大鼠肝缺血预处理对肝缺血再灌注所致肝外脏器损伤的保护作用

目的　探讨大鼠肝缺血预处理 (IP )对缺血再灌注 (I/R )致肝外主要脏器损伤的保护作用。方法　 72只SD大鼠随机分为IP ,I/R组及S(假手术 )组 ,每组 2 4只。建立IP及I/R模型后观察术后 2 ,2 4h及 1周时小肠、胰腺、心肌、肾、肺、脑及骨骼肌组织病理学改变。结论　 (1)小肠组织损伤程度 :在 2h及 2 4h时IP组及I/R组显著高S组 (P <0 .0 1) ,且I/R组显著高于IP组 (P <0 .0 1)。 (2 )肾脏组织损伤程度 :I/R组在 2 ,2 4h及 1周时均显著高于S组 (P <0 .0 5 ,P <0 .0 1,P <0 .0 5 ) ,IP组 2 4h及 1周时显著低于I/R组 (P <0 .0 1,P <0 .0 5 )。 (3 )IP组胰腺和肺组织损伤虽较I/R组有所以改善 ,但无统计学差异 (P >0 .0 5 ) ,但IP组及I/R组均显著高于S组。 3组的脑、心肌及骨骼肌组织未见明显损伤。结果　大鼠肝脏缺血预处理能有效减轻肝缺血再灌注对小肠及肾脏的损伤。     

Prolonged curarisation following renal transplantation

A retrospective study of postoperative respiratory morbidity in 247 patients requiring renal transplantation between 1955 and 1973 showed that 7 patients required postoperative controlled ventilation for up to 6 days. The nondepolarising relaxants tubocurarine and pancuronium were used in only 65 patients, but all 7 cases of respiratory failure occurred in this group. This suggests that the use of these drugsin anephric patients is potentially hazardous so far as postoperative respiratory insufficiency is concerned.     

气腹与肾脏损伤

动物及临床实验均显示气腹可使肾脏血流量减少 ,气腹压力越高 ,这种变化越大 ,由此可引起肾小球滤过率下降、尿量减少、血清血肌苷和尿素氮水平升高等表现。这与气腹导致的肾脏血液流变学改变 ,以及神经内分泌因子、体位变化和气体种类等有关 ,同时缺血再灌注损伤可能是一个不容忽视的因素。提示气腹可导致肾脏功能的改变 ,这种影响是由多重机制参与的并在一定压力范围和持续时间内是可逆的。过高的气腹压或对于肾功能不全的肾脏可能造成更为明显的损害。     

痛风康对急性痛风性关节炎病理改变的影响

【目的】探讨有补肾活血、清热祛湿作用的中药制剂痛风康(由鹿角霜、川续断、牛膝、赤芍、毛冬青、威灵仙等组成)治疗急性痛风性关节炎的作用机理。【方法】以尿酸钠造成急性痛风性关节炎大鼠模型,观察痛风康对关节滑膜组织炎症病理变化的影响,同时设立正常组、模型组和西药别嘌呤醇组为对照。【结果】痛风康能显著缩小关节周径,改善痛行为步态;同时能减轻炎性细胞浸润,抑制纤维组织增生;且高剂量中药组优于西药组(P<0.05或P<0.01)。【结论】痛风康对急性痛风性关节炎有明显的抗炎镇痛、抗肿胀的作用。     

调肝健脾补肾方药对反复心理应激大鼠的中枢调整作用

【目的】观察调肝、健脾、补肾方药及人参总皂甙对反复心理应激大鼠中枢的调整作用。【方法】大鼠随机分为6组:正常组、模型组、调肝组、健脾组、补肾组和人参总皂甙组。采用免疫组织化学法检测下丘脑酪氨酸羟化酶(TH)阳性细胞;采用OPA高效液相色谱分析法检测下丘脑、海马酪氨酸(Tyr)含量。【结果】模型组大鼠下丘脑弓状核和下丘脑腹内侧核TH阳性细胞明显增多(P<0.01);补肾组两核TH阳性细胞数量无明显变化;调肝组、健脾组和人参总皂甙组两核TH阳性细胞数量明显增加(P<0.01)。模型组下丘脑与海马Tyr无明显变化;调肝组、健脾组与人参总皂甙组下丘脑Tyr含量明显下降(P<0.01);补肾组与健脾组海马Tyr含量明显升高(P<0.01)。【结论】调肝、健脾方药以及人参总皂甙能增强应激大鼠中枢TH功能,进而增强机体应对应激的能力;而调肝、健脾、补肾方药及人参总皂甙对于调节反复心理应激反应具有共同的中枢机制。     

Incidence of Fractures Before and After Dialysis Initiation

Fractures are common in dialysis patients, but little is known about the trajectory of incidence rates of different types of fractures before and after dialysis initiation. To address this, we investigated the incidence of major fractures before and after dialysis initiation. We performed a retrospective statistical analysis using the Swedish Renal Registry of 9041 incident dialysis patients (median age 67 years, 67% men) starting dialysis 2005 through 2015 to identify major fractures (hip, spine, humerus, and forearm) occurring during the dialysis transition period from 1 year before until 1 year after dialysis initiation. Using flexible parametric hazard models and the Fine-Gray model, we estimated adjusted fracture incidence rates and predictors of major fractures. We identified 361 cases with primary diagnosis of major fracture, of which 196 (54%) were hip fractures. The crude incidence rate of major fractures before dialysis initiation was 17 per 1000 patient-years (n = 157) and after dialysis initiation it was 24 per 1000 patient-years (n = 204). The adjusted incidence rate of major fractures began to increase 6 months before dialysis initiation, and then stabilized at a higher rate after 1 year. The adjusted incidence rate of hip fractures started to increase sharply 3 months before dialysis initiation, peaked at initiation, and declined thereafter. In contrast, the adjusted incidence rate of non-hip fractures was stable during the transition period and gradually increased over time. Higher age, female sex, and history of previous major fractures were associated with increased fracture incidence both before and after dialysis initiation. We conclude that the incidence of major fractures, especially hip fractures, start to rise 6 months before initiation of dialysis therapy, indicating that heightened surveillance with implementation of preventive measures to avoid fractures is warranted during the transition period to dialysis. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Effects of denosumab on fracture and bone mineral density by level of kidney function

