Renal Hemodynamics in AKI: In Search of New Treatment Targets

Novel therapeutic interventions are required to prevent or treat AKI. To expedite progress in this regard, a consensus conference held by the Acute Dialysis Quality Initiative was convened in April of 2014 to develop recommendations for research priorities and future directions. Here, we highlight the concepts related to renal hemodynamics in AKI that are likely to reveal new treatment targets on investigation. Overall, we must better understand the interactions between systemic, total renal, and glomerular hemodynamics, including the role of tubuloglomerular feedback. Furthermore, the net consequences of therapeutic maneuvers aimed at restoring glomerular filtration need to be examined in relation to the nature, magnitude, and duration of the insult. Additionally, microvascular blood flow heterogeneity in AKI is now recognized as a common occurrence; timely interventions to preserve the renal microcirculatory flow may interrupt the downward spiral of injury toward progressive kidney failure and should, therefore, be investigated. Finally, development of techniques that permit an integrative physiologic approach, including direct visualization of renal microvasculature and measurement of oxygen kinetics and mitochondrial function in intact tissue in all nephron segments, may provide new insights into how the kidney responds to various injurious stimuli and allow evaluation of new therapeutic strategies.     

细胞因子白细胞介素-6及胰岛素生长样因子-1与类风湿关节炎临床表现的关联性研究

目的研究白细胞介素-6(interleukin-6,IL-6)及胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)与类风湿关节炎(rheumatoid arthritis,RA)临床表现的关联性。方法采用酶联吸附免疫法(enzyme linked immunosorbent assay,ELISA)测定RA患者血清IL-6及IGF-1浓度,分析其于RA临床表现的关联性。结果1.骨质疏松组IGF-1水平明显低于无骨质疏松组(P0.05)。而男性组与女性组、RF阳性组与阴性组、ACCP阳性组与阴性组、无+轻度贫血与中度+重度贫血、白细胞减少与白细胞不减少、血小板升高与无血小板升高之间均无显著性差异(P0.05)。2.IGF-1与ACCP滴度、RF滴度、病程、ESR、年龄、CRP均无相关性(P0.05),与疼痛关节数及肿胀关节数呈负相关(P0.05)。3.男性RA患者IL-6水平明显比女性RA患者水平低(P0.05),ACCP阴性组明显比阳性组低(P0.05),骨质疏松组明显比无骨质疏松组低(P0.05)。而RF阳性组与阴性组、无+轻度贫血与中度+重度贫血、白细胞减少与白细胞不减少、血小板升高与无血小板升高之间均无显著性差异。(P0.05)。4.IL-6水平与ACCP滴度、疼痛关节数及肿胀关节数呈正相关(P0.05),与IGF-1水平呈负相关(P0.05),与RF滴度、病程、ESR、年龄、CRP均无相关性(P0.05)。结论IL-6及IGF-1与RA病情活动有关。女性患者Il-6高,易于发生骨质疏松     

磁共振扩散张量成像与纤维束成像在脊髓型颈椎病中的应用研究

目的 :评价磁共振扩散张量成像技术(diffusion tensor imaging,DTI)对脊髓型颈椎病的诊断价值。方法 :对收集的2014年1月至2015年4月20例健康志愿者和50例脊髓型颈椎病(CSM)患者行颈髓DTI。以健康志愿者作为对照组。依据颈髓MRI平扫结果将CSM患者分A、B、C组,A组17例(单纯硬膜囊受压),B组23例(颈髓受压,信号正常),C组10例(颈髓受压,T2高信号)。分析4组颈髓的平均表观扩散系数(ADC)、平均分数各向异性值(FA)之间的差异,对所有受检者行颈髓纤维束成像。结果:对照组C_2/C_3、C_3/C_4、C_4/C_5、C_5/C_6、C_6/C_7之间ADC值及FA值差异无统计学意义(P0.05),平均ADC值为(0.875±0.096)×10~(-3)mm~2/s,平均FA值为0.720±0.051;对照组与A组比较,平均ADC值、FA值差异无统计学意义,对照组与B、C组及A、B、C组间比较,平均ADC值、FA值差异均有统计学意义。结论:颈髓DTI较常规MRI能够早期、准确地量化脊髓型颈椎病的颈髓微结构改变,颈髓纤维束成像可以反映脊髓纤维束受压损伤的范围。     

