狼疮性肾炎17例病理和临床分析

对１７例狼疮性肾炎行肾穿刺活检，病理形态学分为：系膜增生型（Ⅱ型）３例（１７．６％），弥漫增生型（Ⅳ型）３例（１７．６％），膜型（Ⅴ型）１０例（５８．８％），进行性硬化型（Ⅵ型）１例（５．９％）。以膜型狼疮性肾炎最多。病程在５年内者１３例（７６．５％），疾病处于活动期，病理损害可见于各种类型，病理改变与病程无一定的关系，不同病理类型的狼疮性肾炎，其临床表现及预后有明显的差异。     

狼疮性肾炎临床与病理的关系

对55例狼疮性肾炎进行了病理组织学研究，其中26例为尸检病例，29例为肾穿刺材料；轻微病变型2例（3．6％），系膜增生型11例（20．0％），局灶型10例（18．2％），弥漫增生型17例（30．9％），膜型13例（23．6％）及增生硬化型2例（3．6％）。肾小球病变的多样性和非典型性，肾小球内巨块状免疫复合物沉积乃至毛细血管壁的白金耳样改变，纤维素样坏死，微血栓形成，小动脉炎，肾间质炎及苏木素小体形成等，均为狼疮性肾炎的常见病变，具有诊断意义。这些病变也是狼疮性肾炎活动进展的指征。     

狼疮肾炎的病理与临床关系探讨

目的 探讨狼疮肾炎的病理改变与临床的联系。方法 对４７例系统性红斑狼疮肾炎患者行肾活检，并进行病理分型，分析各病理类型的临床特点。结果 Ⅱ、Ⅲ、Ⅳ型狼疮肾炎常呈现出临床活动，Ⅴ型临床上呈现非活动状态；Ⅳ型血尿、肾功能不全发生率高，Ⅴ型主要表现为大量蛋白尿。肾脏病理急性活动指数与系统性红斑狼疮的临床活动指数及抗ｄｓＤＮＡ抗体滴度无相关性。结论 狼疮肾炎的病理改变与临床表现有一定联系，但二者之间不平衡     

狼疮肾炎肾间质浸润与肾损害进展及肾功能相关性的研究

目的：观察狼疮肾炎肾间质浸润的白细胞类型与肾功能损害进展的关系。方法：检测40例狼疮肾炎患者24h尿蛋白定量、血肌酐，随即进行肾活检及免疫组织化学检测，21例患者进行二次肾活检。结果：狼疮肾炎患者首次肾活检时显示T淋巴细胞与单核细胞所占比例差异无显著性，而第2次肾活检时以单核细胞为主。首次肾活检时间质浸润的淋巴细胞CD4^ ／CD8^ 较正常对照组增加，第2次肾活检时CD^ ／CD8^ 低于正常对照组。第2次肾活检时显著间质浸润的发生率由首次活检时的47.5％升至100％。浸润白细胞总数与血肌酐水平呈正相关，其中T细胞、中性粒细胞亦与血肌酐呈正相关，单核细胞与血肌酐无显著相关性。结论：重复肾活检可发现更多病例肾间质损害，狼疮肾炎肾间质的主要浸润细胞类型呈疾病进展阶段依赖性，CD4^ T细胞在间质损伤机制中起始发作用，CD8^ T细胞的作用可能是继发的，长期的蛋白尿可能对CD8^ 细胞的浸润有激发作用。     

58例狼疮性肾炎病理与临床分析

目的 分析肾活检及相关实验室检测结果，探讨狼疮性肾炎（LN）病理类型与临床表现的关系。方法 对58例LN患者进行肾活检及常规实验室检查。根据WHO 1982年标准进行病理分型，并分别进行活动性指数（AI），慢性指数（CI）和肾小管间质病变（TIL）评分。结果 病理类型以Ⅳ型LN最多，占38％，其次Ⅱ型（26％）和Ⅴ型（24％），Ⅱ型与Ⅲ型多表现为肾炎综合征，Ⅳ型和Ⅴ型多表现为肾病综合征。Ⅳ型和LN的血,高血压，肾功能不全发生率最高，其AI亦显著高于其他类型。LN肾间质受累以Ⅳ型最为显著。血Cr水平与肾间质受累程度呈正相关。与TIL0－1级相比，2－3级病程相对要长。1－2级者尿蛋白排泄较0级与3级为高。结论 LN的病理类型与临床表现有一定关系，根据其临床表现和实验室检查可大致推测其病理类型。肾活检对判断疾病活动性，指导治疗与估计预后有重要意义。     

