盐酸丙卡特罗口服或硫酸特布他林雾化联合布地奈德雾化治疗儿童咳嗽变异性哮喘的有效性及经济性研究

目的 比较盐酸丙卡特罗口服溶液口服联合布地奈德雾化与硫酸特布他林雾化液雾化吸入联合布地奈德雾化治疗儿童咳嗽变异性哮喘患儿的有效性和经济性。方法 纳入2020年1月—2020年12月上海中医药大学附属龙华医院收治的120例咳嗽变异性哮喘患儿,按随机数字表法将其分为丙卡特罗组与特布他林组,每组各60例。丙卡特罗组予以布地奈德雾化联合盐酸丙卡特罗口服溶液口服治疗,特布他林组予以布地奈德联合硫酸特布他林雾化治疗。评估两组疗效和安全性。比较两组治疗前后1秒用力呼气容积（FEV₁）、用力肺活量（FVC）、呼气峰值流速（PEF）、嗜酸性粒细胞（EOS）、免疫球蛋白E（IgE）水平。比较两组成本-效果。结果 特布他林组总有效率（96.67%）显著高于丙卡特罗组（86.67%,P＜0.05）。两组患儿治疗后FEV₁、FVC、PEF显著高于治疗前（P＜0.05）,特布他林组患儿FEV₁、FVC、PEF显著高于丙卡特罗组（P＜0.05）。两组患儿治疗后EOS和IgE水平显著低于治疗前（P＜0.05）,特布他林组患儿EOS和IgE水平显著低于丙卡特罗组（P＜0.05）。特布他林组患儿不良反应发生率与丙卡特罗组比较差异无统计学意义（P＞0.05）。丙卡特罗组治疗经济学显著优于特布他林组（P＜0.05）。结论 与丙卡特罗口服液相比,硫酸特布他林雾化吸入治疗儿童咳嗽变异性哮喘可能具有较好效果及安全性,但丙卡特罗口服液具有更高经济价值。     

布地奈德联合猪肺磷脂注射液对重度新生儿呼吸窘迫综合征患儿肺功能的影响

目的 探讨吸入用布地奈德混悬液联合猪肺磷脂注射液对重度新生儿呼吸窘迫综合征患儿肺功能的影响。方法 选取2016年8月-2018年7月南京市大厂医院收治的重度新生儿呼吸窘迫综合征（NRDS）患儿61例为研究对象,根据随机数字表法分为两组。对照组给予猪肺磷脂注射液联合机械通气治疗,100 mg/kg气管内给药,用药时升温至37℃摇匀,用无菌注射器抽取。观察组在对照组的基础上给予吸入用布地奈德混悬液0.25 mg/kg雾化吸入。比较两组患儿的临床治疗效果、肺功能相关指标及血清铁蛋白（SF）和纤溶酶原激活物抑制剂-1（PAI-1）表达水平。结果 观察组的总有效率为93.55%,高于对照组的73.33%,组间差异有统计学意义（P<0.05）。治疗前两组患儿动脉血氧分压（pO₂）、动脉二氧化碳分压（pCO₂）、吸氧浓度（FiO₂）和氧合指数（OI）无统计学差异;治疗后pO₂和OI显著升高,pCO₂和FiO₂显著下降,同组治疗前后比较差异有统计学意义（P<0.05）;观察组pO₂和OI显著高于对照组,pCO₂显著低于对照组,组间差异有统计学意义（P<0.05）。两组治疗前SF和PAI-1表达水平无统计学差异;治疗后SF和PAI-1均显著降低,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组低于对照组,差异有统计学意义（P<0.05）。结论 吸入用布地奈德混悬液联合猪肺磷脂注射液可显著降低重度新生儿呼吸窘迫综合征患儿的SF和PAI-1表达水平,改善患儿肺功能,提高临床治疗效果。     