Artificial oocyte activation with calcium ionophore for frozen sperm cycles

Fertilization problems are the major problems that may be faced in 30–55% of the patients during an intracytoplasmic sperm injection (ICSI) cycle. A successful oocyte activation depends on factors related to both sperm and oocyte, and one of the important factors that mediates the process is Ca²⁺ concentration within the oocyte. Artificial oocyte activation (AOA) is a method used for fertilization problems that commonly involve the usage of Ca²⁺ ionophores and is usually used in problems such as total fertilization failure (TFF) and globozoospermia. The aim of the present study was to investigate possible effects of AOA for different groups of patients with fertilization failure. Four groups of patients (previous TFF, low oocyte number, severe sperm quality, and frozen sperm (FS) group) that underwent ICSI with AOA were included in the study. All groups had similar control groups with same indications except TFF, where AOA was not performed. Fertilization rates were significantly higher in the TFF group than those observed in other AOA groups. Fertilization rates and quality of embryos observed in the remaining AOA groups were higher than those of the controls, which were statistically insignificant. Prgenancy rates were higher in all AOA groups compared to the controls, although the differences were significant in FS group only. Quality of embryos and pregnancy rates were lower in the TFF group compared to the remaining AOA groups indicating possible concomitant problems. Fertilization rates, quality of embryos and pregnancy rates seemed to be increased in all indication groups suggesting that not only TFF patients but also a wide variety of patients with different indications may benefit from AOA.

Abbreviations: ICSI: Intracytoplasmic sperm injection; ARTs: Assisted reproductive techniques; Ca: Calcium; AOA: Artificial oocyte activation; TFF: Total fertilization failures; OAT: Oligoasthenoteratozoospemia; IVF: In vitro fertilization; SOAT: Severe OAT; LON: Low ooctye number; FS: Frozen sperm; hCG: human chorionic gonadotrophin; PVP: polyvinylpyrrolidone; HSA: human serum albumin     

小檗碱治疗代谢性疾病抗炎作用的研究进展

慢性非可控性炎症在代谢性疾病如糖尿病、非酒精性脂肪性肝病（NAFLD）和动脉粥样硬化的发生和发展过程中发挥关键作用。天然产物小檗碱对代谢性疾病有良好的改善作用并对其伴随的慢性炎症有明显的抑制作用。研究显示小檗碱主要通过调控AMP依赖的蛋白激酶（AMPK）、核转录因子-κB（NF-κB）和肠道菌群来发挥抗炎活性。对小檗碱抗炎作用的深入研究将为其应用于临床治疗代谢性疾病提供进一步科学依据。     

Insulin deprivation decreases insulin degrading enzyme levels in primary cultured cortical neurons and in the cerebral cortex of rats with streptozotocin-induced diabetes

Background

Many studies have indicated a relationship between diabetes and Alzheimer’s disease (AD). However, the molecular mechanism underlying this association has not been clarified. Among several factors, insulin degrading enzyme (IDE), which plays roles in the degradation of both insulin and amyloid β (Aβ), has gained interest as a potential target in efforts to solve this puzzle. This study sought to examine the effects of varying insulin and/or glucose concentrations on IDE expression.

非风湿性房颤血栓前血清脂蛋白（a）、脂质过氧化物与红细胞变形能力的检测及临床意义

目的 :探讨非风湿性房颤患者血栓前血清脂蛋白 (a) [L P(a) ]、脂质过氧化物 (L PO)及红细胞变形能力(RCD- IF)的变化对房颤血栓形成的影响及临床意义。方法 :分别对 36例非风湿性慢性房颤患者、4 0例器质性心脏病窦性心律患者及 4 0例健康对照组其 L P(a)、L PO、RCD- IF三项指标进行测定。结果 :非风湿性慢性房颤患者 L P(a)、L PO的升高及 RCD- IF的降低与窦性心律组 (P<0 .0 5 )及对照组 (P<0 .0 1)均存在显著性差异 ;窦性心律组的三项指标与对照组比较其差异亦具显著性 (P<0 .0 5 )。房颤组、窦性心律组两组的 L PO与 RCD- IF均存在相关关系 ;而两组的 L P(a)与 L PO、RCD- IF间无相关关系。结论 :降低 L P(a)、L PO水平及提高 RCD- IF有利于防治房颤患者心房血栓的形成。     

