肾小球疾病患者肾间质泡沫细胞的分布及其临床意义

目的：观察肾小球疾病患者肾间质泡沫细胞的分布特点,分析其与临床表现及肾组织病理改变之间的联系.方法：选取经临床病理明确诊断的Alport综合征（AS）125例,特发性膜性肾病（IMN）192例,IgA肾病（IgAN）388例,局灶节段性肾小球硬化（FSGS）137例.观察肾组织泡沫细胞的分布,并对肾间质有无泡沫细胞患者的临床和病理进行比较.结果：（1）AS、IMN、IgAN、FSGS四种疾病肾组织中均存在肾间质泡沫细胞,发生率分别为64.8%、21.4%、12.4%、36.5%,其中以AS中最为多见.（2）肾间质泡沫细胞组肾小球节段硬化的发生率及硬化比例均显著高于无泡沫细胞的对照组,AS、IgAN患者泡沫细胞组间质纤维化程度重于对照组.（3）AS、IgAN患者肾间质泡沫细胞组尿蛋白、血脂水平显著高于对照组（P＜0.01）.FSGS患者肾间质泡沫细胞组三酰甘油水平显著高于对照组,但两组间尿蛋白水平未见差异.结论：肾间质泡沫细胞在AS、IMN、IgAN、FSGS患者中均可以发现,但以AS患者最多见.肾间质泡沫细胞的形成与尿蛋白、血脂的水平有关.肾间质泡沫细胞的存在可能与肾组织慢性化病变形成有关.     

Left ventricular opacification after peripheral venous injection of a modified albumin solution.

The usefulness of a modified albumin solution was assessed in 8 dogs after peripheral venous and inferior vena cava injections. The contrast agent is a mixed solution made of glucose, albumin and glycerin, with sonicated microbubble diameter of 5.0 +/- 2.3 microns. Multiple injections (8 ml each) of this contrast agent (total 80 injections) into peripheral vein and inferior cava were performed. The blood pressure from femoral artery was measured before, during and after injections. Two-dimensional echocardiograms were recorded in a modified long axis view on videotapes for play back analysis. The pulmonary transit time and left ventricular contrast persistent time was determined for each injection. The videodensity of the region of interest (ROI) at the center of right ventricle and left ventricle was measured. The background videodensity of both ventricles was evaluated. The videodensity over the ROI of both ventricles with peak contrast enhancement was measured in all frames for 3 consecutive cardiac cycles. The peak videodensity of right and left ventricle subtracting the background videodensity of each ventricles was further calculated respectively. The injections caused no change in blood pressure or heart rate. All injections produced right ventricular contrast echo. As much as 85% of peripheral venous and 82.5% of inferior vena cava injections resulted in left ventricular contrast which was 0.68 and 0.65 as bright as that produced in the right ventricle. Pulmonary transit time and left ventricle contrast persistent time of peripheral venous injection was 4.05 +/- 0.53 and 13.67 +/- 4.28 seconds respectively. No difference of these data (3.93 +/- 0.47 and 11.65 +/- 4.66 seconds) from those produced by inferior vena cava injections were noted.(ABSTRACT TRUNCATED AT 250 WORDS)     

不同类型IgA肾病的流行病学及临床特点分析

目的:分析不同类型IgA肾病(IgAN)患者流行病学及临床表现的特点。方法:回顾性分析我院收治的759例IgAN患者。根据其临床表现、病理特点将其分为孤立性镜下血尿型、尿检异常型、反复发作肉眼血尿型、血管炎型、大量蛋白尿型、高血压型等七型。对各类型患者进行流行病学、临床表现的回顾性分析。结果:IgAN患者759例,平均起病年龄(30·0±10·0)岁,男女性别比为0·98:1。其中,孤立性镜下血尿型占2·8%,反复发作肉眼血尿型13·2%,尿检异常型42·9%,新月体型7·2%,大量蛋白尿型10·9%,高血压型18·9%。各类型IgAN患者的临床表现有显著不同:孤立性镜下血尿型以镜下血尿为唯一临床表现,临床表现较轻。尿检异常型为IgAN中最多见的一种类型,47%的患者在体检中发现,因而起病隐匿。反复发作肉眼血尿型起病年龄为24岁,与平均年龄相比差异显著(P<0·001),69%的患者在起病前有上呼吸道感染或腹泻等前驱症状。血管炎型以血尿为主要临床表现,起病时常合并有大量蛋白尿[(3·35±2·90)g/24h],肾功能不全(SCr1·23±1·05)mg/dl。大量蛋白尿型青年男性多见,起病即表现为大量蛋白尿[(5·26±3·37)g/24h],与其他各型相比有显著区别(P<0·05),常合并有高血压、肾功能不全等预后不良因素。高血压型亦以男性多见(男∶女1·87∶1),与平均男女比例相比有显著区别(P<0·001),起病年龄平均为33岁,显著高于其他各组,63.2%的患者起病即有肾功能损伤。结论:不同类型IgAN在流行病学、临床表现等方面均有显著不同,提示它们在发病机制、治疗方法上均有所区别。     

