Growth hormone and insulin-like growth factor-I and mesangial matrix in uremic rats

Combined growth hormone (GH) and insulin-like growth factor-I (IGF-I) therapy has been advocated for clinical use to minimize the diabetogenic effect of GH and enhance their anabolic effects. However, GH has been shown to accelerate the development of glomerular sclerosis in experimental animals and IGF-I mediates the renal effects of GH. The purpose of this study was therefore to examine morphometrically the effects of GH (1 mg intraperitoneally three times a week), IGF-I (50 g/kg body weight subcutaneously twice a day), and combined GH/IGF-I treatments in vivo on mesangial matrix at 3–20 days after 5/6 nephrectomy in 140- to 150-g rats. There were no significant changes in growth and renal function after GH and/or IGF-I treatment. The effects of GH and IGF-I on glomerular size were additive, which were more prominent in juxtamedullary glomeruli. GH induced proportional increases in mesangial area (MA) and glomerular area (GA), whereas IGF-I induced a similar increase in GA without a corresponding change in MA. When compared with GH treatment alone, combined GH/IGF-I treatment resulted in a lesser degree of mesangial expansion despite an enhanced glomerular size. While additional studies are needed to examine the long-term effects of these findings, our results suggest a potentially beneficial effect of combined GH/IGF-I therapy during uremia.     

Renal transplantation in infants, a therapeutic option?

Renal transplantation is widely accepted as the treatment of choice for endstage renal failure in childhood. Since dialysis is regularly applied to infants with renal failure, the question logically arises, can infants also receive renal transplants and what are the outcomes? A review of the literature and the clinical experience at the University of Minnesota supports the performance of renal transplantation in infancy. Present patient and graft survival rates for infants are indistinguishable from those of older children. While living adult donors are preferred, adult cadaveric kidneys have also been successfully transplanted. Following successful transplantation, the infants have generally enjoyed catch-up growth and accelerated psychomotor development. While there may be problems related to fluid and electrolyte balance in these smallest patients, the majority of the problems encountered mirror those seen in any child undergoing transplantation. Renal transplantation is regularly successful in infancy and should be considered an integral component of the therapy for any child with chronic renal failure.     

Is Vecuronium Toxicity Abolished by Hemodialysis? A Case Report

Vecuronium is a curaric agent, largely used in anesthesia. Indications as to its employ in uremic patients appear to be debated because of partial renal elimination of the drug. A 52-year-old hemodialyzed woman required transplantectomy for rejection. At awakeness after general anesthesia (induced with fentanyl, propofol, and 6 mg of vecuronium, repeated with a single 2 mg dose 30 min later), she presented diafragmatic and muscular limb weakeness that lasted 180 min in spite of prostigmine administration. A 2 h 30 min predilutional hemofiltration was then performed, which induced rapid disappearance of neuromuscular blockade. Even if vecuronium can be used in dialysis patients, one should remember its possible side effects, especially with repeated doses, in determining prolonged neuromuscular blockade. Cautious use of this drug in renal failure is mandatory. Low dosage must be employed and repeated administration avoided. Neuromuscular blockade seems to be rapidly reversible with dialytic treatment.     

Vitamin D Deficiency and Susceptibility to Tuberculosis

Vitamin D, a modulator of macrophage function, can activate human anti-mycobacterial activity. Vitamin D deficiency is therefore associated with a higher risk of tuberculosis (TB) infection, as indicated by several observations. First, TB tends to occur during the colder seasons when cutaneous synthesis of vitamin D from sun exposure is reduced and serum vitamin D levels are lower. Second, patients with untreated TB, particularly those from a temperate climate, have lower serum vitamin D levels than healthy subjects. Third, the incidence of TB is higher among subjects with relatively low serum vitamin D levels, such as the elderly, uremic patients, and Asian immigrants in the U.K. Received: 21 July 1999 / Accepted: 10 January 2000     

一例Ⅱ期低分化结肠腺癌合并尿毒症患者的围手术期护理

T3NOM0期结肠低分化腺癌是胃肠道肿瘤中常见的恶性肿瘤，但通过手术，可以协除肿块，缓解临床症状，延长生存期。尿毒症则是肾功能衰竭的晚期表现，必须通过血液透析来排出机体内代谢产生的毒素和多余的水分，患者各器官功能均受到疾病影响，机体功能下降。临床上结肠低分化腺癌合并尿毒症患者较少，但此类患者机体状况更差，     

