支气管动脉灌注化疗治疗晚期原发性肺癌近期疗效影响因素分析

目的探讨经支气管动脉灌注化疗(BAI)治疗晚期肺癌近期疗效的影响因素。方法回顾性分析1990年3月至2006年6月间胸部X线片复查资料相对完整的82例经BAI治疗的原发性晚期肺癌的近期疗效。结果完全有效(CR)10例(12.2%)、部分有效(PR)32例(39.0%)、轻微有效(MR)23例(28.0%)、稳定(SD)15例(18.3%)、进展(PD)2例(2.4%)。单因素方差分析结果显示,半月时肿瘤缩小率(TDR1/2month)(χ2=25.92,P<0.01)、BAI次数(TBAI)(χ2=17.70,P<0.01)、肿瘤大小(Tsize)(χ2=14.21,P<0.01)和肿瘤血供丰富程度(χ2=6.59,P<0.01)对近期疗效的影响具有统计学意义。对年龄、病理类型等12项协变量进行二项分类Logistic回归分析,采用向后删除法经10步二次迭代,得到Logistic回归方程:P(1)=1/[1 e-(-8.953 2.656TDR1/2month 1.382TBAI 1.230Tsize)],方程对BAI近期疗效有效与无效的预测正确率分别为85.7%和70.0%。结论第1次BAI后半月时的肿瘤缩小率、BAI治疗次数和肿瘤的大小是影响BAI近期疗效的因素。     

METABOLIC AND CNS CORRELATES OF COGNITIVE DYSFUNCTION WITH RENAL FAILURE

Experimental uremia in primates has been demonstrated to produce severe decrements in psychological functions which are related to the accumulation of toxic metabolites in blood. More recent neurophysiological research has referred uremic encephalopathy to disrupted sodium-potassium exchange in uremic brain. The present clinical investigations have found decrements in cognitive functioning with repeated testing in patients maintained on intermittent hemodialysis, which were correlated with plasma concentrations of potassium and creatinine. Power Spectral Density analyses of EEG indicated a shift to lower frequencies in these patients as compared to control subjects. No significant departure from normal functioning has been determined in patients receiving renal transplant tested within 60 days post-surgically.     

Klassifikation der Nierenzellkarzinome/Tumoren und ihre Beziehung zum Nephron-Sammelrohrsystem

Summary After a controversial phase of nomenclature (including — among others — the terms hypernephroma and hypernephroid carcinoma) a cytomorphologically defined subtyping of renal cell tumours (adenomas, carcinomas, oncocytomas) is offered, based on new electron microscopical and histochemical observations. These data are in part supported by cytogenetical findings reported in the literature. Phenotypical/histogenetical relations to different parts or cell types, respectively, of the nephron-collecting duct system could be demonstrated. Chromophobe cell carcinoma and oncocytoma exhibit features of the intercalated cells.

Herrn Prof. Dr. Dr. h.c. Adalbert Bohle gewidmet     

Antigenemia,immunoblotting, and enzyme immunoassay for early diagnosis of cytomegalovirus infection in renal transplant patients

Timely and rapid diagnosis of cytomegalovirus (CMV) infection is important for the management of transplant patients. We compared three serological assays, IgM immunoblot and IgG/IgM enzyme immunoassay (EIA), as well as the detection of CMV antigens in polymorphonuclear blood leukocytes (antigenemia), for their value in the early diagnosis of CMV infection. Thirty-one patients were monitored longitudinally for 3 months after renal transplantation. Laboratory documented CMV infection occurred in 20 patients. All of these cases showed a positive IgM immunoblot result that was confirmed by at least one of the other test assays (IgG EIA 19/20, antigenemia assay 13/20, and IgM EIA 12/20). All of the ten patients whose clinical picture was compatible with symptomatic CMV disease were positive for CMV infection according to IgM immunoblot and IgG EIA, nine were positive according to the antigenemia assay, and seven were positive according to IgM EIA. With reference to the temporal pattern, the antigenemia assay indicated CMV infection significantly earlier than the serological tests (P0.05). In symptomatic patients CMV antigen-positive leukocytes were, on the average, detected on the day of onset of symptoms, whereas detection by IgM immunoblot, IgG EIA, and IgM EIA followed 8, 13, and 14 days later, respectively. These results show that: (1) the CMV antigenemia assay is very useful for the early diagnosis of symptomatic CMV infections; (2) CMV antibodies, as an indicator of CMV infection, are detectable earlier and more frequently by IgM immunoblot than by IgG/IgM EIA; (3) compared to CMV anti-genemia, the IgM immunoblot indicated CMV infection more often but significantly later; and (4) only a combination of several diagnostic methods allows optimal detection of CMV infections in renal transplant patients.     