前瞻性比较普乐可复与环磷酰胺诱导治疗Ⅴ型伴Ⅳ型狼疮性肾炎的疗效

目的前瞻性比较普乐可复(FK506)与环磷酰胺(CTX)联合激素诱导治疗Ⅴ型合并Ⅳ型(Ⅴ+Ⅳ型)狼疮性肾炎LN)的临床疗效.方法经肾活检诊断为Ⅴ+Ⅳ型活动性、女性LN患者37例,平均年龄(30.0±9.8)岁,尿蛋白定量≥2.0 g/d,血清白蛋白＜3.0 g/dl,随机分为两组,分别给予口服FK506[FK506组,n=19,起始剂量0.1mg/(kg·d)]或CTX静脉冲击治疗(CTX组,n=18)(0.5～1.0g/m2 BSA,1/月×6月),同时口服泼尼松[起始剂量0.6 mg/(kg·d)],其中17例接受甲基泼尼松龙静脉冲击治疗.主要评价指标为治疗6个月完全缓解率(CR,定义为尿蛋白定量＜0.4 g/24h,尿红细胞正常范围,无管型尿及白细胞尿,血清白蛋白≥3.5 g/dl,SCr正常或上升不超过正常范围15%,无肾外狼疮活动),次要观察指标为治疗6个月部分缓解率(PR)和有效率(CR+PR).结果(1)临床疗效有31例患者完成6个月诱导期治疗,其中FK506组15例,CTX组16例;6例退出治疗,CTX组2例,FK506组4例.FK506组4例患者获得CR(26.7%),10例患者PR(66.7%),而CTX组仅1例CR(6.3%)、7例PR(43.8%).FK506组治疗有效率明显高于CTX组(93.3% vs 50%,P=0.015).两组患者治疗后SLE-DAI、血清白蛋白、补体较前有显著改善,但血尿及抗dsDNA抗体的阳性率无明显改变;FK506组平均尿蛋白较治疗前显著减少,而CTX组较治疗前无明显下降;(2)FK506剂量浓度与不良反应FK506诱导治疗剂量在0.086～0.091 mg/(kg·d),平均谷浓度水平为6.6～8.1 ng/ml.4例获得CR的患者FK506浓度在6.9～10.2 ng/ml,10例PR患者血药浓度平均为(8.1±3.3)ng/ml.在此剂量下治疗6个月,未见肾小管间质损害.FK506组不良反应的发生率(肝酶升高、上消化道不适、白细胞减少、感染、脱发、月经紊乱等)低于CTX组,尤其是月经紊乱的发生率显著低于CTX组(5.6% vs 38.9%,P=0.041);虽然血压升高、糖代谢异常等并发症高于CTX组,但两组间无统计学差异.结论FK506诱导治疗Ⅴ型合并Ⅳ型病变的LN疗效明显优于CTX治疗,不良反应小.     

Recurrent deep neck abscess and piriform sinus tract: A 15-year review on the diagnosis and management

Background

Piriform sinus tract (PST) is a rare congenital condition. A delay in diagnosis is common leading to recurrent inflammation.

Method

A retrospective review was performed on all cases of PST treated at a tertiary referral centre between May 1997 and May 2012.

Results

Eighteen patients were reviewed with a mean age of 5.4 years at presentation (ranged from 0 day to 14 years). Most patients presented as acute inflammation (88.9%) and 16 had a left sided lesion. 72.2% of the PST are identified by contrast swallow study. The diagnostic yield was significantly higher if the study was done after the initial acute inflammation settled. Ultrasonography and computer tomography are less sensitive. The median duration from presentation to diagnosis was 17.6 months (ranged 0–120 months). Ten patients (55.6%) experienced recurrent inflammation before confirming the diagnosis. Fistulectomy alone was performed in 15 patients while an additional en-bloc hemithyroidectomy was done in 2 patients.

Conclusion

PST should be suspected in children presenting with a left deep neck abscess. Contrast swallow study is very effective in making diagnosis but has to be postponed after the acute inflammation settles. The condition can be effectively treated by fistulectomy without hemithyroidectomy in majority of our cases.     

