Novel insights into the relationship between glomerular pathology and progressive kidney disease

Both glomerular and tubulointerstitial damage are important factors in the pathophysiology and progression of nephropathy. Glomerular injury is associated with tubulointerstitial inflammation, and many studies show that tubulointerstitial changes correlate well with progressive renal functional decline. Strong evidence supports the concept that once established, proteinuric glomerular injury can cause tubular injury. This review briefly summarizes the pathophysiological consequences of glomerular damage that are responsible for tubulointerstitial injury. It further focuses on tubule-derived renal injury biomarkers that may be used to monitor the progression of kidney disease. This monitoring is predicted to become increasingly useful as novel therapeutic interventions preventing progressive renal damage are introduced. In particular, biomarkers of kidney dysfunction, such as urinary podocytes, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, hematopoietic growth factor-inducible neurokinin 1, or periostin, might be useful in the diagnosis or detection of early nephropathy and risk assessment of kidney disease. However, these biomarkers require further study before they are used in routine screening or in guiding patient therapy.     

腰骶角与退变性脊柱滑脱的相关性分析

目的 探讨腰骶角与腰椎稳定性、退变性脊柱滑脱之间的关系。方法 对114例退变性脊柱滑脱患者进行腰椎动力位X线摄片，测量每例患者不同体位的腰骶角度和椎体滑脱程度并进行相关性分析。结果 腰骶角与前向椎间位移不稳及退变性脊柱滑脱之间存在显著正相关；立位、过伸位的腰骶角度及椎体滑脱程度明显大于卧位。结论 腰骶角的大小与退变性脊柱滑脱的发生及椎体滑脱程度有直接的关系，腰椎动力位摄片更有利于脊柱滑脱的显示。     

Permanent cardiac pacing following surgery for acquired valvular disease.

Between January 1980 and January 1998, implantation of a permanent pacemaker (PP) was performed in 22 patients (6.7%) following 327 acquired valvular surgeries. The indications for implantation of a PP were bradycardia with atrial fibrillation in 12 cases, sick sinus syndrome in 7 cases and complete atrioventricular block in 3 cases. These patients received an implantation after surgery for mitral valvular disease in 14 cases, aortic valvular disease in 3 cases and combined valvular disease in 5 cases. These cases were also concomitant with a tricuspid valve annuloplasty in 6 cases for secondary regurgitation and with a maze procedure in 4 cases. For the purpose of this study, these patients were compared to patients who did not require implantation of a PP after surgery. Univariate analysis showed the significant factors to be female gender (p = 0. 041), preoperative atrial fibrillation (p = 0.013), redo cardiac surgery (p < 0.0001), and the use of blood cardioplegia (p = 0.003). There were no differences in valvular disease, age at the last valvular operation, addition of tricuspid valve annuloplasty, extracorporeal circulation times, or aortic cross-clamp times between those patients with and those without PP. Among these factors, logistic regression analysis showed female gender, redo surgery and the use of blood cardioplegia to be more significant predictors for the requirement of PP after acquired valvular disease operation. Maze procedure was not a significant predictor for the requirement of PP after surgery.     

Etiopathogenical relationship between ENT pathology and tabacco smoke

The upper aerodigestive tract is the first compartment of the human body that takes contact with the harmful components of the tobacco smoke. The passage of the smoke, whether in an active or even passive smoker determines some alterations in the ENT area, which is directly exposed to the harmful action of the tobacco smoke. In this study we intend to analyze the relations between the ENT pathology exemplified at all levels (nasal, laryngeal, ear) and the tobacco smoke. Based on some studies, this paper describes the alterations that occur at the level of the nasal fossae, oral cavity, larynx and pharynx, and also at the level of the ear. The article analyses the relationship between these alterations and the determined pathology. Based on the statistic studies, we relate the active and passive smoke with the possibility of the development of neoplasia in some organs of the ENT area. In conclusion we insist on the necessity that the medical publications as well as the mass media to incriminate smoking as the most relevant risk factor in the development of cancer in the upper mentioned organs, in the twenty first century where tobacco is considered a worldwide epidemic.     

