他克莫司联合黄葵胶囊治疗难治性膜性肾病的临床疗效

目的:探讨他克莫司联合黄葵胶囊治疗难治性膜性肾病疗效及安全性。方法:选取2014年3月-2015年10月我院收治的60例难治性膜性肾病患者,按随机数字表法分为观察组和对照组各30例,对照组给予泼尼松治疗,观察组在此基础上增加他克莫司联合黄葵胶囊口服,两组均治疗6个月,观察两组临床疗效,检测并对比两组治疗前后尿蛋白(uPRO)、血清白蛋白(sALB)、血清肌酐(sCr)、血谷丙转氨酶(sALT)、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)以及不良反应情况。结果:观察组的有效率高于对照组(P0.05);治疗后两组uPRO、TNF-α、TGF-β1均明显降低,sALB、sCr明显升高(P0.05),且观察组uPRO、TNF-α、TGF-β1低于对照组(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论:他克莫司联合黄葵胶囊治疗难治性膜性肾病具有较好的疗效,降低肾功能损伤,不良反应低,值得临床推广。     

血液透析、灌流对糖尿病肾病患者血清TNF-α、CRP、IL-6水平的影响

目的:探讨血液透析辅助血液灌流对终末期糖尿病肾病血清C反应蛋白(C-reactive protein, CRP)、肿瘤坏死因子(tumor necrosis factor, TNF-α)及白细胞介素(Interleukin,IL)-6水平的影响。方法:选取近3年收治的79例糖尿病肾病患者,将其随机分为研究组(n=40)和对照组(n=39),对照组患者接受血液透析治疗,研究组患者接受血液透析辅助血液灌流治疗,对比两组患者治疗前后血清TNF-α、CRP、IL-6水平的变化情况。结果:治疗后,研究组患者的治疗总有效率、血红蛋白(haemoglobin,Hb)、转铁蛋白水平(transferring,TRF)、白蛋白(albumin,Alb)及营养不良-炎症评分(malnutrition inflammation score,MIS)均明显高于对照组(P0.05),而MIS评分明显低于对照组(P0.05);两组患者治疗后血清CRP、TNF-α、IL-6水平均明显低于治疗前(P0.05),且研究组患者以上指标明显低于对照组(P0.05)。结论:血液透析辅助血液灌流治疗糖尿病肾病可显著改善患者的临床症状和营养状态,降低TNF-α、CRP、IL-6水平,减轻炎症反应。     

胰岛素联合百令胶囊对早期糖尿病肾病患者临床疗效的影响

目的:探讨胰岛素联合百令胶囊对早期糖尿病肾病患者临床疗效的影响。方法:选取前来我院就诊的已确诊的早期糖尿病肾病患者70例,随机分为对照组和治疗组,每组35例。对照组给予门冬胰岛素治疗;治疗组在对照组基础上联合百令胶囊。比较治疗前后两组患者的血糖、尿白蛋白排泄率(UAER)、24 h尿蛋白定量、β2—微球蛋白(β2-MG)、血肌酐(SCr)、尿素氮(BUN)、T淋巴细胞(CD68)水平的变化情况,记录分析两组患者的临床疗效。结果:治疗组总有效率明显高于对照组(P0.05)。治疗后,两组患者血糖、UAER、24h尿蛋白定量、β2-MG、SCr、BUN、CD68水平均较治疗前显著降低,且治疗组低于对照组(P0.05)。结论:胰岛素和百令胶囊的联合应用能有效控制早期糖尿病肾病患者的血糖水平,减少肾脏损伤,缓解临床症状,提高临床疗效。     