Overexpression of C-terminal fragment of glutamate receptor 6 prevents neuronal injury in kainate-induced seizure via disassembly of GluR6-PSD95-MLK3 signaling module

Our previous study showed that when glutamate receptor （GluR）6 C terminus-containing peptide conjugated with the human immunodeficiency virus Tat protein （GluR6）-9c is delivered into hippocampal neurons in a brain ischemic model, the activation of mixed lineage kinase 3 （MLK3） and c-Jun NH2-terminal kinase （JNK） is inhibited via GluR6-postsynaptic density protein 95 （PSD95）. In the present study, we investigated whether the recombinant adenovirus （Ad） carrying GluR6c could suppress the assembly of the GluR6-PSD95-MLK3 signaling module and decrease neuronal cell death induced by kainate in hippocampal CA1 subregion. A seizure model in Sprague-Dawley rats was induced by intraperitoneal injections of kainate. The effect of Ad- Glur6-9c on the phosphorylation of INK, MLK3 and mitogen-activated ldnase kinase 7 （MKK7） was observed with western immunoblots and immunohistochemistry. Our findings revealed that overexpression of GluR6c inhibited the interaction of GluR6 with PSD95 and prevented the kainate-induced activation of INK, MLK3 and MKK7. Furthermore, kainate-mediated neuronal cell death was significantly suppressed by GluR6c. Taken together, GluR6 may play a pivotal role in neuronal cell death.     

Electronic evidence of an insulator–superconductor crossover in single-layer FeSe/SrTiO3 films

In high-temperature cuprate superconductors, it is now generally agreed that superconductivity is realized by doping an antiferromagnetic Mott (charge transfer) insulator. The doping-induced insulator-to-superconductor transition has been widely observed in cuprates, which provides important information for understanding the superconductivity mechanism. In the iron-based superconductors, however, the parent compound is mostly antiferromagnetic bad metal, raising a debate on whether an appropriate starting point should go with an itinerant picture or a localized picture. No evidence of doping-induced insulator–superconductor transition (or crossover) has been reported in the iron-based compounds so far. Here, we report an electronic evidence of an insulator–superconductor crossover observed in the single-layer FeSe film grown on a SrTiO₃ substrate. By taking angle-resolved photoemission measurements on the electronic structure and energy gap, we have identified a clear evolution of an insulator to a superconductor with increasing carrier concentration. In particular, the insulator–superconductor crossover in FeSe/SrTiO₃ film exhibits similar behaviors to that observed in the cuprate superconductors. Our results suggest that the observed insulator–superconductor crossover may be associated with the two-dimensionality that enhances electron localization or correlation. The reduced dimensionality and the interfacial effect provide a new pathway in searching for new phenomena and novel superconductors with a high transition temperature.The iron-based superconductors (1–4) represent the second class of high-temperature superconductors after the discovery of the first class of high-temperature cuprate superconductors. It is now generally agreed that the superconductivity in cuprates is realized by doping a Mott (charge transfer) insulator (5). In the iron-based superconductors, however, the parent compounds mostly exhibit a poor metallic behavior with an antiferromagnetic order, thus raising a debate on whether an appropriate starting point should go with an itinerant picture or a localized picture (6–18), particularly whether the picture of doping a Mott insulator is relevant to the iron-based superconductors (1, 3, 11, 16, 17). Some theoretical calculations indicate that the iron-based superconductors may be in proximity to a Mott insulator (11, 16, 17), and attempts have also been made to unify cuprates and iron-based superconductors in theory (18). However, so far no clear experimental evidence of doping (or carrier concentration)-induced insulator–superconductor transition (or crossover) has been reported in the iron-based superconductors.The latest discovery of possible high-temperature superconductivity in the single-layer FeSe films grown on a SrTiO₃ substrate has attracted much attention both experimentally (19–27) and theoretically (28–32). The reduced dimensionality with enhanced interfacial effect makes this system distinct from its bulk counterpart. First, it has a simple crystal structure that consists of a single-layer Se-Fe-Se unit, which is an essential building block of the iron-based superconductors (19). Second, the superconducting single-layer FeSe/SrTiO₃ film possesses a distinct electronic structure that exhibits only electron pockets near the Brillouin zone corner without any Fermi crossing near the zone center (20–22). In particular, it was found that annealing in vacuum can tune the carrier concentration of the FeSe/SrTiO₃ films (21, 33), thus providing a good opportunity to investigate its carrier-dependent behaviors.In this paper, to our knowledge, we report the first observation of an insulator–superconductor crossover in the iron-based superconductors by performing systematic angle-resolved photoemission (ARPES) measurements on the single-layer FeSe/SrTiO₃ films at various carrier concentrations. At a very low carrier concentration, the spectral weight near the Fermi level is suppressed, accompanied with the opening of an insulating energy gap. When the carrier concentration increases, the spectral weight begins to fill in the insulating gap, resulting in a decrease in gap size with the formation and sharpening of the peak at the Fermi level. Eventually, when the carrier concentration increases to a critical value, the insulating gap closes and superconductivity starts to emerge. The overall evolution in the single-layer FeSe/SrTiO₃ film is quite similar to the insulator–superconductor transition observed in the cuprate superconductors (34–38). Our observations have established a clear case that an insulator–superconductor crossover takes place with increasing carrier concentration in a 2D iron-based superconductor. The similarities between the current observations and those in cuprates provide new insights in understanding the superconductivity mechanism in these systems. The observed insulator–superconductor crossover in the single-layer FeSe/SrTiO₃ film points to the significant role of the reduced dimensionality in dictating the physical properties and superconductivity.     