The incidences of osteoporosis and chronic kidney disease (CKD) both increase with increasing age, yet there is a paucity of data on treatments for osteoporosis in the setting of impaired kidney function. We examined the efficacy and safety of denosumab (DMAb) among subjects participating in the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) Study. We estimated creatinine clearance (eGFR) using Cockcroft‐Gault and classified levels of kidney function using the modified National Kidney Foundation classification of CKD. We examined incident fracture rates; changes in bone mineral density (BMD), serum calcium, and creatinine; and the incidence of adverse events after 36 months of follow‐up in subjects receiving DMAb or placebo, stratified by level of kidney function. We used a subgroup interaction term to determine if there were differences in treatment effect by eGFR. Most (93%) women were white, and the mean age was 72.3 ± 5.2 years; 73 women had an eGFR of 15 to 29 mL/min; 2817, between 30 to 59 mL/min; 4069, between 60 to 89 mL/min, and 842 had an eGFR of 90 mL/min or greater. None had stage 5 CKD. Fracture risk reduction and changes in BMD at all sites were in favor of DMAb. The test for treatment by subgroup interaction was not statistically significant, indicating that treatment efficacy did not differ by kidney function. Changes in creatinine and calcium and the incidence of adverse events were similar between groups and did not differ by level of kidney function. It is concluded that DMAb is effective at reducing fracture risk and is not associated with an increase in adverse events among patients with impaired kidney function. © 2011 American Society for Bone and Mineral Research     

中药癌复康对乳腺癌术后化疗患者生存质量的影响

[目的]探讨具有益气健脾、补肾固本、抗癌解毒功效的中药癌复康(主要由黄芪、茯苓、白术、太子参、淮山、肉苁蓉、山茱萸、女贞子、制首乌、莪术、半枝莲、薏苡仁等组成)对乳腺癌术后化疗患者生存质量(QOL)的影响。[方法]将120例乳腺癌术后化疗患者随机分为癌复康组(治疗组)61例和未服癌复康组(对照组)59例,引入乳腺癌生存质量专用量表EuroQLQ-BR23,就生存质量进行比较观察。[结果]治疗组的生理分、认知分、情感分、社会机能分、乳腺癌相关症状及生存质量总计分等上升的幅度均大于对照组(P<0.01),治疗组各症状改善的程度也均较对照组高(P<0.01)。[结论]癌复康能改善乳腺癌术后化疗患者症状,提高患者的生存质量。     

穴位注射治疗肾病血尿39例疗效观察和机制探讨

采用中药穴位注射治疗肾病血尿３９例，基本痊愈１６例、好转１６例、无效７例，总有效率８２．０４％。动物实验表明，中药穴位注射具有抗氧自由基、降低血粘度及改善肾组织损伤作用。本治法未见明显副作用，是临床治疗肾病血尿有效方法之一。     

Associations of FGF23 With Change in Bone Mineral Density and Fracture Risk in Older Individuals

Elevated levels of the phosphate‐regulating hormone fibroblast growth factor 23 (FGF23) have been linked to greater risk of fractures in some studies, especially among individuals with chronic kidney disease (CKD). We evaluated FGF23 as a risk factor for bone loss and fractures in the Health, Aging, and Body Composition (Health ABC) study, which is a prospective biracial cohort of well‐functioning adults aged 70 to 79 years recruited at two clinical centers in the United States. The sample for the bone mineral density (BMD) analyses consisted of 2234 participants who had at least two serial total hip areal BMD measures. The fracture analyses included 2786 participants, 567 of whom sustained a fracture during a median follow up of 4.95 years. Linear mixed‐effects models were used for longitudinal measurements of total hip areal BMD and the proportional subdistribution hazard regression model subject to competing risks of death was used for risk of fracture. The median FGF23 was 46.7 (interquartile range [IQR] 36.7 to 60.2) pg/mL. The mean annualized percent change in total hip areal BMD did not vary significantly according to FGF23 quartile in all participants (p for trend = 0.70), but the effect was modified by CKD status (adjusted p for interaction <0.001). Among participants with CKD, the unadjusted mean annualized percent change in total hip areal BMD was greater with higher levels of FGF23 (unadjusted p for trend = 0.02), but the trend was attenuated with adjustment for estimated glomerular filtration rate and parathyroid hormone (adjusted p for trend = 0.30). FGF23 was not significantly associated with fracture risk in crude (hazard ratio [HR] per doubling of FGF23, 0.97; 95% CI, 0.85 to 1.12) or adjusted models (HR per doubling of FGF23, 1.02; 95% CI, 0.86 to 1.22), and these findings were not modified by gender or CKD status. FGF23 levels are not associated with bone loss or fracture risk in older adults with low prevalence of CKD. © 2015 American Society for Bone and Mineral Research.