迷迭香酸对系膜增生性肾炎系膜细胞抗氧化应激的影响

目的探讨在系膜增生性肾小球肾炎(M sPGN)中系膜细胞氧化损伤与抗氧化系统的改变及迷迭香酸的干预作用。方法培养大鼠肾小球系膜细胞,以PDGF刺激系膜增生及RAD干预;另外,用兔抗大鼠胸腺细胞免疫血清(ATS),制备大鼠抗THy1.1系膜增生性肾小球肾炎模型,并以迷迭香酸干预。体外及体内实验均设正常对照组、肾炎组、单纯迷迭香酸组和迷迭香酸干预组。利用分光法分别测定培养细胞和肾脏组织中丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。结果在抗THy1.1肾炎的肾脏组织及PDGF刺激肾小球系膜细胞中MDA含量升高和SOD减少;迷迭香酸的干预后MDA的产生降低,而SOD增加。结论氧自由基及其诱发的脂质过氧化在系膜增生性肾小球肾炎的致病中起重要作用,而迷迭香酸则能抑制肾炎系膜细胞的上述改变,具有抗氧化活性。     

系膜增生性肾小球肾炎炎症因子分泌的变化及其意义

目的：探讨在增生的大鼠肾小球系膜细胞（GMC）及大鼠抗Thy1．1系膜增生性肾小球肾炎（MsPGN）模型肾组织中转化生长因子-β1（TGF-β1）、单核细胞趋化蛋白-1（MCP-1）及纤维连接蛋白（FN）等炎症介质变化及其意义。方法：体外培养大鼠GMC，予血小板源性生长因子-BB（PDGF-BB）刺激，应用ELISA法检测培养上清液中TGF-β1、MCP-1及FN的蛋白分泌量。另外制备大鼠MsPGN模型，免疫组化方法检测大鼠肾皮质中增生细胞核抗原（PCNA）、TGF-β1、MCP-1及FN的相对表达量。结果：PDGF-BB诱导GMC增殖后，GMC分泌TGF-β1、MCP-1增多，FN蛋白合成增加。模型大鼠较正常大鼠于肾小球毛细血管襻及系膜区TGF-β1、FN和MCP-1表达明显增多。结论：增生的GMC分泌TGF-β1、MCP-1增多，并能刺激GMC合成FN。在大鼠MsPGN模型肾小球系膜区及毛细血管襻中TGF-β1、FN和MCP-1表达同样明显增多。因而MsPGN发病机制可能部分与TGF-β1及MCP-1的过高表达有关。[著者文摘]     

肝细胞生长素在体外对大鼠肾小球系膜细胞生物活性的影响

目的 观察低分子肝细胞生长素(HPN)对炎症因子刺激下的大鼠肾小球系膜细胞增殖及产生TGFβ的影响。方法 用^3H—TdR掺入法检测肾小球系膜细胞(GMC)增殖变化，用ELISA法检测肾小球系膜细胞培养上清中TGFβ的水平。结果 在无IL-1β存在时，浓度为400u/孔的低分子肝细胞生长素对常规培养的系膜细胞增殖有明显抑制作用(P＜0．01)，而对TGFβ的产生无影响；但它对IL-β刺激下的大鼠系膜细胞增殖和TGFβ产生均有明显抑制作用(均P＜0．01)。低分子肝细胞生长素在100u/孔浓度时无上述作用。结论 高剂量HPN可抑制体外培养的大鼠系膜细胞增殖，降低IL-β刺激系膜细胞产生TGFβ。低分子肝细胞生长素无种属特异性和组织特异性。     