Precision synthesis of 3-substituted urushiol analogues and the realization of their urushiol-like performance

Urushiol is a resource-limited natural coating material with diverse applications; however, the synthesis of urushiol analogues and the realization of their urushiol-like performance remain challenging. Herein, four urushiol analogues, namely, 3-((4-alkenoylpiperazin-1-yl)methyl)catechols with the precise 3-substitution pattern on a catechol as that found in urushiol were synthesized by employing the Mannich reaction of catechol with formaldehyde and N-Boc-piperazine as the key step in a two-step route. By using optimization, the advantages of convenience in operation, cost-effectiveness, and scalability could be obtained. The electropolymerization of these analogues on copper was found to be practical due to their higher aerobic stability than urushiol, affording robust coatings with desirable hardness, adhesion strength, hydrophobicity, and thermal stability. Furthermore, the coatings exhibited effective corrosion protection on copper with initial anticorrosion efficiency up to 99.9% and comparatively higher efficiency (more than 97%) after 4 weeks of immersion in 3.5 wt% NaCl solution. The evidence from the electrochemical and infrared spectroscopic characterization data revealed that the electropolymerization process mechanically involved the free radical coupling of phenoxyl radicals to themselves and to the C C bonds in the side chain, forming a robust crosslinking coating. This work paves a way for the synthesis of high-performance urushiol analogues with potential applications as metal protection materials.

Regioselective Mannich reaction was performed on catechol, yielding 3-substituted urushiol analogues that could be electropolymerized to achieve the desirable urushiol-like performance.     

我国生物样本库建设现状与对策

生物样本库作为临床治疗和医学科学研究的基础设施,是推动临床医学学科创新与诊疗技术创新的关键。目前我国生物样本库行业处于加速发展阶段,但存在缺乏统一的标准化流程,生物样本学科尚未建成、缺乏专业的人才队伍、各个样本库之间相互独立缺乏资源共享机制、样本库的成本效益低,样本使用率低等问题。针对上述问题,应加强生物样本库标准化建设,建立生物样本学,培养高素质专业人才,整合样本资源,实现信息共享,提高样本使用率,促进可持续发展。     

Trans-Caryophyllene Suppresses Hypoxia-Induced Neuroinflammatory Responses by Inhibiting NF-κB Activation in Microglia

Microglia cells have been reported to mediate hypoxia-induced inflammation through the production of proinflammatory cytokines, including interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and IL-6. Given the fact that the activation of the type 2 cannabinoid receptor (CB2R) provides antioxidative and anti-inflammatory results, it is suspected that its selective agonist, trans-caryophyllene (TC), may have protective effects against hypoxia-induced neuroinflammatory responses. In this study, TC was found to significantly inhibit hypoxia-induced cytotoxicity as well as the release of proinflammatory cytokines, including IL-1β, TNF-α, and IL-6, through activation of BV2 microglia following hypoxic exposure (1 % O₂, 24 h). Furthermore, TC significantly inhibited hypoxia-induced generation of reactive oxygen species (ROS) in mitochondria as well as the activation of nuclear factor kappa B (NF-κB) in microglia. Importantly, TC’s effects on inhibiting the activation of NF-κB and the secretion of inflammatory cytokines can be abolished by muting the CB2R using small RNA interference. These observations indicate that TC suppresses the hypoxia-induced neuroinflammatory response through inhibition of NF-κB activation in microglia. Therefore, TC may be beneficial in preventing hypoxia-induced neuroinflammation.