动剂(FGF2)组(F组),Anosmin-1蛋白组(A组)和Anosmin-1蛋白+FGF 1型受体抑制剂(Su5402)组(S组)。C组为空白对照组,培养液中不加任何药物处理;F组为阳性对照组,于培养液中加入FGF2 25 ng/ml; A组于培养液中加入Anosmin-1蛋白2 nmol/L;S组于培养液中加入Anosmin-1蛋白2 nmol/L和Su5402 30μmol/L。四组细胞处理24 h后,采用Transwell法检测嗅鞘细胞迁移能力,Western blot法检测嗅鞘细胞磷酸化ERK1/2(p-ERK1/2)蛋白、磷酸化AKT(p-AKT)蛋白和神经型钙粘连蛋白(N-cadherin)含量,免疫荧光染色法检测N-cadherin荧光强度。结果纯化后的嗅鞘细胞占总细胞的85.6%。与C组比较,F组和A组迁移至下室的嗅鞘细胞明显增多(P0.05),p-ERK1/2蛋白、N-cadherin含量明显升高(P0.05)。与A组比较,S组迁移至下室的嗅鞘细胞明显减少(P0.05),p-ERK1/2蛋白、N-cadherin含量明显降低(P0.05)。S组和C组间、F组和A组间迁移至下室的嗅鞘细胞数量、p-ERK1/2蛋白、N-cadherin含量差异无统计学意义。四组p-AKT蛋白含量差异无统计学意义。结论 Anosmin-1蛋白通过FGF 1型受体激活ERK1/2信号通路,从而上调N-cadherin,增强嗅鞘细胞的迁移能力。     

SphK1/S1P信号通路在肾脏疾病中的作用

鞘氨醇-1-磷酸（sphingosine 1-phosphate,S1P）具有很高的生物学活性,它参与细胞的增殖、凋亡、代谢等多个生理过程,是治疗多种疾病的一个潜在靶点。鞘氨醇激酶1(sphingosine kinase-1,SphK1)是一种广泛存在的脂类激酶,是维持体内S1P水平的关键调节酶,其在生物体内参与癌症、感染和炎症等诸多疾病的发生发展。目前已证实SphK1和S1P受体在肾脏中表达,并且多种肾脏疾病的发生发展与之相关,因此SphK1和S1P在肾脏疾病中作用受到人们越来越多的关注。本文就SphK1/S1P信号通路在肾脏疾病中的作用的研究现状进行综述,重点介绍SphK1/S1P信号通路及其在多种肾脏疾病进展中的作用。     

FTY720对大鼠肝癌肝移植后肝癌复发的抑制作用

肝移植后肝癌复发严重影响受者预后,而移植后免疫抑制剂的使用会增加肝癌复发的风险.鞘氨醇磷酸酯(sphingosine-1-phosphate, S1P)是鞘氨醇在体内被磷酸化后的产物,是一种有力的信号脂类分子,它可以引起多种细胞的生物学反应.S1P受体家族有S1P1, S1P2, S1P3, S1P4和S1P5等亚型,其中S1P1, S1P2, S1P3广泛表达于全身各部分,而S1P4主要表达于淋巴组织和血小板,S1P5主要表达于中枢神经系统.现有证据尚未发现肝癌细胞表达S1P受体.FTY720是新开发的免疫抑制剂,是一种S1P受体拮抗剂.     

血清S1P与绝经后2型糖尿病患者骨密度和骨代谢指标之间的相关性研究

目的探讨血清1-磷酸鞘氨醇(S1P)与绝经后2型糖尿病患者骨密度(bone mineral density,BMD)和骨代谢指标之间的相关性。方法选取2018年2月至2019年12月期间在海口市妇幼保健院就诊的绝经后2型糖尿病女性,收集患者一般临床资料和获取其血液标本,检测生化指标、S1P和髋部、腰椎骨密度。结果最终选取130名血糖控制较好的绝经后2型糖尿病女性参与本研究,年龄为(59.3±8.9)岁,血糖为(8.75±1.5)mmol/L;S1P平均浓度为(6.46±0.78)μmol/L。相关分析表明S1P与腰椎(L1~4)、全髋和股骨颈BMD呈显著负相关(P均<0.05)。多步逐步回归分析表明,血清S1P和Ⅰ型胶原交联C末端肽(β-CTX)与腰椎(L1~4)、全髋和股骨颈BMD密切相关;而血清S1P和β-CTX是各部位BMD独立危险因素。结论1-磷酸鞘氨醇与绝经后2型糖尿病女性骨密度和β-CTX水平密切相关。     