阿托伐他汀联合厄贝沙坦对老年早期糖尿病肾病患者肾功能及微炎症状态的影响

目的:探讨阿托伐他汀联合厄贝沙坦对老年早期糖尿病肾病(DN)患者肾功能及微炎症状态的影响。方法:选取2016年4月到2017年2月在我院肾内科接受治疗的老年早期DN患者84例,根据随机数字表法将患者分为对照组和观察组,各42例。对照组给予厄贝沙坦进行治疗,观察组给予阿托伐他汀联合厄贝沙坦进行治疗。比较两组患者的尿微量白蛋白排泄率(UAER)及两组患者血肌酐(Scr)、血尿素氮(BUN)、β2微球蛋白(β2-MG)、白细胞介素-1(IL-1)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平,并比较两组患者治疗过程中出现的不良反应。结果:治疗后两组患者的UAER、Scr、BUN、β2-MG水平均降低,且观察组的UAER、Scr、BUN、β2-MG均低于对照组(P0.05)。治疗后两组患者血清中IL-1、TNF-α水平均降低,IL-10水平升高(P0.05);治疗后观察组血清中IL-1、TNF-α水平低于对照组,IL-10水平高于对照组(P0.05)。两组不良反应发生率比较差异无统计学意义(P0.05)。结论:阿托伐他汀联合厄贝沙坦对老年早期DN患者有较好的治疗效果,可显著改善患者的肾功能,减轻微炎症状态,且安全性较好,值得临床推广应用。     

缬沙坦胶囊联合醋酸泼尼松片治疗原发性肾病综合征患儿的疗效及对肾功能及炎性因子的影响

目的:探讨原发性肾病综合征(NS)患儿在醋酸泼尼松片治疗的基础上联合缬沙坦胶囊治疗的临床疗效及对肾功能和炎性因子的影响。方法:选取2017年2月~2019年4月期间我院收治的NS患儿107例,根据随机数字表法分为对照组(n=53,醋酸泼尼松片治疗)和研究组(n=54,对照组的基础上联合缬沙坦胶囊治疗),比较两组患儿的临床疗效、肾功能指标及炎性因子指标变化情况,记录两组治疗期间不良反应情况。结果:研究组治疗12周后的临床总有效率为90.74%(49/54),高于对照组的69.81%(37/53)(P<0.05)。两组患儿治疗12周后白蛋白(Alb)较治疗前升高,24 h尿蛋白定量、肌酐(Cr)、尿素氮(BUN)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)均较治疗前降低(P<0.05);研究组治疗12周后Alb高于对照组,24 h尿蛋白定量、Cr、BUN、IL-6、IL-8、TNF-α则低于对照组(P<0.05)。两组不良反应发生率比较无差异(P>0.05)。结论:缬沙坦胶囊联合醋酸泼尼松片治疗在提高NS患儿疗效的同时还可有效改善患儿肾功能及炎性因子水平,用药安全性较好。     

内外联合固定术治疗骨盆骨折的临床疗效及对血清ALP, TNF-α,TGF-β水平的影响

目的:研究内外联合固定术治疗骨盆骨折的临床观疗效及对血清碱性磷酸酶(ALP)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)水平的影响。方法:选取2014年8月至2015年7月本院收治的86例骨盆骨折患者,根据入院顺序分为观察组和对照组,43例每组。对照组使用常规内固定术,观察为内外联合固定术。分析两组患者临床疗效、手术情况、并发症的发生情况,比较两组患者治疗前后血清ALP、TNF-α、TGF-β水平的变化。结果:治疗后,观察组的优良率显著高于对照组[81.40%(35/43)比41.86%(18/43)](P0.05),手术时间、术中出血量、骨折愈合时间显著短于或少于对照组(P0.05)。治疗前,两组患者血清ALP、TNF-α、TGF-β水平比较无显著性差异(P0.05);治疗后,两组患者血清ALP水平显著高于治疗前(P0.05),TNF-α、TGF-β水平较治疗前显著降低(P0.05),其中观察组的ALP水平明显比对照组高(P0.05),TNF-α、TGF-β水平明显比对照组低(P0.05)。观察组的并发症发生率明显低于对照组[0.00%(0/43)比11.63%(5/43)](P0.05)。结论:内外联合固定术治疗骨盆骨折患者的临床疗效和安全性均较高,可有效升高患者血清ALP水平,降低TNF-α、TGF-β水平。     