珠贝定喘丸联合沙美特罗替卡松治疗儿童支气管哮喘的疗效观察

目的 探讨珠贝定喘丸联合沙美特罗替卡松治疗儿童支气管哮喘的临床效果。方法 选取2016年9月-2018年9月河南科技大学第一附属医院（开元院区）收治的支气管哮喘患儿116例,随机分为对照组（58例）和治疗组（58例）。对照组吸入沙美特罗替卡松气雾剂,1揿/次,1次/d;治疗组患儿在对照组的基础上口服珠贝定喘丸,3~4岁儿童1丸/次,5~6岁2丸/次,7~8岁3丸/次,9~10岁4丸/次,11~13岁5丸/次,3次/d。两组患儿连续治疗3个月。观察两组患者临床疗效,同时比较治疗前后两组患者症状和体征消失时间,肺功能指标一秒用力呼气容积（FEV₁）、用力肺活量（FVC）和FEV₁/FVC,及血气指标血氧分压（pO₂）和二氧化碳分压（pCO₂）。结果 治疗后,对照组和治疗组临床有效率分别为84.48%和96.55%,两组比较差异具有统计学意义（P<0.05）。治疗组患儿症状、体征消失时间均明显短于对照组（P<0.05）。治疗后,两组FEV₁、FVC、FEV₁/FVC均显著升高（P<0.05）,且治疗组明显高于对照组（P<0.05）。治疗后,两组患儿pO₂明显升高（P<0.05）,而pCO₂明显降低（P<0.05）;且治疗组患儿pO₂和pCO₂明显好于对照组（P<0.05）。结论 珠贝定喘丸联合沙美特罗替卡松治疗小儿支气管哮喘可显著提升疗效,有助于改善肺功能并缩短病程时间,且安全性较高。     

止喘灵口服液联合沙丁胺醇治疗儿童喘息性支气管炎的临床研究

目的 探讨止喘灵口服液联合沙丁胺醇治疗儿童喘息性支气管炎的临床疗效。方法 选择2019年4月—20121年4月在周口市中心医院治疗的106例喘息性支气管炎患儿,根据用药的差别分为对照组和治疗组,每组各53例。对照组雾化吸入硫酸沙丁胺醇雾化吸入溶液,0.5 mL/次加入生理盐水2 mL,4次/d;治疗组在对照组基础上口服止喘灵口服液,10 mL/次,3次/d。两组均经1周治疗。观察两组患儿临床疗效,比较治疗前后两组患儿临床症状改善时间,肺功能指标第1秒用力呼气量（FEV₁）、第1秒用力呼气量预计值百分比（FEV₁%）和第1秒用力呼气量占所有呼气量的比例（FEV₁/FVC）,及炎症介质可溶性细胞间黏附分子-1（sICAM-1）、嗜酸细胞阳离子蛋白（ECP）、白细胞介素-6（IL-6）、半胱氨酰白三烯（CysLTs）和白细胞介素-17（IL-17）水平。结果 经治疗,对照组和治疗组总有效率分别为84.91%和98.11%（P<0.05）。经治疗,治疗组患儿临床症状改善时间明显早于对照组（P<0.05）。经治疗,两组患儿FEV₁、FEV₁%、FEV₁/FVC均明显升高（P<0.05）,且治疗组升高更明显（P<0.05）。经治疗,两组血清sICAM-1、ECP、IL-6、CysLTs、IL-17水平均明显下降（P<0.05）,且治疗组下降最明显（P<0.05）。结论 硫酸沙丁胺醇联合止喘灵口服液治疗儿童喘息性支气管炎不但促使患儿症状改善,而且有利于肺功能及促炎因子的改善。     

清热散结胶囊联合布地奈德治疗急性咽炎的临床研究

目的 观察清热散结胶囊联合吸入用布地奈德混悬液治疗急性咽炎的临床疗效。方法 选取2021年6月—2022年3月在天津市第五中心医院诊治的90例急性咽炎患者，将入选的患者根据随机数字表法分为对照组和治疗组，每组各45例。对照组患者雾化吸入吸入用布地奈德混悬液，2mg/次，1次/d。治疗组在对照组治疗的基础上口服清热散结胶囊，3粒/次，3次/d。两组患者均连续治疗5d。观察两组的临床疗效，比较两组临床症状缓解情况、血清炎症因子白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平。结果 治疗后，治疗组的总有效率为91.11%，对照组患者的总有效率为71.11%，组间比较差异显著（P<0.05）。治疗后，治疗组患者的咽痛/咽干症状、声音嘶哑、咳嗽消失时间均明显短于对照组（P<0.05）。治疗后，两组血清IL-6、TNF-α水平明显下降（P<0.05），且治疗组血清IL-6、TNF-α水平低于对照组（P<0.05）。结论 清热散结胶囊联合吸入用布地奈德混悬液治疗急性咽炎具有较好的疗效，可迅速缓解症状，降低炎症因子水平，安全有效。     