脊髓背角小胶质细胞组织蛋白酶S在大鼠骨癌痛维持中的作用

目的 探讨脊髓背角小胶质细胞组织蛋白酶S(CatS)在大鼠骨癌痛维持中的作用.方法 雌性未交配SD大鼠50只,4～6周龄,体重150～ 180 g,采用随机数字表法,将其分为5组(n=10):假手术组(S组)、骨癌痛组(BCP组)、假手术+CatS抑制剂吗啉亮氨酸高苯丙氨酸乙烯基苯基砜(LHVS)组(S+L组)、骨癌痛+二甲基亚砜组(BCP+D组)和骨癌痛+LHVS组(BCP+L组).左侧胫骨骨髓腔内接种浓度为2×107/ml Walker256细胞5μl制备大鼠骨癌痛模型.分别于造模后10、11、12d时S+L组和BCP+L组鞘内注射LHVS 50 nmol/10l,1次/d,BCP+D组给予等容量二甲基亚砜.分别于造模前1d(基础状态)及造模后3、6、9、10、11、12 d(T0-6)测定机械缩爪反应阈(MWT),分别于鞘内给药前、鞘内给药后0.5、1.0、3.0、6.0、9.0、12.0、24.0 h时测定(MWT).处死大鼠,取L4-6脊髓组织,采用免疫组化法测定OX-42表达.结果 与S组比较,BCP组、BCP+D组和BCP+L组T2-6时MWT降低,脊髓背角OX-42表达上调(P＜0.01),S+L组MWT和脊髓背角OX-42表达差异无统计学意义(P＞0.05);与BCP组比较,BCP+L组T4-6时MWT升高,脊髓背角OX-42表达下调(P＜0.01),BCP+D组MWT和脊髓背角0X-42表达差异无统计学意义(P＞0.05).S+L组和BCP+D组鞘内给药后3.0、6.0、9.0h时MWT低于BCP+D组(P＜0.01).结论 脊髓背角小胶质细胞CatS激活参与了大鼠骨癌痛的维持.     

5-HT5A受体在长春新碱致神经病理性痛大鼠脊髓背角星形胶质细胞活化中的作用

目的 评价5-羟色胺5A受体(5-HT5AR)在长春新碱致神经病理性痛大鼠脊髓背角星形胶质细胞活化中的作用.方法 雄性成年SD大鼠40只,体重180～200 g,随机分为4组(n=10):对照组(C组)、神经病理性痛组(P组)、空载体腺病毒组(B组)和siRNA重组腺病毒载体组(S组).C组腹腔注射生理盐水1 ml;P组、B组和S组第1～5天和第8～12天每天定时腹腔注射0.1 mg/kg长春新碱建立大鼠神经病理性痛模型.腹腔给药结束第2天测定机械痛阈,然后P组、B组和S组分别鞘内注射人工脑脊液、空载体腺病毒和siRNA重组腺病毒载体25μl.鞘内给药后第7天测定机械痛阈,然后处死大鼠,取L4.5脊髓组织,测定脊髓背角5-HT5AR及胶原纤维酸性蛋白(GFAP)的表达.结果 与C组比较,P组、B组和S组各时点机械痛阈降低,脊髓背角5-HT5AR和GFAP的表达均上调(P＜0.05);与P组比较,S组鞘内给药后第7天机械痛阈降低,脊髓背角5-HT5AR表达下调,GFAP表达上调(P＜0.05),B组上述指标差异无统计学意义(P＞0.05).结论 5-HT5AR参与了星形胶质细胞活化的抑制过程,从而减轻长春新碱致大鼠神经病理性痛.     