尿毒症血清诱导人脐动脉平滑肌细胞成骨样转化和钙化的研究

目的 研究尿毒症血清对原代培养人脐动脉平滑肌细胞（HUASMC）成骨样转化和细胞外基质钙沉积的影响。 方法 收集40例健康人、40例非透析尿毒症患者和45例透析尿毒症患者血清，检测有关生化指标。组织植块法原代培养HUASMC，分别给予健康人血清（对照组）、透析（透析组）和非透析（非透析组）尿毒症血清孵育。茜素红S钙沉积染色及甲氧-酚酞络合酮法检测细胞层钙盐含量。实时定量PCR、荧光定量法及Western 印迹分别检测骨特异性碱性磷酸酶（BAP）、骨桥蛋白（OPN）和骨形成蛋白2（BMP２）基因以及蛋白表达。 结果 血清生化检测结果显示尿毒症血清较健康对照存在高磷、高脂、高全段甲状旁腺激素（iPTH）、高C反应蛋白（CRP）、白细胞介素6（IL-6）和低胎球蛋白A（P < 0.05），而透析组血清的三酰甘油、CRP、IL-6较非透析组血清高（P < 0.05）。与健康对照组相比，透析组和非透析组尿毒症血清均使HUASMC钙盐沉积更显著，BAP、OPN以及BMP2的表达上调（P < 0.05），且透析组血清作用更明显。 结论 尿毒症血清体外能够诱导HUASMC成骨样转化和钙化，提示可能和尿毒症相关的血管钙化有关。透析并发的微炎性反应状态可能加速了这一过程。     

Red Eye Syndrome: Clinical and Experimental Experience in a New Aspect of Diffuse Eosinophilic Infiltration?

Twenty-two of 24 hemodialysis patients dialyzed simultaneously with a new batch of cellulose acetate dialyzers promptly developed a spectrum of symptoms and physical signs including red eyes, hearing loss, tinnitus, and bone pain, previously described as red eye syndrome. We subsequently injected 4 rabbits with an eluate from a dialyzer of the same or a control batch. Six hours following exposure, the animals developed, in addition to red eyes, diffuse eosinophilic infiltration of various organs as well as myopathic changes and moderate brain edema. On the basis of these data, we suggest that it cannot be concluded whether the underlying pathophysiological mechanisms were toxic, allergic or both and that the occurrence of relevant symptomatology in 2 or more simultaneously dialyzed patients is a strong argument against unnecessary diagnostic or therapeutic procedures. Finally, a second exposure in a given patient should be avoided.     

血红素氧合酶1对尿毒症环境脐静脉内皮细胞单核细胞趋化蛋白1表达的影响

目的 体外观察尿毒症患者血清对人脐静脉内皮细胞（HUVEC）合成单核细胞趋化蛋白1(MCP-1)的影响，探讨诱导血红素氧合酶1（HO-1）高表达对调节MCP-1合成的作用。 方法 以含10％尿毒症血清的M199培养基体外培养HUVEC细胞株。采用RT-PCR法检测HUVEC MCP-1 mRNA的表达。用ELISA法检测HUVEC MCP-1蛋白的分泌。然后分别以HO-1诱导剂氯化血红素（hemin）及阻断剂原卟啉锌(ZnPP)预处理HUVEC，应用RT-PCR法和免疫组织化学法检测细胞内HO-1及MCP-1 mRNA及蛋白的表达。 结果 尿毒症血清可上调细胞MCP-1 mRNA的表达，促进MCP-1蛋白合成，MCP-1蛋白量为对照组的2.95倍。hemin诱导的HO-1高表达可下调尿毒症血清引起的MCP-1基因表达，抑制MCP-1蛋白合成，ZnPP可阻断其作用。30 μmol/L hemin可使HUVEC合成MCP-1蛋白减少34.4％，而hemin与ZnPP共同作用组的MCP-1蛋白量恢复至尿毒症血清组的98.0％。 结论 尿毒症血清可诱导HUVEC 的MCP-1高表达。促进HO-1高表达时可抑制MCP-1合成及分泌。HO-1有减轻尿毒症环境对内皮细胞功能损伤的作用。     

尿毒症肺部感染危险因素分析

目的：探讨致尿毒症部感染的危险因素，方法：本院１９９８年９月～１９９９年１２月住院的尿毒症患１７６例，合并肺部感染４０例，与无感染４６例比较，结果：尿毒症合并肺部感染与盆血，血清白蛋降低有显差异（Ｐ〈０．０５），未血透患还与血肌酐升高有非常显差异（Ｐ〈０．０１），结论：纠正贫血、改善营养、充分透析、加强重视呼吸管理是减少尿毒症肺部感染的关键。     

大黄素、川芎嗪对中分子物质损伤人胚大脑皮层神经元影响的实验研究

目的研究大黄素、川芎嗪对中分子物质引起大脑皮层神经元损伤的保护作用。方法在人胚大脑皮层神经元培养体系中，加入不同浓度的大黄素、川芎嗪及主要中分子物质损伤组份（MMSⅢ）进行四唑嗅蓝（MTT）快速自动微显比色分析测A值及自动速率法测乳酸脱氢酶（LDH）漏出量实验。结果①10μg／ml浓度的大黄素、川芎嗪加入体外培养的人胚大脑皮层神经元后，A值与LDH漏出量均与对照组无显著性差异，此浓度对神经元无损伤作用。②10μg／ml浓度的大黄素与MMS见共同加入体外培养的人胚大脑皮层神经元，A值与LDH漏出量均与损伤对照组有显著差异，川芎嗪则无显著差异。结论大黄素对大脑皮层神经元有免受MMSⅢ损伤而具保护作用，川芎嗪则无保护作用。