孟鲁司特钠联合布地奈德治疗小儿哮喘的疗效及其对肺功能和细胞免疫的影响

目的 探讨孟鲁司特钠联合布地奈德对小儿哮喘的疗效及其对细胞免疫的影响。方法 选取延安大学附属医院2017年1月-2019年1月120例哮喘患儿为研究对象,根据随机法将患儿分为对照组和观察组,每组60例。对照组患儿将吸入用布地奈德混悬液1.0 mg采用2.0 mL生理盐水溶解后以氧气为驱动力进行雾化吸入治疗,流量控制在6 L/min以内,2次/d,15 min/次。观察组患儿在对照组的基础上口服孟鲁司特钠咀嚼片,5 mg/次,1次/d。两组连续治疗2周。观察两组患者的临床疗效,同时比较两组治疗前后的、症状评分、肺功能指标及免疫功能指标水平。结果 治疗后,对照组总有效率为78.33%,显著低于观察组的93.33%（P<0.05）。治疗后,两组日间及夜间症状评分均显著降低（P<0.05）,且观察组显著低于对照组（P<0.05）。治疗后,两组第1秒用力呼气容积（FEV₁）、用力肺活量（FVC）、呼气峰流速（PEF）和FEV₁/FVC水平均明显升高（P<0.05）,且观察组各肺功能指标均显著优于对照组（P<0.05）。治疗后,两组CD3⁺、CD4⁺和CD4⁺/CD8⁺水平均显著升高（P<0.05）,且观察组CD3⁺、CD4⁺和CD4⁺/CD8⁺水平明显高于对照组（P<0.05）。结论 孟鲁司特钠联合布地奈德可有效改善患儿临床症状及肺功能,正向调节机体免疫水平,疗效确切,在小儿哮喘治疗中具有较高的应用价值。     

痰热清胶囊联合乌美溴铵维兰特罗治疗慢性阻塞性肺疾病稳定期急性发作的临床研究

目的 探讨痰热清胶囊联合乌美溴铵维兰特罗吸入粉雾剂治疗慢性阻塞性肺疾病稳定期急性发作的临床疗效。方法 选取2020年6月—2022年2月首都医科大学附属北京潞河医院收治的100例慢性阻塞性肺疾病患者,按随机数字表法将100例分为对照组和治疗组,每组各50例。对照组使用干粉吸入装置经口吸入乌美溴铵维兰特罗吸入粉雾剂,1吸/次,1次/d。治疗组在对照组治疗的基础上口服痰热清胶囊,3粒/次,3次/d。7 d为1个疗效,两组连续治疗2个疗程统计疗效。观察两组的临床疗效,比较两组症状消失时间、肺功能、血清可溶性CD40配体（sCD40L）、粒细胞–巨噬细胞集落刺激因子（GM-CSF）、白三烯B₄（LTB₄）水平。结果 治疗后,治疗组总有效率为96.00%,高于对照组的总有效率84.00%,组间比较有显著差异（P＜0.05）。治疗后,治疗组的肺啰音、咳嗽、咯痰消失时间均明显短于对照组（P＜0.05）。治疗后,两组的1秒用力呼气量（FEV₁）/用力肺活量（FVC）、一氧化碳弥散量（DLCO）、第1秒用力呼气容积预测值（FEV₁% pred）均显著增加（P＜0.05）,治疗组FEV₁/FVC、DLCO、FEV₁% pred明显高于对照组（P＜0.05）。治疗后,两组的血清sCD40L、GM-CSF、LTB₄水平显著降低（P＜0.05）;治疗组患者的血清sCD40L、GM-CSF、LTB₄水平明显低于对照组（P＜0.05）。结论 痰热清胶囊联合乌美溴铵维兰特罗吸入粉雾剂治疗慢性阻塞性肺疾病的疗效确切,能改善临床症状,提高肺功能,降低炎症反应。     

清咳平喘颗粒联合沙美特罗替卡松治疗热伤肺络型咳嗽变异性哮喘的临床研究

目的 观察清咳平喘颗粒联合沙美特罗替卡松吸入粉雾剂治疗热伤肺络型咳嗽变异性哮喘的临床疗效。方法 选取2020年3月—2021年3月在哈尔滨市中医医院呼吸科门诊就诊的100例热伤肺络型咳嗽变异性哮喘患者，采用随机数字表法将所有患者分为对照组和治疗组，每组各50例。对照组患者给予沙美特罗替卡松吸入粉雾剂，1吸（泡）/次，2次/d。治疗组在对照组的基础上开水冲服清咳平喘颗粒，10 g/次，3次/d。两组患者均连续治疗4周。观察两组患者临床疗效，比较两组患者的中医证候积分、肺功能指标和血清免疫功能指标水平。结果 治疗后，治疗组患者的总有效率为90.00%，明显高于对照组的总有效率80.00%，差异有统计学意义（P<0.05）。治疗后，两组患者咳嗽、咳痰、喘息、哮鸣音评分均显著降低（P<0.05），且治疗后治疗组患者咳嗽、咳痰、喘息、哮鸣音评分明显低于对照组，差异有统计学意义（P<0.05）。治疗后，两组患者第1秒用力呼气容积（FEV_l）、最大呼气流速（PEF）、FEV₁/FVC均显著升高（P<0.05），且治疗组FEV_l、PEF、FEV₁/FVC显著高于对照组，差异有统计学意义（P<0.05）。治疗后，两组患者血清嗜酸性粒细胞（EOS）、免疫球蛋白E（IgE）水平均显著降低（P<0.05），且治疗组的血清EOS、IgE水平均低于对照组，差异具有统计学意义（P<0.05）。结论 清咳平喘颗粒联合沙美特罗替卡松吸入粉雾剂治疗热伤肺络型咳嗽变异性哮喘具有较好的临床疗效，可缓解患者临床症状，改善肺功能指标，有效恢复患者EOS、IgE至正常水平，具有良好的临床安全性。     