鞘内注射单唾液酸神经节苷脂对布比卡因椎管麻醉诱发大鼠脊髓毒性的治疗效果

目的 评价鞘内注射单唾液酸神经节苷脂(GM-1)对布比卡因椎管麻醉诱发大鼠脊髓毒性的治疗效果.方法 健康成年雄性SD大鼠,体重280～300 g,于L3,4椎间隙向尾端行鞘内置管,取鞘内置管成功的大鼠144只,采用随机数字表法,将其分为4组(n=36):假手术组(S组)、GM-1组、布比卡因组(B组)和布比卡因+ GM-1组(BG组).B组和BG组鞘内注入5％布比卡因20μl,间隔1.5h给药1次,共3次,24 h后,BG组和GM-1组鞘内注射GM-1 20 μg,1次/d,连续7d.于鞘内注射布比卡因前及注射后1、3、5、7、14、28 d(T0-6)时测定甩尾反应潜伏期(TFL),计算最大抗辐射热效应(MPE)百分比,并行后肢运动功能评分(BBB评分);TFL和BBB评分测定后取脊髓组织,行HE染色,观察组织病理学改变,光镜和电镜下行组织损伤评分;采用免疫组化和RT-PCR法测定脊髓caspase-3蛋白及其mRNA表达水平.结果 与S组和GM-1组比较,B组T1-6时MPE百分比、组织损伤评分、脊髓caspase-3 mRNA和蛋白表达水平升高,BBB评分降低(P＜0.05),BG组T1-5时MPE百分比升高(P＜0.05),T6时恢复至基础值(P＞0.05),T1-6时BBB评分降低,脊髓组织损伤评分、caspase-3 mRNA和蛋白表达水平升高(P＜0.05).S组和GM-1组各时点各指标比较差异无统计学意义(P＞0.05).与B组比较,BG组T2-6时MPE百分比、脊髓caspase-3 mRNA及蛋白表达水平降低,T3-6时脊髓组织损伤评分降低,T4-6时BBB评分升高(P＜0.05).B组T1-6时脊髓组织病理学损伤明显,BG组T1-3时脊髓组织病理学损伤明显,T4-6时逐渐恢复.结论 鞘内注射GM-1对布比卡因椎管麻醉诱发大鼠脊髓毒性有治疗效果,其机制与抑制脊髓神经细胞凋亡有关.     

盐酸芬戈莫德对大鼠颈动脉球囊损伤后1型和3型1-磷酸鞘氨醇受体表达的影响

目的探讨新型免疫抑制剂盐酸芬戈莫德对大鼠颈动脉球囊损伤后1型和3型1-磷酸鞘氨醇受体(S1P1,S1P3)表达的影响。方法 60只SD大鼠随机分为假手术组(n=15)、阴性对照组(n=15)、模型组(n=15)和药物处理组(n=15),采用球囊损伤的方法制备大鼠颈动脉球囊损伤模型,于术后3天、7天和21天取材,行HE染色观察其组织学变化,采用Real-time PCR(RT-PCR)检测大鼠血管中丝氨酸/苏氨酸蛋白激酶2(AKT2)的表达,Western Blot检测大鼠血管中S1P1和S1P3的表达水平。结果 HE染色显示模型组与其他组相比血管增殖明显;RT-PCR显示AKT2在药物处理组的表达低于模型组,但只在7天时差异有统计学意义(P0.05),在同一时间点模型组和药物处理组的表达量均高于假手术组和阴性对照组(P均0.05),假手术组和阴性对照组在各时间点的表达量差异均无统计学意义(P均0.05);Western Blot在球囊损伤初期S1P1和S1P3表达增加,随着时间推移特别是药物干预作用后,到21天时的表达与正常组织相比无明显差异。结论S1P1和S1P3参与了球囊损伤后平滑肌细胞的迁移与增殖,新型免疫抑制剂盐酸芬戈莫德可以抑制AKT2及S1P1和S1P3的表达,减轻球囊损伤后的再狭窄。     

