Insulin‐like growth factor‐II is produced by,signals to and is an important survival factor for the mature podocyte in man and mouse

Podocytes are crucial for preventing the passage of albumin into the urine and, when lost, are associated with the development of albuminuria, renal failure and cardiovascular disease. Podocytes have limited capacity to regenerate, therefore pro‐survival mechanisms are critically important. Insulin‐like growth factor‐II (IGF‐II) is a potent survival and growth factor; however, its major function is thought to be in prenatal development, when circulating levels are high. IGF‐II has only previously been reported to continue to be expressed in discrete regions of the brain into adulthood in rodents, with systemic levels being undetectable. Using conditionally immortalized human and ex vivo adult mouse cells of the glomerulus, we demonstrated the podocyte to be the major glomerular source and target of IGF‐II; it signals to this cell via the IGF‐I receptor via the PI3 kinase and MAPK pathways. Functionally, a reduction in IGF signalling causes podocyte cell death in vitro and glomerular disease in vivo in an aged IGF‐II transgenic mouse that produces approximately 60% of IGF‐II due to a lack of the P2 promoter of this gene. Collectively, this work reveals the fundamental importance of IGF‐II in the mature podocyte for glomerular health across mammalian species. Copyright © 2013 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90)

Background  

Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions.     

Septal Dyskinesia and Global Left Ventricular Dysfunction in Pediatric Wolff‐Parkinson‐White Syndrome with Septal Accessory Pathway

LV Dysfunction in WPW Syndrome. Introduction: Echocardiographic studies have shown that some patients with Wolff‐Parkinson‐White (WPW) syndrome have myocardial dyskinesia in the segments precociously activated by an accessory pathway (AP). The aim of the present study was to determine the extent to which the AP contributes to global left ventricular (LV) dysfunction. Methods: Electrophysiological and echocardiographic data from 62 children with WPW (age at diagnosis = 5.9 ± 4.2 years) were retrospectively analyzed. Results: The left ventricular ejection fraction (LVEF) of patients with septal APs (53 ± 11%) was significantly lower than that of patients with right (62 ± 5%) or left (61 ± 4%) APs (P = 0.001). Compared to patients with normal septal motion (n = 56), patients with septal dyskinesia (n = 6) had a reduced LVEF (61 ± 4% and 42 ± 5%, respectively) and an increased LV end diastolic dimension (P < 0.001 for both comparisons). Multivariate analysis identified septal dyskinesia as the only significant risk factor for reduced LVEF. All 6 patients with septal dyskinesia had right septal APs, and a preexcited QRS duration that was longer than that of patients with normal septal motion (140 ± 18 ms and 113 ± 32 ms, respectively; P = 0.045). After RFA there were improvements in both intraventricular dyssynchrony (septal‐to‐posterior wall motion delay, from 154 ± 91 ms to 33 ± 17 ms) and interventricular septal thinning (from 3.0 ± 0.5 mm to 5.3 ± 2.6 mm), and a significant increase in LVEF (from 42 ± 5% to 67 ± 8%; P = 0.001). Conclusion: The dyskinetic segment activated by a right septal AP in WPW syndrome may lead to ventricular dilation and dysfunction. RFA produced mechanical resynchronization, reverse remodeling, and improvements in LV function. (J Cardiovasc Electrophysiol, Vol. 21, pp. 290–295, March 2010)     

血液病患者合并侵袭性真菌感染的相关危险因素分析

目的 探索血液病合并侵袭性真菌感染(IFI)患者的临床发病率、相关危险因素及预后,为临床诊疗提供参考依据.方法 回顾性分析2009年1月-2011年6月医院收治的450例血液疾病患者临床资料.结果 诊断血液病合并IFI 91例,发生率为20.22％;包括7例确诊:血液感染5例、曲霉菌属感染2例;50例临床诊断:均为肺部感染,其中有1例伴有肝多发低密度灶;34例疑似病例:均为肺部感染;确诊及临床诊断IFI 57例,发生率为12.67％;平均随访时间为240 d,累计发病率为24.44％;年龄、粒细胞缺乏时间及活动性基础疾病为IFI的独立危险因素(P＜0.01);450例患者治疗后1年的总体生存率为76.67％,IFI的相关死亡率为3.78％;确诊及临床诊断组在诊断6周及12周的病死率均显著高于疑似诊断组(P＜0.01).结论 针对年龄＞33岁,且伴有活动性基础疾病的血液病患者应予以重点关注,必要时应积极进行抗真菌预防治疗,以降低合并真菌感染的发生率     

Sesame oil in injectable gold: two drugs in one?