狼疮性肾炎组织类型的转变

分析38例狼疮性肾炎(LN)患者,发现LN病程中组织学类型转变的发生率是44.7％,其中Ⅱ型发生转型的比例最高(66.7％),Ⅳ型为26.7％,Ⅴ型为33.3％。LN转型呈多向性,各型病变都可以互相转化,临床表现与实验室检查难以预测转型。然而,肾活检病理病变的活动指数、肾间质中CD_4~+、CD_8~+细胞的数量变化及分布特点,对判断组织类型的转变有一定意义。鉴于以往对LN的分型标准不尽合理,作者建议新的分类方法应包括体液及细胞免疫状态,肾小球、肾小管与间质病变,以及病变活动性与慢性化病变等内容。     

狼疮性肾炎的诊断和治疗进展

狼疮性肾炎的诊断和治疗进展中山医科大学附属第一医院肾科叶任高，张金黎狼疮性肾炎（Ｉｕｐｕｓｎｓｐｈｒｉｔｉｓ．ＬＮ）是系统性红斑狼疮（ＳＬＥ）主要的临床表现之一，ＳＬＥ病人５０％～８０％有ＬＮ的临床表现，肾活检则几乎都有肾脏病变。ＬＮ的病理类型在病理...     

血中透明质酸浓度变化对狼疮肾炎活动的评价意义

目的　探讨血中透明质酸 (HA)变化对狼疮肾炎活动度的评价。方法　对 30例狼疮肾炎患者作肾活检并按病理组织学分析计算狼疮活动积分 ,用放射免疫分析法测定血中HA浓度 ,分析狼疮肾炎组HA浓度变化与肾脏狼疮活动积分高低的相关性 ,并对比研究 5 4例慢性肾小球肾炎病人的血清HA变化。结果　狼疮肾炎患者血中HA浓度与狼疮活动度呈明显正相关 (P <0 0 0 1) ,狼疮活动控制后血中HA明显下降 (P <0 0 1) ,狼疮性肾炎组HA浓度明显高于慢性肾炎组。结论　测定血中HA浓度可作为评估狼疮活动的指标之一。     

伴肾病综合征Ⅱ型狼疮性肾炎的临床病理特征

目的:比较临床表现肾病综合征(NS)和非NS的Ⅱ型狼疮性肾炎(LN)患者的临床、病理特征和预后. 方法:回顾性分析经肾活检病理确诊为Ⅱ型LN患者124例,其中女性112例,男性12例,平均年龄29.2±11.4岁,根据尿蛋白定量分为NS组(尿蛋白定量≥3 g/d,血清白蛋白＜30 g/L)和非NS组(尿蛋白定量＜3g/d,血清白蛋白≥30 g/L,伴或不伴镜下血尿).比较两组患者的临床、免疫学指标、肾脏病理特征及预后. 结果:124例Ⅱ型LN中NS组27例(21.8％),非NS组97例(78.2％),两组患者性别、发病年龄和病程无差异.NS组以肾损害为首发症状(77.8％vs15.5％,P＜0.01)及病程中出现急性肾损伤的比例(29.6％vs0,P＜0.01)均显著高于非NS组,而皮疹(40.7％ vs 69.1％,P＜0.01)、发热(14.8％vs62.9％,P＜0.01)和关节炎(29.6％vs75.3％,P＜0.01)的发生率及血清抗-dsDNA阳性率(29.6％vs52.6％,P＜0.05)明显低于非NS组.肾活检病理NS组患者肾小球中重度系膜增生的比例显著低于非NS组(7.4％vs59.8％,P＜0.01),电镜下肾小球足细胞足突广泛融合的比例显著高于非NS组(88.9％vs0,P＜0.01).NS组和非NS组激素治疗均获得高缓解率(100％vs98.4％,P=0.882),但NS组复发率显著高于非NS组(69.9％vs33.3％,P＜0.01),两组分别随访8～125月(中位时间55月)和6～274月(中位时间57月),均未发生终末期肾病.7例复发者重复肾活检,NS组2例病理类型均未转型,非NS组5例均发生转型. 结论:表现为NS的Ⅱ型LN其本质为足细胞病,非NS的Ⅱ型LN为系膜增生性病变,两者临床表现、免疫学异常及病理转型的显著差异表明两者的发生机制不同,狼疮足细胞损伤的机制有待进一步研究.     

狼疮性肾炎患者40例临床病理分析

目的 探讨狼疮性肾炎(LN)的病理类型与临床及实验室检查的关系.方法 对40例狼疮性肾炎患者进行肾活检(其中9例重复肾活检)及病理分型,分析各病理类型的临床特点、实验室检查特点、临床活动性及肾脏病理活动性.结果 所有患者均有病理学异常,Ⅳ型最多见(占42.5%),Ⅳ型LN高血压、肾功能不全及血液系统损害发生率高,血清补体C3下降明显;临床活动性及肾脏病理活动性明显;Ⅳ型、Ⅴ型LN肾病综合征发生率高.结论 狼疮性肾炎的病理类型与临床表现、实验室检查有一定联系;根据狼疮性肾炎的临床表现、实验室检查可以大致推测其病理类型,估计肾损害的严重程度;恰当地治疗可以缓解病情,改善预后.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.