肾平颗粒对1-磷酸鞘氨醇刺激大鼠肾小球系膜细胞增生的调节作用研究

目的:观察肾平颗粒对1-磷酸鞘氨醇(S1P)刺激大鼠肾小球系膜细胞(RBMC)增生的调节作用。方法:S1P刺激RGMC后,用MTT法观察RGMC增生情况的变化,用Real-Time PCR法观察结缔组织生长因子(CTGF)mRNA水平的变化,用Western blot法观察内皮分化基因受体3/5(endothelial differentiation gene3/5,EDG3、EDG5)、CTGF蛋白水平的变化;制备EDG3、EDG5质粒。EDG3、EDG5质粒同时转染RGMC后,观察肾平颗粒对RGMC增生及EDG3、EDG5、CTGF表达的影响。结果:(1)肾平颗粒能抑制S1P刺激引起的RGMC增生。转染EDG3和EDG5后,抑制作用明显减弱。(2)肾平颗粒能抑制S1P刺激引起的RGMC表面EDG3和EDG5蛋白水平的过表达,转染EDG3和EDG5后,肾平颗粒的抑制作用明显减弱。(3)肾平颗粒能抑制S1P刺激引起的RGMC内S1P通路下游CTGF蛋白的过表达,转染EDG3和EDG5后,肾平颗粒对CTGF蛋白和mRNA的抑制作用明显减弱。结论:肾平颗粒能通过抑制S1P刺激引起的RGMC表面的EDG3、EDG5过度表达,来实现抑制RGMC增生及S1P通路下游CTGF表达的作用。     

μ受体在抗神经生长因子抗体减轻大鼠骨癌痛中的作用

目的 评价μ受体在抗神经生长因子抗体(anti-NGF)减轻大鼠骨癌痛中的作用.方法 实验一健康雌性SD大鼠60只,体重200～220 g,随机分为4组(n=15):假手术组(S组)、假手术+anti-NGF组(SN组)、骨癌痛组(P组)和骨癌痛+anti-NGF组(PN组).P组和PN组于左侧胫骨上段骨髓腔内注射10μl Walker256乳腺癌细胞(1×105个)制备骨癌痛模型;S组和SN组于左侧胫骨上段注射PBS 10μl.于肿瘤细胞接种后13 d时,进行鞘内置管.鞘内置管成功后3 d,SN组和PN组鞘内注射anti-NGF 10μg(用生理盐水稀释至10μl),S组和P组鞘内注射生理盐水10μl,2次/d,连续5 d.于肿瘤细胞接种前、肿瘤细胞接种后13、16、18、21 d时测定自发缩足次数(NSF)、热缩足潜伏期(PWL)和机械性痛阈(PWT).肿瘤细胞接种后21 d时,处死大鼠,取L4.5段脊髓背角和背根神经节,测定μ受体及其mRNA的表达.实验二健康雌性SD大鼠30只,体重200～220 g,随机分为2组(n=15):骨癌痛+anti-NGF组(PN组)和骨癌痛+纳洛酮+anti-NGF组(PNN组).于左侧胫骨上段骨髓腔内注射10μlWalker256乳腺癌细胞(1×105个)制备骨癌痛模型.于肿瘤细胞接种后13 d时,进行鞘内置管.鞘内置管成功后3 d,PN组鞘内注射鞘内注入anti-NGF 10μg(生理盐水稀释至25μl);PNN组鞘内注射纳洛酮10μg(生理盐水稀释至25μl),0.5 h后,鞘内注射anti-NGF 10μg(生理盐水稀释至25 μl),2次/d,连续5 d.于肿瘤细胞接种前、肿瘤细胞接种后13、16、18、21 d时测定大鼠NSF、PWL和PWT.结果 实验一与S组比较,SN组NSF、PWL和PWT差异无统计学意义,SN组和PN组μ受体及其mRNA表达差异无统计学意义(P＞0.05),P组和PN组瘤细胞接种后13～21 d时NSF增加,PWL缩短,PWT降低,P组μ受体及其mRNA表达下调(P＜0.05或0.01);与P组比较,PN组肿瘤细胞接种后18～21 d时NSF减少,PWL延长,PWT升高,μ受体及其mRNA表达上调(P＜0.05或0.01).实验二与PN组比较,PNN组肿瘤细胞接种后18～21 d时NSF增加,PWL缩短,PWT降低(P＜0.05或0.01).结论 anti-NGF减轻大鼠骨癌痛与μ受体的激活有关.     