慢性肾脏病患者成纤维细胞生长因子23与心脏瓣膜钙化的关系研究

目的 观察慢性肾脏病(chronic kidney disease,CKD)患者血中成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)水平,探讨CKD患者FGF23的水平与心脏瓣膜钙化之间的关系.方法 选择CKD患者89例为CKD组,28例非CKD患者为对照组;将CKD组患者根据肾脏病/透析的临床实践指南(Kidney Disease Outcome Quality Initiative,K/DOQI),按估算肾小球滤过率(estimated glomerular filtration rate,eGFR)水平分为CKD 1～2期组16例,CKD 3～4期组20例,CKD 5期组16例及CKD 5D期组37例.应用酶联免疫分析法测定血清FGF23,同时测定血清全段甲状旁腺激素水平(parathyroid hormone,iPTH)、血钙、血磷、三酰甘油、血总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等指标.所有患者应用超声心动检测心脏瓣膜是否存在钙化.比较对照组及CKD 1～2期组、CKD 3～4期组、CKD 5期组及CKD 5D期组年龄、血钙、血磷、三酰甘油、血总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、iPTH、FGF23水平及糖尿病、心血管疾病、瓣膜钙化比例.根据是否存在心脏瓣膜钙化将CKD患者89例分为瓣膜钙化组14例和无瓣膜钙化组75例,比较2组间年龄、相关指标、糖尿病、冠心病及透析所占比例.结果 ①CKD 5期组Log iPTH(2.40±0.26)及CKD 5D期组(2.47±0.20)较对照组(1.57±0.14)、CKD 1～2期组(1.54±0.10)、CKD 3～4期组(1.82±0.29)明显升高(P＜0.001),CKD 5D期组(2.67±0.54)的Log FGF23较对照组(1.37±0.11)、CKD 1～2期组(1.42±0.12)、CKD 3～4期组(1.62±0.26)、CKD 5期组(1.83±0.37)明显升高(P＜0.001).CKD 5D期组的心脏瓣膜钙化比例(12/37)明显高于对照组(2/28)、CKD 1～2期组(2/26)、CKD 3～4期组(1/20)及CKD 5期组(0/16),差异有统计学意义(P＜0.05);②瓣膜钙化组的年龄[(73.3±9.9)岁]、三酰甘油[(4.10±2.09) mmol/L]、Log FGF23 (2.52±0.71)、透析患者所占比例(11/14)较无钙化组的年龄[(64.8±12.6)岁]、三酰甘油[(1.90±1.59)mmol/L]、Log FGF23(1.96±0.62)、透析患者所占比例(26/75)明显升高,差异有统计学意义(P＜0.05);③Logistic回归分析显示,年龄、Log FGF23、血总胆固醇及糖尿病病史是影响心脏瓣膜钙化的独立影响因素.结论 CKD患者血清FGF23升高,且随着肾功能的恶化,FGF23水平呈升高趋势,FGF23升高为心脏瓣膜钙化的危险因素.     

关节突关节角变化与退变性腰椎滑脱间关系的研究

目的探讨关节突关节角的改变与退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)发生之间的因果关系。方法回顾性选取2011-07-2014-07我科收治的50例L4-5单节段退变性前滑脱患者作为DLS组,另选同期50例无腰腿痛和脊椎滑脱的正常患者作为对照组,且使性别、年龄与DLS组相匹配。两组均行站立位腰椎正侧位X线片及腰椎三维CT检查,在腰椎侧位X线上测量腰椎滑脱指数;在CT矢状位图像上选取平行于L3-4、L4-5、L5-S1椎间隙上缘终板的CT横断位图像作为关节突的头侧部分;过椎弓根下缘且平行于L3-4、L4-5、L5-S1椎间隙下缘终板的CT横断图像作为关节突的尾侧部分,在横断位上进行关节突角度测量,同时在骨窗下对关节突的退变进行评估。结果 DLS组L3-4头侧关节突关节角(61.9±6.3)°大于对照组的(56.3±7.5)°,尾侧关节突关节角(57.1±6.9)°大于对照组的(51.9±6.8)°;DLS组L4-5头侧关节突关节角(55.8±5.6)°大于对照组的(50.2±6.7)°,尾侧关节突关节角(53.2±6.8)°大于对照组的(47.0±5.9)°;DLS组L5-S1头侧关节突关节角(49.1±7.8)°大于对照组的(43.9±6.9)°,尾侧关节突关节角(45.1±6.9)°大于对照组的(41.7±5.1)°,差异均具有显著性(P0.05)。DLS组患者L4-5头尾侧角度差值(2.1±0.8)°小于对照组的(5.0±1.3)°,差异具有显著性(P0.05)。DLS组L4-5左右两侧关节突关节角不对称度(8.0±2.0)°大于对照组的(4.2±1.3)°,差异有显著性(P0.05)。按关节突关节退变等级将DLS患者分成3组,各组间滑脱指数差异具有显著性(P0.05),不同退变等级中头、尾侧关节突关节角度差异具有显著性(r=0.457,P0.05)。结论关节突关节矢状化改变更可能是腰椎退变性滑脱发生预先存在的解剖学因素。     