吡格列酮对高糖培养的肾小球系膜细胞单核细胞趋化蛋白-1表达和合成的影响

目的观察过氧化物酶体增殖物激活受体激动剂-吡格列酮对肾小球系膜细胞单核细胞趋化蛋白-1（MCP-1）表达和合成的影响,探讨其肾脏保护机制。方法体外培养肾小球系膜细胞,随机分组为正常对照糖（NG组）、高糖（HG组）及高糖＋不同浓度吡格列酮（P1、P2、P3组）。培养48小时后收集各组细胞及上清液,应用RT-PCR方法检测细胞MCP-1mRNA含量,采用ELLSA法检测细胞上清液中MCP-1蛋白浓度。结果 （1）肾小球系膜细胞可表达及合成MCP-1;（2）与NG组比较,高糖刺激后肾小球系膜细胞MCP-1mRNA表达以及细胞上清液中MCP-1蛋白含量显著增高（P〈0.05）;（3）加入吡格列酮干预后,肾小球系膜细胞MCP-1mRNA表达以及细胞上清液中MCP-1蛋白含量显著下降,且呈现浓度依赖性。结论吡格列酮可抑制肾小球系膜细胞MCP-1mRNA表达和蛋白合成,且呈现剂量依赖性,该作用可能与其肾脏保护部分有关。     

缬沙坦对高糖环境中小鼠肾小球系膜细胞炎症介质的影响

目的 观察缬沙坦对高糖环境中小鼠肾小球系膜细胞单核细胞趋化蛋白1(MCP-1)及细胞间黏附分子1(ICAM-1)表达的影响,探讨缬沙坦对糖尿病肾病的防治作用.方法 高糖环境中培养小鼠肾小球系膜细胞,于培养12、24、48小时,应用四甲基偶氮唑盐微量酶反应比色法(MTT)检测细胞增殖程度,分别应用免疫细胞化学和蛋白质印迹法检测系膜细胞MCP-1、ICAM-1蛋白表达水平,酶联免疫吸附法(ELISA)检测细胞培养上清Ⅳ型胶原浓度.结果 高糖环境中小鼠肾小球系膜细胞MCP-1及ICAM-1表达增强,细胞增殖明显(0.815±0.007)A,细胞上清液中Ⅳ型胶原浓度升高(17.29±1.95)μg/L,缬沙坦干预后MCP-1及ICAM-1表达减弱,细胞增殖受抑制(0.652±0.004)A,Ⅳ型胶原浓度降低(13.19±0.89)μg/L.结论 缬沙坦可下调MCP-1及ICAM-1表达,抑制系膜细胞增殖及系膜外基质积聚,发挥其独立于降压之外的肾脏保护作用.     

洛伐他汀对人肾小球系膜细胞转化生长因子-β_1和细胞外基质的影响

目的　观察他汀类药物对人肾小球系膜细胞转化生长因子 β1 (TGF β1 )表达及纤维连接蛋白、层粘连蛋白和Ⅳ型胶原分泌的影响 ,探讨其在糖尿病肾病防治中的意义。方法　于体外培养人胎肾小球系膜细胞 ,观察低糖 ( 5 6mol/L)和高糖( 3 0mol/L)环境下系膜细胞TGF β1 mRNA的表达 ,并检测细胞培养液中TGF β1 、纤维连接蛋白、层粘连蛋白和Ⅳ型胶原的含量。分别在培养液中加入洛伐他汀、西拉普利及洛伐他汀 +西拉普利 ,观察不同时间和不同药物浓度下细胞培养液中上述指标浓度的变化 ,并检测洛伐他汀和 /或西拉普利刺激 48h后对系膜细胞TGF β1 mRNA表达水平的影响。结果　高糖可刺激肾小球系膜细胞过度增殖 ,细胞培养液中TGF β1 、纤维连接蛋白、层粘连蛋白和Ⅳ型胶原浓度升高 ,TGF β1 mRNA表达明显增加。加入洛伐他汀和西拉普利后 ,细胞增殖明显抑制 ,细胞上清液中TGF β1 、纤维连接蛋白、层粘连蛋白和Ⅳ型胶原浓度下降 ,TGF β1 mRNA表达亦显著降低。联用洛伐他汀和西拉普利对系膜细胞TGF β1 表达的抑制作用较单独用药更强。结论　高糖可促进系膜细胞TGF β1 表达和基质蛋白的分泌 ,洛伐他汀和西拉普利均能一定程度地逆转上述现象 ,提示他汀类药物有直接抑制系膜细胞TGF β1 表达和基质蛋白分泌的?     