硬膜外分娩镇痛对胎儿脐动脉和大脑中动脉血流的影响

目的运用多普勒超声观察硬膜外分娩镇痛对胎儿脐动脉和大脑中动脉血流的影响。方法选择要求硬膜外分娩镇痛的产妇59例(R组),同时选取拒绝分娩镇痛产妇25例(N组)。记录产妇产程时间、出血量、分娩方式、新生儿情况。当宫口开至2 cm时,R组记录镇痛前(T0)、镇痛后15 min(T1)、镇痛后30 min(T2)和镇痛后60 min(T3)胎儿大脑中动脉、脐动脉阻力指数(RI)、搏动指数(PI)和最大峰值血流速度/舒张末期血流速度(S/D),N组在相同时间间隔记录上述参数。结果两组产妇产程时间、出血量及分娩方式差异无统计学意义。T0~T2时,R组胎儿大脑中动脉、脐动脉PI和S/D有下降趋势,大脑中动脉RI有增加趋势,但组内差异无统计学意义。N组在各时点无明显改变,组间差异无统计学意义。结论硬膜外分娩镇痛对母婴无明显影响,不良反应少,有很好的临床应用价值。     

超声引导下右侧星状神经节阻滞对腹腔镜胃癌根治术患者双侧脑血流的影响

目的观察超声引导下右侧星状神经节阻滞(stellate ganglion block, SGB)对腹腔镜下胃癌根治术患者双侧脑血流的影响。方法选择2017年8月至2019年2月择期行腹腔镜下胃癌根治术患者60例,男31例,女29例,年龄60~80岁,ASAⅡ或Ⅲ级,采用随机数字表法将患者随机分为两组,每组30例:SGB组(S组)和对照组(C组)。S组于麻醉诱导前在超声引导下行右侧SGB,注入0.375%罗哌卡因8 ml,C组注射等容量生理盐水。通过经颅多普勒超声(TCD)记录SGB前(T0)、SGB后5 min(T1)、30 min(T2)、60 min(T3)、手术结束(T4)时双侧大脑中动脉(MCA)平均血流速度(Vm),计算搏动指数(PI)和阻抗指数(RI),同时记录T0-T4时的MAP、HR和CVP。结果与T0时比较,T2-T4时C组双侧Vm、MAP明显降低,双侧PI和RI明显升高(P<0.05);T2-T4时S组双侧Vm明显明显降低(P<0.05),非阻滞侧PI和RI明显升高(P<0.05);T2时S组MAP明显降低(P<0.05)。T3、T4时C组MAP明显低于S组(P<0.05)。结论超声引导右侧星状神经节阻滞可以明显降低阻滞侧颅内动脉血管阻力,增加腹腔镜下胃癌根治术中颅内血流动力学的稳定性。     

The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure

BACKGROUND: The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurements of downstream renal artery resistance. PI and RI have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. The aim of the present study was to evaluate the potential relationship between these indices and the rate of decline in renal function, as reflected by changes in different parameters of renal function in patients with chronic renal failure. METHODS: Twenty- one patients (8 females; 13 males, mean age 58 years (36-75)) with chronic renal failure were enrolled in the study. Doppler examinations were performed in the segmental arteries by an Acuson 128XP. The PI and the RI was calculated from the blood flow velocities. Parameters of renal function were measured every 3 1/2 months, and all patients were followed for 18-21 months. Progression of renal dysfunction was estimated by linear regression of parameters of renal function versus time. RESULTS: In a multiple regression analysis both PI and RI correlated significantly to the rate of decline in reciprocal serum creatinine (PI: r = -0.48, P = 0.03; RI: r = -0.52, P = 0.02). Furthermore, when separating the patients in two groups by the median RI value, there was a significant difference between the groups in rate of decline in reciprocal serum creatinine (P = 0.02). For PI this distinction was also present (P = 0.04). CONCLUSION: PI and RI correlated to the severity of the renal disease, as reflected by the rate of decline in reciprocal serum creatinine during antihypertensive treatment. The median RI or PI value could separate the patients into groups one of slow and another of fast progression.      