通心络胶囊联合前列地尔、尼可地尔对急性冠脉综合征患者行PCI 术后心肌损伤和血脂水平的影响

目的:观察通心络胶囊联合前列地尔、尼可地尔对急性冠脉综合征(ACS)患者行经皮冠脉介入术(PCI)后心肌损伤和血脂水平的影响。方法:选择120例ACS患者,随机分为对照组与研究组各60例。2组均给予常规治疗,对照组在常规治疗基础上给予前列地尔、尼可地尔治疗,研究组在对照组基础上给予通心络胶囊治疗。比较2组临床疗效、心肌损伤标志物及血脂水平变化情况。结果:与同组治疗前比较,PCI术后24 h 2组心肌肌钙蛋白I (cTnI)、肌酸激酶同工酶(CK-MB)水平均升高(P0.05);与对照组PCI术后24 h比较,研究组PCI术后24 h cTnI、CK-MB水平均较低(P0.05)。与同组治疗前比较,治疗后2组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)水平均下降(P0.05),高密度脂蛋白胆固醇(HDL-C)水平均升高(P0.05);与对照组治疗后比较,研究组治疗后TC、LDL-C、TG水平均较低(P0.05),HDL-C水平较高(P0.05)。研究组心血管总不良事件发生率为6.67%,明显低于对照组的23.33%(P0.05)。结论:通心络胶囊联合前列地尔、尼可地尔治疗ACS行PCI术患者的疗效显著,不仅能有效调节血脂代谢,减轻心肌损伤程度,且有利于减少心血管不良事件发生风险。     

Mid-term results of open debridement and reattachment surgery for insertional Achilles tendinopathy: A retrospective clinical study

ObjectiveThe aim of this study was to determine the effects of age and body mass index (BMI) on the functional outcomes, satisfaction rates, and recovery time after open debridement and reattachment surgery in non-athletic patients with insertional Achilles tendinopathy (IAT).MethodsIn this retrospective study, 33 non-athletic patients (34 ankles) in whom open debridement and reattachment surgery was performed for IAT from 2006 to 2016 were included. Change in pain intensity was assessed using a Visual Analogue Scale (VAS) preoperatively and at the final follow-up. Functional assessment was done by preoperative and postoperative American Orthopaedics Foot and Ankle Score (AOFAS) and final follow-up Victorian Institute of Sport Tendon Study Group-Achilles Tendinopathy score (VISA-A). Patient satisfaction was evaluated by Roles & Maudsley score (RMS). The recovery time was defined as the time interval from the first appearance to postoperative relief of symptoms and recording. In addition, the recurrent Haglund’s deformity was determined by postoperative control radiographs.ResultsThe mean age at the time of the operation was 51.19 years. The mean follow-up was 61.75±8.49 months. According to BMI, 5 patients were determined as morbid obese, 19 as obese, 3 as overweight, and 6 as normal. The mean VAS score significantly decreased from 8.5 preoperatively to 1.3 postoperatively (p<0.001). The mean AOFAS score significantly improved from 55.8 preoperatively to 92 postoperatively (p<0.001). Postoperative VISA-A score was 86% (range=32%–100%). According to RMS, 22 patients reported the result as excellent, 8 as good, 2 as fair, and 1 as poor. The mean recovery time was 11.8 (range=2–60) months, but one patient did not reach a symptom free status and thus was not included in the recovery time analysis. Postoperative control radiographs revealed signs of recurrence deformity in four patients. Recovery time showed a negative correlation with the age of the patients (r=−0.65). Postoperative scores and BMI showed no significant correlations with the recovery time on the basis of Spearman’s rho test (p=0.196).ConclusionThe results of this study have shown that open debridement and reattachment surgery may be an effective surgical method in relieving pain and improving functional status with high satisfaction rate and acceptable recovery time in the management of non-athletic patients with IAT.Level of EvidenceLevel IV, Therapeutic study