低骨量与老年钙化性心脏瓣膜病的相关研究

目的评价老年人心脏瓣膜钙化和骨量情况,探讨低骨量与老年钙化性心脏瓣膜病(senile calcified valvulardisease,SCVD)的关系。方法连续收集2011年1月至2013年5月期间在新疆医科大学第一附属医院干部病房住院的患者,年龄≥60岁,符合纳入标准,共353例,其中男性215例,平均年龄(72.09±7.73)岁,女性138例,平均年龄(69.54±6.59)岁。应用超声心动图观察其心脏瓣膜情况,根据老年钙化性心脏瓣膜病诊断标准,将其分为SCVD组(男性57例,女性47例),非SCVD组(男性158例;女性91例);同时所有研究对象均行双能X线骨密度测定,评估腰椎、全髋关节、股骨颈骨量情况。结果(1)SCVD组和非SCVD组低骨量总人数比较,差异有统计学意义(χ2=4.315,P0.05)。但无论在男性还是女性,两组间比较,差异无统计学意义(P0.05)。(2)SCVD组低骨量患者全髋关节骨密度较非SCVD组降低,差异有统计学意义(t值:2.455,P0.05),两组间股骨颈T值比较,差异有统计学意义(t值:2.051,P0.05),两组间全髋关节T值比较,差异有统计学意义(t值:3.066,P0.05),两组间最低T值比较,差异有统计学意义(t值:3.218,P0.05)。(3)未发现男性SCVD组和非SCVD组腰椎、全髋关节、股骨颈骨密度及T值比较,差异有统计学意义(P0.05),但两组间最低T值比较,差异有统计学意义(t值:2.354,P0.05)。(4)女性SCVD组和非SCVD组全髋关节T值比较,差异有统计学意义(t值:2.452,P0.05),两组间最低T值比较,差异有统计学意义(t值:2.352,P0.05)。(5)经logistic回归分析后,无论男性还是女性,SCVD组与非SCVD组年龄比较均存在显著差异,有统计学意义(男性OR:1.061,95%CI:1.019~1.105,P0.05,女性OR:1.077,95%CI:1.017~1.139,P0.05),年龄与老年钙化性心脏瓣膜病发生风险独立相关,未发现性别、体重指数、高血压、高脂血症、糖尿病、冠心病、低骨量与老年钙化性心脏瓣膜病发生风险相关。(6)经logistic回归分析后,女性最低T值在SCVD组与非SCVD组存在差异,有统计学意义(OR:0.645,95%CI:0.441~0.945,P0.05)。结论 (1)年龄是SCVD发生的独立危险因素之一。(2)女性SCVD患者需行骨密度测定,尤其是全髋关节部位,来评估骨量情况。(3)女性最低T值与SCVD发病相关,推测女性低骨量可能是使老年钙化性心脏瓣膜病发生风险增加的独立因素。女性低骨量患者需进一步评估瓣膜情况及相关心血管疾病。     

合并恶液质的风湿性心脏瓣膜病的外科治疗

目的　总结风湿性心脏瓣膜病合并心源性恶液质病人的围手术期治疗经验。方法　回顾性分析近 6年 42例心脏恶液质瓣膜患者的围手术期治疗。结果　术后早期死亡 4例( 9 .5 2 % ) ,2 0例术后出现并发症 ,3 8例患者出院时肝脾明显缩小 ,食欲好转 ,血红蛋白、血浆蛋白及肝、肾功能正常。随访 10个月～ 6年 ,心功能恢复至Ⅰ级 2 4例 ,Ⅱ级 14例。结论　充分的术前准备、围术期营养支持 ,正确地选择好手术时机 ,加强术中处理 ,积极治疗术后并发症是提高手术疗效的关键。     