The intrarenal vascular resistance parameters measured by duplex Doppler ultrasound shortly after kidney transplantation in patients with immediate, slow, and delayed graft function

BACKGROUND: Evaluation of pulsatility (PI) and resistive (RI) indexes by duplex Doppler ultrasound shortly after kidney transplantation reflects the exacerbation of interstitial edema. The aim of study was to characterize factors that influence PI and RI in patients with immediate (IGF), slow (SGF), or delayed (DGF) kidney graft function. PATIENTS AND METHODS: PI and RI were measured in 200 transplanted patients at 2 to 4 days postoperatively. We excluded patients with acute rejection episodes within the first month. IGF, which was defined as serum creatinine <264 micromol/L at 3 days, SGF, which was defined as creatinine >264 micromol/L by day 3 with a maximum of one dialysis, and DGF, which was defined as more than 1 dialysis were observed in 33.3%, 41.5%, and 25.2% of patients, respectively. The examined donor parameters were age, hypotensive episodes, catecholamine infusion, central venous pressure, and glomerular filtration rate. The recipient factors were age, history of hypertension, diabetes mellitus, ischemic heart disease, and stroke. Additionally cold ischemia time (CIT), HLA mismatch, and PRA were analyzed. RESULTS: The lowest PI and RI values were observed among patients with IGF (PI 1.37 [1.28 to 1.46]; RI 0.72 [0.69 to 0.74]); moderate values in SGF (PI 1.65 [1.52 to 1.78]; RI 0.78 [0.76 to 0.80]) and the highest values in DGF (PI 2.09 [1.83 to 2.35]; RI 0.83 [0.80 to 0.86]) differences that were highly significant. Hypotensive episodes and catecholamine infusion in the preharvest period had essential impacts on PI or RI values in the early posttransplant period. There was no significant correlation between PI or RI values and CIT. A slower ATN resolution was observed in DGF patients with higher PI values. CONCLUSION: Ischemic injury, which occurred mainly prior to organ harvesting, played a dominant role determining intrarenal resistance in the early posttransplant period.     

Doppler ultrasonographic indices after renal transplantation as renal function predictors

OBJECTIVES: Doppler ultrasonography is mostly used for assessment of both graft and native kidney vascular status. In this study, correlation between Doppler sonographic indices and transplanted kidney function was evaluated. METHODS: In our retrospective study, we reviewed data on 273 renal transplanted (RTx) patients. The Doppler ultrasonographic evaluation included resistive index (RI), pulsatility index (PI) in interlobar arteries as well as stenosis (TRAS) or thrombosis of renal arteries and veins. Serum creatinine (Cr) and cyclosporine levels (CsA) were measured just prior to sonography. RESULTS: The mean age of 154 male and 119 female patients was 36.67 +/- 13.13 years. Both RI and PI showed significant linear correlations with serum Cr (P = .033 and P = .002, respectively). Also, direct linear correlations existed between patient age and RI and PI values (P = .004; r = +.174 and P = .003; r = +.183 respectively). The prevalence of TRAS was 11.35%. Among patients with TRAS or thrombosis the mean Cr level (2.08 +/- 1.7 mg/dL) was significantly higher than that among patients without TRAS or thrombosis (1.48 +/- 0.97 mg/dL; P = .004). Despite this finding, RI and PI were significantly lower among patients with TRAS or thrombosis than those with a patent renovascular tributary (0.59 +/- 0.15 vs 0.65 +/- 0.11; P = .029 vs 1.02 +/- 0.40 vs 1.18 +/- 0.46; P = .049). CONCLUSIONS: Both RI and PI were two valuable Doppler ultrasonographic markers to evaluate renal allograft function and related vascular complications.     

Renal vascular resistance in normal children – a color Doppler study

To investigate the relationship between age and renal vascular resistance and to establish nomative data of the systolic/diastolic ratio (S/D ratio), pulsatility index (PI), and resistant index (RI) of the renal artery in the normal pediatric population, we studied 252 normal children aged newborn to 13 years (a total of 449 kidneys) with a color Doppler unit. After the normality of the kidney was established, color flow mapping was performed to localize the segmental portion of the renal artery. Flow velocity waveforms were then obtained by pulsed Doppler, and S/D ratio, PI, and RI were calculated. Multiple regression analysis confirmed the age dependence of the S/D ratio, PI, and RI of the renal artery in normal children. Renal vascular resistance continuously declines after birth and stabilizes at the age of 102 – 130 months. Normative data for S/D ratio, PI, and RI of the renal artery in normal children were established for each age group. Since renal vascular resistance decreases with age and stabilizes at 8 – 10 years, we suggest using different normal ranges for each age group when studying renal vascular resistance in pediatric patients. Received October 5, 1995; received in revised form and accepted April 24, 1996     