PDGF,TGF-β1与肝纤维化关系的研究

目的探讨血小板衍生生长因子BB（PDGF—BB）和转化生长因子β1（TGF—β1）与肝纤维化的关系。方法45例慢性丙型肝炎患者，根据PCⅢ分为对照组及实验组，检测聚乙二醇化干扰素治疗后o，12，24W时PDGF—BB、TGF—β1及PCⅢ水平。结果实验组PCⅢ，PDGF—BB及TGF—β1含量在治疗的12，24W与0W相比有显著性下降，PDGF—BB及TGF—β1随PCⅢ的下降而减低；实验组PDGF—BB，TGF—β1与PCⅢ具有相关性。结论PDGF—BB，TGF—β1是肝纤维化标志物，在肝纤维化检测中有重要作用。     

血管紧张素Ⅱ对肾小球系膜细胞MCP-1表达的影响

目的观察血管紧张素Ⅱ（AngⅡ）对大鼠肾小球系膜细胞单核细胞趋化蛋白-1（MCP-1）mRNA表达和蛋白合成的影响,并讨论其机制。方法试验分组：10%小牛血清MEM（含糖5.6 mmol/L,未加其他刺激因素）为对照组（C组）;A1组、A2组和A3组分别在培养液中加不同浓度AngⅡ（10-9mol/L、10-7mol/L和10-5mol/L）。培养48 h后收集各组细胞和细胞上清液,RT-PCR检测肾小球系膜细胞MCP-1mRNA表达,采用ELISA检测培养细胞上清中MCP-1蛋白的浓度。结果①肾小球系膜细胞可表达及合成MCP-1;②与C组比较,A1组、A2组和A3组肾小球系膜细胞MCP-1mRNA表达增强（P〈0.01）;③与C组比较,A1组、A2组和A3组细胞培养上清液MCP-1浓度明显增高（P〈0.01）;④与A1组比较,A2和A3组系膜细胞MCP-1mRNA明显增强,上清液MCP-1浓度显著升高（P〈0.01）,其中以A2组最明显。结论 AngⅡ可刺激肾小球系膜细胞MCP-1mRNA表达和蛋白合成增加,并具有一定的浓度依赖性。     

氯沙坦阻断血小板源生长因子诱导的系膜细胞增殖活性的研究

目的探讨氯沙坦对系膜细胞增殖的影响以及对血小板源生长因子(PDGF)所诱导的细胞增殖作用。方法取传代培养的大鼠肾小球系膜细胞,分别加入不同浓度的PDGF、血管紧张素Ⅱ(AngⅡ)和氯沙坦,用BrdU掺入法和四甲基偶氮唑盐(MTT)法测定细胞增殖的情况。结果PDGF和AngⅡ明显促进系膜细胞的生长(P<0.01);氯沙坦(10-7~10-5mol/L)有抑制系膜细胞增殖的作用(P<0.01),与维拉帕米联合使用则抑制作用更为明显;PDGF组加入氯沙坦后,系膜细胞增殖明显减弱,与单纯PDGF组比较,有显著差异(P<0.01)。结论PDGF具有明确的促进大鼠肾小球系膜细胞增殖作用。氯沙坦则抑制系膜细胞增殖活性,可能是通过阻断PDGF的诱导增殖作用而介导的。     

维拉帕米抑制肾小球系膜细胞增殖效应及机制探讨

目的探讨维拉帕米对肾小球系膜细胞增殖的影响及可能的作用机理。方法体外培养的大鼠肾小球系膜细胞 ,经不同浓度的维拉帕米、血小板源生长因子 (PDGF)和 PDGF加维拉帕米处理后 ,Brd U和 MTT法作细胞增殖测定 ,并计算抑制率。结果维拉帕米抑制大鼠系膜细胞的生长 ,随药物浓度增加 ,抑制率随之增强。而 PDGF则呈现明显的促进作用 ,与对照组比较有显著性差异 (P<0 .0 1)。再经维拉帕米处理后 (维拉帕米 + PDGF组 )系膜细胞生长减缓 (0 .796± 0 .0 13 ) ,较单纯 PDGF组 (1.2 67± 0 .0 3 5 )有显著性差异 (P<0 .0 1)。结论维拉帕米具有抑制大鼠肾小球系膜细胞增殖的作用 ,其机理之一可能是拮抗 PDGF所介导的细胞增殖效应     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。