椎间盘退行性改变与力学因素关系的研究进展

椎间盘退变性疾病是临床常见的严重危害人群健康的疾病,研究椎间盘退变的机制和逆转方法是治疗椎间盘退变性疾病的主要策略。很多因素与椎间盘退变有关,包括遗传因素,力学因素,环境因素,年龄和性别因素等。近年来许多研究表明力学因素与椎间盘退变有着密切关系。学者们通过研究静态压力、动态压力、渗透压和牵拉等力学因素对椎间盘组织代谢和形态结构的影响,     

Differences between rheumatoid and degenerative disease in total hip replacement

The aim of this study was to compare total hip replacement (THR) in rheumatoid and osteoarthritic patients. Ten rheumatoid and ten osteoarthritic patients undergoing THR were compared with respect to preoperative diagnostics, operative therapy, nursing and rehabilitation. Statistically significant differences existed between the groups: In rheumatoid patients, radiographic diagnostics were more extensive ( P=0.0021), surgery time was extended ( P=0.0355), referrals to non-orthopedic subspecialties were more frequent ( P=0.0524) and rehabilitation was more extensive ( P=0.0000). The groups were not significantly different with respect to the duration of hospitalisation, preoperative hemoglobin, perioperative blood loss, transfusion requirements, duration of intensive care and nursing requirements. THR in the rheumatoid population required additional resources during inpatient therapy in comparison to THR in osteoarthritic patients.     

Benfluorex and valvular heart disease

Benfluorex is responsible of restrictive organic valvular regurgitations via one of its metabolites, the norfenfluramine. It has been withdrawn from the european market in June 2010. In France, about five millions of people have been exposed to benfluorex since its market launch in 1976. At the time of its market withdrawn, over 300,000 patients in France were taking the drug. Aortic and mitral valves are the most frequent involved. The prevalence of this type of valve damage is not yet known with accuracy. Severe regurgitations appear to be rare (less than one case per thousand exposed patients-year).     

Pregnancy and valvular heart disease

Heart disease can affect anyone at any time, and pregnant women are not exceptions. Some type of cardiac pathologic disease can be seen in 1% to 2% of all pregnant women. Because of the high fetal mortality rate and the high relative rate of maternal mortality in surgery, medical management is the first line of treatment. Nevertheless, when medical treatment fails, cardiac surgery may be necessary. Here we present such a case of cardiac valvular disease complicated by pregnancy. Current decision-making, treatment, and trends are reviewed.     

胆管癌微血管生成及其病理学特征与预后的关系

目的探讨胆管癌微血管生成及其病理学特征与预后的关系。方法应用免疫组化法检测50例胆管癌标本的微血管密度、血管内皮生长因子和血管内皮生长因子受体Flk-1／KDR的表达,结合临床病理学资料和随访资料进行分析。结果胆管癌组织和癌旁组织的微血管密度 (34．04±11．08、32．80±9．28)均高于正常组织(11．67±4．64)(P<0．01);血管内皮生长因子和 Flk-1／KDR在肿瘤组织和癌旁组织中的表达均高于正常组织(P<0．01);伴淋巴结转移组微血管密度 (41．07±11．83)高于无转移组(30．93±9．18)(P<0．05);伴神经浸润组微血管密度(37．85±12．04) 高于无浸润组(30．32±8．51)(P<0．05);微血管密度<30和30-39组的生存率高于≥40组(P< 0．05)。结论微血管生成与胆管癌的发生、发展和预后密切相关。     

Relationship between preoperative amiodarone treatment and complications observed during anaesthesia for valvular cardiac surgery

Two groups of ASA physical status class III and IV patients undergoing cardiac surgery were reviewed in an attempt to obtain more conclusive data concerning dangerous interactions between amiodarone and anaesthesia. The amiodarone group (Group 1, ten patients, cumulative dose 10 g) was compared with a control group (nine patients, Group 2). Amiodarone (A) and desethylamiodarone (NA) concentrations in plasma and myocardium were measured and haemodynamic and antiarrhythmic effects were analysed. Throughout anaesthesia haemodynamic status was similar in both groups. No correlation was found between A/NA and cardiac index changes. No patients needed intraaortic blood pressure augmentation or developed low systemic vascular resistances. Pacemaker dependency was similar in both groups and there was no evidence of increased anaesthetic risk. An excellent antiarrhythmic effect was obtained during the postoperative period. We conclude that preoperative treatment with amiodarone is effective against postoperative arrhythmias.