Urinaryα 1 as an index of proximal tubular function in early infancy

Urinary ₁-microglobulin (U-A₁M) was measured in healthy term infants on days 1, 4, 7, 14, 28, 90 and 180 of life. U-A₁M was high until day 14 and declined thereafter. It was significantly correlated with urinary ₂-microglobulin (U-B₂M) throughout the study, but not with serum A₁M on days 1 or 7. Similar to U-B₂M, U-A₁M in the clinically stable term infants with intrauterine growth retardation (n=4–7) was not elevated on days 1–7. In the sick infants who needed immediate resuscitatio at birth (n=4–8), U-A₁M as well as U-B₂M was high on days 1–7 and then decreased to normal levels, suggesting that U-A₁M can be used as a sensitive marker of acute proximal tubular damage and its recovery. These observations indicate that U-A₁M is a useful index of proximal tubular function in early infancy.     

The renal nerves in the newborn rat

Immunocytochemical methods were used to investigate the distribution of afferent [calcitonin gene-related peptide-(CGRP) immunoreactive and substance P-immunoreactive] nerves and efferent (neuropeptide Y-immunoreactive and dopamine -hydroxylase-immunoreactive) nerves in the kidneys of rats within the 1st day of life. The newborn rat kidney possesses an afferent and efferent innervation. Both afferent and efferent nerves reach the kidney in the same bundles. The afferent sensory fibers predominate overwhelmingly in the renal pelvis and ureter while the efferent fibers clearly predominate in the vasculature. The corticomedullary connective tissue contains both types of innervation with a more prominent afferent innervation (CGRP immunoreactive). Only afferent arterioles of perihilar nephrons were innervated by efferent sympathetic fibers. The distribution and extent of afferent and efferent innervation is consistent with the renal nerves playing a significant role in the transition from fetal to newborn life. The close proximity between afferent and efferent fibers suggests a possible interaction between the two systems.     

Renal functional reserve in children with reduced renal mass: study by two dietary periods

It has been suggested that the renal functional reserve (RFR) defined by the rise in glomerular filtration rate (GFR) after a protein load could disappear in patients with severe nephron loss but with a normal GFR. This study compared, in 17 children, inulin clearance (C _in) measured by the plasma inulin plateau at the end of two 14-day randomized periods differing in protein intake: 100% (low protein, LP), or 200% (high protein, HP) of recommended dictary allowances (RDA). Diets were aimed at maintaining food habits and energy intake. Compliance was assessed by records of the last 3–4 days, an interview with the dietician and by urinary nitrogen measurements. Mean actual protein intake was 109% (56%–139%) RDA for the LP period and 220% (163%–319%) RDA for the HP period.C _in did not change in 14 children with GFR below (n=7) or within (n=7) the normal range.C _in was higher in the HP period than in the LP period (+32, 50, 63%) in 3 children who had a 50% (single kidneys) or a 25% (sclerosed glomeruli) nephron loss. Non-responding children had a GFR below 105 ml/min per 1.73 m². Nephron loss (70% sclerosed glomeruli) was estimated in only 1 child with no RFR. The results suggest that GFR measurement after prolonged dietary stimulation could help in evaluating the severity of nephron loss in children with normal or borderline GFR. The prognostic value of this test has to be confirmed by long-term follow-up.     