To investigate the potential anti-inflammatory effects of sesame oil, which is present in the injectable gold preparation Auromyose, the synthesis of tumour necrosis factor alpha (TNF-alpha), prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) by in vitro stimulated blood cells was measured before, during and after 12 weeks of dietary supplementation with 18 g of sesame oil daily in 11 healthy male volunteers. Neither TNF-alpha, PGE2 nor LTB4 production levels showed statistically significant changes during the 12 weeks of dietary supplementation with sesame oil. These results do not suggest an anti-inflammatory effect of sesame oil as present in injectable gold preparations which are used in the treatment of rheumatoid arthritis.      

Comparison of IgA-alpha1-antitrypsin levels in rheumatoid arthritis and seronegative oligoarthritis: complex formation is not associated with inflammation per se

Serum complexes between IgA and alpha1-antitrypsin (IgA alpha1AT) have been found at raised levels in early rheumatoid arthritis (RA), where they appear to be associated with more erosive disease. We have now measured the levels of these complexes in the sera and synovial fluid of patients with RA and seronegative oligoarthritis to determine whether there is a relationship between complex levels and joint inflammation, and if bacterial stimulation of the mucosa is associated with complex formation in seronegative oligoarthritis. IgA-alpha1AT complexes were measured in patients with RA (n = 75) and seronegative oligoarthritis, with or without definite reactive arthritis (n = 28), using a newly developed sandwich ELISA. The results were compared with serum levels from healthy volunteers (n = 30). IgA and alpha1AT were also measured using ELISA and radial immunodiffusion (RID) techniques, respectively. IgA-alpha1AT complex levels in the sera of RA patients [mean = 25.6 arbitrary units (au)] were significantly higher (P = 0.0034) than those in patients with seronegative oligoarthritis (mean = 12.36 au) and healthy controls (mean = 8.08 au). There was no evidence for the inflamed joint being the source of IgA-alpha1AT complexes since synovial fluid levels were lower than corresponding serum levels, although higher amounts were found in RA than seronegative oligoarthritis (12.84 au vs 4.11 au, P = 0.01). Serum levels of IgA and alpha1AT were similar in RA and seronegative oligoarthritis patients, and were higher than in normals. There was a significant correlation between complex and serum IgA levels in RA (r = 0.49, P < 0.001) and seronegative oligoarthritis (r = 0.53, P < 0.001) patients, although no relationship was found with alpha1AT levels. There was no correlation with other markers of the acute-phase response (C-reactive protein, erythrocyte sedimentation rate), nor with any clinical markers. In RA patients, serum complex levels were significantly higher in seropositive than seronegative patients (30.75 vs 16.48 au, P = 0.03), and we have demonstrated that a small amount of alpha1AT may be complexed with IgA rheumatoid factor. Our data suggest that the formation of IgA-alpha1AT complexes is not associated with inflammation per se, and does not appear to be related to bacterial stimulation of the mucosal immune system in patients with seronegative oligoarthritis.      

经动脉药盒化疗治疗转移性黑色素瘤病人的护理

[目的]总结经动脉药盒化疗治疗转移性黑色素瘤病人的护理。[方法]对10例转移性黑色素瘤病人行动脉药盒植入术,利用动脉药盒进行化疗,并做好治疗前、中、后的护理。[结果]10例病人中1例出现化疗药物外渗终止治疗,其余均能按计划完成治疗。[结论]掌握动脉药盒植入后的护理操作方法是行动脉灌注化疗的关键,有利于治疗的顺利进行。     

Utilization of retrieved oocytes as an index of the efficiency of superovulation strategies for in-vitro fertilization treatment

An analysis of 581 in-vitro fertilization treatment cycles was carried out to determine the pattern of utilization of retrieved oocytes. Patients were divided into five groups depending on the number of retrieved oocytes. The mean fertilization rate of 57% was broadly similar amongst the groups but the proportion of retrieved oocytes that produced embryos of a quality suitable for transfer or cryopreservation (the cycle efficiency index) fell significantly with increase in the retrieved oocyte number. However, the pregnancy rate increased with the number of retrieved oocytes (13-38%). It is important to determine the point at which advantages of multifollicular development are outweighed by the potential for complications. Increased utilization of retrieved oocytes will decrease the need for production of a large number of oocytes.