Plasminogen activator inhibitor-1 and diabetic nephropathy

SUMMARY:   Diabetic nephropathy is characterized by excessive accumulation of extracellular matrix (ECM) in the kidney. Decreased ECM degradation as well as increased ECM synthesis plays an important role in ECM remodeling that favours tissue fibrosis. Plasminogen activator (PA)/plasmin/PA inhibitor (PAI) system is involved in ECM degradation and PAI-1 plays a critical role in ECM remodeling in the kidney. Normal human kidneys do not express PAI-1 but PAI-1 is overexpressed in pathologic conditions associated with renal fibrosis including diabetic nephropathy. Reactive oxygen species mediate PAI-1 up-regulation in renal cells cultured under high glucose, hypoxia, and TGF-β1. Recent studies utilizing PAI-1 deficient mice suggest that PAI-1 induce ECM deposition in diabetic kidney through increased ECM synthesis by TGF-β1 up-regulation as well as through decreased ECM degradation by suppression of plasmin and MMP-2 activity.     

经皮肝胆道造瘘硬质胆道镜治疗肝内胆管结石

目的探讨经皮肝胆道造瘘硬质胆道镜治疗肝内胆管结石的可行性、疗效及优势。方法 2009年6月至2010年7月采用经皮肝胆道造瘘硬质胆道镜碎石取石的方法治疗肝内胆管结石22例,其中男10例,女12例,年龄30～82岁,平均(50.9±10.1)岁;左肝胆管结石4例,右肝胆管结石4例,左右肝胆管结石5例,左右肝胆管合并胆总管结石9例。结果 22例均成功施行经皮肝胆道造瘘硬质胆道镜取石术,其中15例取净结石,7例仍有少许残余结石,结石取净率68.2%。手术时间40～270min,平均(113.0±41.9)min;取石次数为1～5次,平均(2.6±0.9)次;术中出血量5～200ml,平均(18.8±20.5)ml;住院天数4～53d,平均(19.4±2.3)d。术后并发右侧胸腔积液和右下肺不张1例,经非手术方法治愈。无胆瘘、胆汁性腹膜炎发生。结论经皮肝胆道造瘘治疗肝内胆管结石,尤其对多次胆道术后复发或残留的复杂性肝内胆管结石是一种安全、有效、创伤小、易重复的方法。经皮经肝穿刺胆管引流术3d后一次性扩张造瘘并取石是安全的。硬质胆道镜经皮肝瘘道行手术是可行的。     

补虚泻实针刺法结合卒中单元模式对肩手综合征患者肩部疼痛的影响

目的观察补虚泻实针刺法结合卒中单元模式对脑卒中后肩手综合征患者肩部疼痛的影响。方法将80例患者随机分为治疗组和对照组,每组40例。治疗组采用补虚泻实针刺法结合卒中单元模式进行治疗,对照组采用普通针刺法结合卒中单元模式进行治疗,4星期后观察两组视觉模拟评分(VAS)和总体疗效。结果治疗组总有效率为92.5%,优于对照组的87.5%(P<0.05);两组治疗后VAS均较治疗前显著减少(P<0.01),且治疗组治疗后VAS低于对照组(P<0.01)。结论补虚泻实针刺法结合卒中单元模式和普通针刺法结合卒中单元模式均能明显降低脑卒中后肩手综合征患者的肩部疼痛的程度,对脑卒中后肩手综合征有明显的治疗效果,但补虚泻实针刺法结合卒中单元模式的疗效更优一些。     

Stromal Caveolin-1 Expression in Breast Carcinoma. Correlation with Early Tumor Recurrence and Clinical Outcome

Caveolin- (cav-1) has been linked to tumor progression and clinical outcome in breast cancer, but its role as a prognostic marker is still unclear. We evaluated stromal and tumor caveolin-1 expression in 91 breast carcinomas, and assessed the association between their expression and clinicopathologic variables as well as patient outcome and early tumor recurrence. Absence of stromal caveolin-1 expression was detected in 18.7% of cases, while 25.3% of cases revealed tumor epithelial caveolin-1 expression. Combined stromal and tumor caveolin-1 immunopositivity was seen in 24.2% of cases. Absence of stromal cav-1 associated with larger tumor size, higher grade, higher nodal stage, higher number of positive nodes, higher TNM stage, positive HER2 status, higher recurrence rate, and shorter mean progression free survival (PFS). Stromal cav-1 status was a significant predictor of PFS in ER+, PR +, and HER2 + tumors. In tamoxifen-treated patients, absence of stromal Cav-1 was a significant predictor of poor clinical outcome, suggestive of tamoxifen resistance. Conversely, tumor epithelial and combined caveolin-1 expression, didnot associate with patient outcome. In multivariate analysis, only TNM stage independently associated with survival. Loss of stromal caveolin-1 is a novel breast cancer biomarker that can predict early tumor recurrence, short PFS, and tamoxifen- resistance. Thus, its use as a predictive biomarker, especially in lower grade, lower stage, ER+, PR+, HER2+, and tamoxifen treated patients may allow for early interventions with more aggressive therapies. Thus, stromal marker expression and epithelial-stromal cross talk may be critical for tumor progression and metastasis.     

MR imaging of the dilated biliary tract

The magnetic resonance (MR) examinations of 18 patients with dilated bile ducts were reviewed retrospectively to determine the capability of MR to demonstrate biliary dilatation, assess MR appearance of the dilated biliary tract using spin-echo techniques, and define the optimal MR imaging parameters (repetition time [TR] and echo time [TE]) for its demonstration. On images with short TR (0.5 sec) and TE (28 msec), the dilated intrahepatic and intrapancreatic bile ducts usually had lower signal intensity compared with the surrounding liver or pancreas; on images with long TR (2.0 sec) and TE (56 msec), they had higher signal intensity. Because of the observed variation in percentage of contrast between dilated bile ducts and surrounding liver and pancreas, two imaging sequences are recommended to obtain reliable demonstration of dilated intrahepatic and intrapancreatic bile ducts. The dilated common bile duct at the level of the hepatic hilus is best seen with a short TR and TE.     

Orbital lesions: proton spectroscopic phase-dependent contrast MR imaging

Thirteen orbital lesions in 12 patients were evaluated with both conventional spin-echo magnetic resonance (MR) imaging and phase-dependent proton spectroscopic imaging. This technique, which makes use of small differences in the resonant frequencies of water and fat protons, provides excellent high-resolution images with simultaneous chemical shift information. In this method, there is 180 degrees opposition of phase between fat protons and water protons at the time of the gradient echo, resulting in signal cancellation in voxels containing equal signals from fat and water. In this preliminary series, advantages of spectroscopic images in orbital lesions included better lesion delineation, with superior anatomic definition of orbital apex involvement; more specific characterization of high-intensity hemorrhage with a single pulse sequence; elimination of potential confusion from chemical shift misregistration artifact; further clarification of possible intravascular flow abnormalities; and improved apparent intralesional contrast.