MN9202保护血栓大鼠尾动脉血管作用

观察新二氢吡啶类钙拮抗剂２,６－二甲基－４－（３－硝基苯基）－１,４－二氢－３,５－吡啶二羧酸－３－甲酯－５－正戊酯（ＭＮ９２０２）对血栓形成大鼠尾动脉血管平滑肌及内皮功能的影响。方法大鼠脚趾ｓｃ注射角叉来胶制备血栓模型,并于注射角叉菜胶前２４ｈ,１ｈ及注射后２４ｈｉｐＭＮ９２０２１μＭＯＬ．ＫＧ＾－１,取尾动脉血栓波及不同区域的三段血管,以去甲肾上腺素（ＮＥ）,乙酰胆碱（ＡＣｈ）,亚硝酸钠（Ｎａ     

Cationic amino acid fluxes beyond the proximal convoluted tubule of rat kidney

To investigate the fluxes of cationic amino acids beyond the proximal convolution, we micropunctured and microperfused superficial tubules of male Wistar rats in vivo et situ. In free-flow micropuncture experiments, the concentrations of endogenous L-arginine⁺, [Arg], and of intravenously infused L-homoarginine⁺, [HoArg], were determined by HPLC. Fluorescein isothiocyanatelabeled inulin was detected on-line in the same tubular fluid samples. To determine undirectional fluxes, radiolabeled Arg and inulin were (1) microperfused through short loops of Henle and (2) microinfused into different tubule segments to measure urinary recovery of the radiolabel. At a mean [Arg]_plasma of 116 mol/l, [Arg] was 9.3 mol/l in the late proximal tubule (LPT), and 35.6 mol/l in the early distal tubule (EDT) corresponding to fractional deliveries (FD) of 0.055 in LPT and 0.078 in EDT. Fractional urinary excretion (FE) of Arg was 0.00033 (P<0.05 vs FD_EDT). Infusion of HoArg (2.5 or 7.5 mol/min) led to respective mean [HoArg]_plasma values of 1.44 and 3.73 mmol/l, and resulted in respective FD_LPT values for HoArg of 0.23 and 0.53, respective FD_EDT values of 0.29 and 0.41, and finally, respective FE values for HoArg of 0.25 and 0.58. When short loops of Henle were microperfused with 1 or 50 mmol/l [¹⁴C]Arg (+[³H]inulin), fractional recovery (FR) of ¹⁴C (relative to inulin) in the EDT was 0.13 and 0.36, respectively. During microinfusion of radiolabeled Arg (1 or 50 mmol/l) and inulin into LPT, the urinary FR of the radiolabel was 0.14, or 0.59, respectively. If 0.007, 1 or 50 mmol/l radiolabeled Arg were microinfused into EDT, the respective urinary FR of the radioactivity was 1.02, 1.10, or 1.01. Microperfusion of microinfusion of 1 mmol/l [¹⁴C]Arg plus 50 mmol/l HoArg resulted in a FR_EDT of ¹⁴C of 0.43 (loop, perfusion) and an FE for ¹⁴C of 0.69. Five conclusions can be drawn. First, cationic amino acids can enter and leave the lumen of short loops of Henle through specific carrier(s) at high rates, although, secondly, net transport is small or absent. Thus, medullary tubule cells can be supplied with Arg from the lumen of short loops of Henle for urea and nitric oxide production. Thirdly, the distal convolution of superficial nephrons and the collecting duct are not permeable to Arg. Thus, fourthly, the difference between FD_EDT and urinary FE of Arg must be explained by an inter-nephron heterogeneity between deep and superficial nephrons. Finally, the process responsible for the different Arg handling in deep nephrons is not accessible to HoArg or, if so, it is saturated at millimolar concentrations.     

肾性骨病的骨膜下骨吸收

笔者采用手骨直接Ｘ线放大摄影和双手Ｘ线平片来研究慢性肾衰血透病人５１例。特征性的指骨骨膜下吸收放大摄影发现２５例占４９％;平片为１１例占２１．６％,结果表明,放大摄影的阳性率明显高于平片（Ｐ＜０．００５）,骨膜下吸收的二,三指中间指骨桡侧及指骨末端是肾性骨病的“靶区”,认为二者无显著差异（Ｐ＞０．５０）。骨膜下吸收还与血透时间,血磷,血钙和碱性磷酸酶水平相关。