核酪口服溶液联合丙酸氟替卡松治疗小儿支气管哮喘的临床研究

目的 探讨核酪口服溶液联合丙酸氟替卡松治疗小儿支气管哮喘的临床疗效。方法 选取2018年6月—2021年8月郑州阳城医院儿科门诊收治的90例支气管哮喘患儿，所有患儿按照随机数字表法分为对照组和治疗组，每组各45例。对照组经鼻腔吸入丙酸氟替卡松吸入气雾剂，50～100µg/次，2次/d。治疗组在对照组基础上口服核酪口服溶液，5 mL/次，2次/d。两组观察其连续用药7 d。比较两组临床效果和症状好转时间，比较两组治疗前后免疫功能指标、血清炎症因子水平和不良反应。结果 治疗后，治疗组总有效率97.78%，显著高于对照组的84.44%（P＜0.05）。治疗后，治疗组出现咳嗽、喘息、胸闷、呼吸困难好转时间均明显短于对照组（P＜0.05）。治疗后，两组血清免疫球蛋白A（IgA）、血清免疫球蛋白G（IgG）、血清免疫球蛋白E（IgE）均显著高于同组治疗前（P＜0.05）；治疗后，治疗组免疫功能指标改善优于对照组（P＜0.05）。治疗后，两组血清白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）水平均显著降低，而白细胞介素-2（IL-2）水平显著升高（P＜0.05）；治疗后，治疗组血清炎症因子水平改善优于对照组（P＜0.05）。治疗组不良反应发生率8.89%，显著低于对照组的17.78%（P＜0.05）。结论 核酪口服溶液联合丙酸氟替卡松治疗支气管哮喘患儿具有较好的临床疗效，可明显改善患儿免疫功能，降低气道炎症反应，值得临床推广。     

益肺胶囊联合布地格福治疗慢性阻塞性肺疾病的临床研究

目的 探讨益肺胶囊联合布地格福治疗慢性阻塞性肺疾病（慢阻肺）的临床效果。方法 选取2019年3月—2021年8月攀钢集团总医院收治的124例慢阻肺患者,利用随机数字表法将入选患者分成对照组和治疗组,每组各62例。对照组经口吸入布地格福吸入气雾剂,2吸/次,2次/d。治疗组在对照组基础上口服益肺胶囊,4粒/次,3次/d。两组均连续治疗12周。观察两组的临床疗效,比较治疗前后两组患者典型表现（咳嗽、咳痰、喘息、胸闷、呼吸困难）评分、肺功能指标[第1秒用力呼气容积（FEV₁）与用力肺活量（FVC）比值（FEV₁/FVC）、FEV₁占预计值百分比（FEV1%预计值）、残气量（RV）与肺总量（TLC）比值（RV/TLC）、一氧化碳弥散量（DLCO）与肺泡通气量（VA）比值（DLCO/VA）]、慢阻肺评估测试（CAT）问卷评分、6 min步行距离（6MWD）、呼出气一氧化氮（FeNO）水平、痰嗜酸性粒细胞（EOS）比例及血清γ干扰素（IFN-γ）、白细胞介素（IL）-1β水平。结果 治疗后,治疗组总有效率是95.2%,较对照组83.9%显著提高（P＜0.05）。治疗后,两组咳嗽、咳痰、喘息、胸闷、呼吸困难评分均显著降低（P＜0.05）;而治疗组下降更显著（P＜0.05）。治疗后,两组FEV₁/FVC、FEV₁%预计值和DLCO/VA均较治疗前显著上升,RV/TLC则均较治疗前显著降低（P＜0.05）;且均以治疗组改善更显著（P＜0.05）。治疗后,两组CAT问卷评分、FeNO水平及痰EOS比例均显著降低,6MWD均显著增加（P＜0.05）;且均以治疗组改善更显著（P＜0.05）。治疗后,两组患者血清IFN-γ、IL-1β水平均较治疗前显著下降（P＜0.05）;且治疗后,治疗组血清IFN-γ、IL-1β水平降低较对照组更显著（P＜0.05）。结论 益肺胶囊联合布地格福治疗慢性阻塞性肺炎具有较好的疗效,能安全、有效地改善患者临床症状,提高肺功能及生活质量,抑制体内炎症反应,值得临床推广应用。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.