Vascular complication and Doppler ultrasonographic finding after renal transplantation

OBJECTIVES: Vascular complications are common after renal transplantation. In this study we correlated Doppler sonographic indices and transplant kidney function. METHODS: We reviewed data on 244 renal transplant patients. Doppler ultrasonographic evaluation was performed during the first 2 weeks after renal transplantation. We determined resistive index (RI) and pulsatility index (PI) in the interlobar arteries and thrombosis of renal and lower limb veins. Serum creatinine (Cr) and cyclosporine levels were evaluated prior to sonographic assessment. RESULTS: The mean age of the 142 male and 102 female patients was 36.31 +/- 3.30 years. Prevalence of real artery stenosis was 9.5%. In these patients the mean serum Cr level (2.21 +/- 1.83 mg/dL) was significantly higher than among patients with patent renovascular tributary (1.49 +/- 1.00 mg/dL; P=.03). RI and PI were also significantly correlated with serum Cr(P=.05 and .001, respectively). There was no relationship between cyclosporine level or panel-reactive antibody with RI and PI. Retransplant patients showed higher RI than first renal allograft recipients (0.72 +/- 0.16 vs 0.63 +/- 0.11; P=.006). Serum Cr level was higher among renal allograft recipients with Doppler evidence of thrombosis of the lower limb veins (3.1 +/- 0.98 mg/dL versus 1.56 +/- 1.13 mg/dL; P=.04). CONCLUSIONS: RI and PI are two valuable Doppler ultrasonographic markers to determine renal allograft function and related vascular complications.     

Carotid hemodynamic parameters in hemodialysis patients

BACKGROUND: Atherosclerotic vascular disease is a major cause of morbidity and mortality for patients with end-stage renal disease on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by intima-media thickness (IMT), presence and structure of plaques and parameters of vascular resistance. The aim of the present study has been to investigate the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients. METHODS: We studied 36 hemodialysis patients (21 female, 15 male; median age 39.5 years, IQR 33.0-54.7 years) and 38 healthy volunteers (20 women, 18 men; median age 41.0 years IQR 32.5-53.5 years). All subjects underwent ultrasonography of common carotid artery, with determination of IMT, PI and RI. RESULTS: Bilateral and mean carotid IMT were found to be significantly higher in hemodialysis patients than in the control group (P<0.0001). Right and left carotid artery RI values were determined to be lower in hemodialysis patients than in the control group (P=0.007 for both). Similarly, right and left carotid PI values were also determined significantly lower in the hemodialysis group (P=0.005 and P=0.004, respectively). There was a moderate negative correlation between the right carotid IMT and right PI (r=-0.258, P=0.026). CONCLUSIONS: In contrast to previous studies in patients with diabetes, hypertension or cerebrovascular disease, PI and RI values decrease when IMT increases in hemodialysis patients. This finding may be a result of peripheral vasodilatation secondary to anemia in hemodialysis patients.     

The place of diuretic enhanced Doppler sonography in distinguishing between obstructive and non-obstructive hydronephrosis in children

OBJECTIVE: In an attempt to differentiate obstructive from non-obstructive dilation of the renal collecting system in children, a prospective clinical study was carried out. MATERIAL AND METHODS: During duplex Doppler sonography examination in 23 children resistive index (RI) and pulsatility index (PI) and RI ratio values before and after intraverous furasemide administration were compared with the findings obtained with diuretic renogram examination (t(1/2)). RESULTS: Evaluation of the results demonstrated that diuresis RI and PI determination may aid differentiation of severely obstructed renal units from those with slight (equivocal) or no obstruction. CONCLUSION: Kidneys with severe UPJ obstruction tended to have more elevated RI and PI values than the non-obstructed or equivocally obstructed ones. Again, determination of RIR values for each kidney showed the same elevation in severely obstructed kidneys, while non-obstructive or indeterminately obstructed ones demonstrated statistically insignificant changes.