COPD合并肺间质纤维化患者临床特点及血清TGF-β1、CTGF、TNF-α检测意义分析

摘要 目的：分析慢性阻塞性肺疾病（COPD）合并肺间质纤维化（PF）患者临床特点及血清转化生长因子-β1（TGF-β1）、结缔组织生长因子（CTGF）、肿瘤坏死因子-α（TNF-α）检测意义。方法：选取2020年1月~2022年1月我院收治的80例COPD患者为研究对象,根据是否合并PF分为COPD合并PF组（n=35）和COPD组（n=45）,分析临床表现、肺功能、血气分析、胸部X线片、胸部CT及高分辨CT（HRCT）结果,检测血清TGF-β1、CTGF、TNF-α水平,并采用ROC曲线分析血清TGF-β1、CTGF、TNF-α水平对COPD合并PF的预测效能。结果：COPD合并PF患者的临床症状位于两种单病之间,肺功检查表现为混合性通气功能障碍,DIco弥散量多表现为中重度减低,血气分析显示低氧血症较明显,胸部X线片和胸部CT具有两病的特点。COPD合并PF组血清TGF-β1、CTGF、TNF-α水平均显著高于COPD组（P<0.05）;ROC曲线分析显示,血清TGF-β1、CTGF、TNF-α水平联合诊断COPD合并PF的敏感度为96.00％,AUC为0.894,均高于单独检测（P<0.05）。结论：COPD合并PF患者具有COPD和PF临床表现融合的特点,使得原来单一的疾病表现不典型而有其独特的临床表现,为疾病诊断、治疗提供了依据,且其血清TGF-β1、CTGF、TNF-α水平呈高表达,对COPD合并PF具有一定预测价值。     

加味苦参汤联合紫归解毒膏对肛瘘术后创面愈合、肛肠动力学及血清TNF-α、IL-6、bFGF、TGF-β1水平的影响

目的:探讨加味苦参汤联合紫归解毒膏对肛瘘术后创面愈合、肛肠动力学及血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、转移生长因子-β1(TGF-β1)、碱性成纤维细胞生长因子(bFGF)水平的影响。方法:选取2015年6月~2019年6月期间我院收治的肛瘘术后患者80例,以随机数字表法将患者分为研究组(n=40,加味苦参汤联合紫归解毒膏治疗)和对照组(n=40,紫归解毒膏治疗),均治疗14 d。比较两组患者疗效、创面愈合情况、肛肠动力学及相关血清细胞因子水平,记录两组患者不良反应发生情况。结果:研究组治疗14 d后的临床总有效率为87.50%(35/40),显著高于对照组的65.00%(26/40),差异有统计学意义(P<0.05)。与对照组相比,研究组创面出血评分、创面水肿评分更低,创面愈合时间更短(P<0.05)。两组患者治疗14 d后直肠静息压(RRP)、肛管静息压(ARP)均下降,但研究组高于对照组(P<0.05)。两组治疗14 d后血清TNF-α、IL-6水平下降,且研究组低于对照组(P<0.05);两组治疗14 d后血清TGF-β1、bFGF水平升高,且研究组高于对照组(P<0.05)。两组不良反应发生率比较无差异(P>0.05)。结论:加味苦参汤联合紫归解毒膏治疗肛瘘术后患者,可促进创面尽快愈合,改善患者肛肠动力学及血清TNF-α、IL-6、TGF-β1、bFGF水平,且不增加不良反应发生率,疗效较好。     

百令片联合坎地沙坦对糖尿病肾病患者的临床效果分析

目的:分析百令片联合坎地沙坦对糖尿病肾病患者的临床治疗效果。方法:选择我院2015年6月~2016年6月收治的98例糖尿病肾病作为研究对象,参照抽签法随机分为对照组与观察组,每组各49例。对照组予以坎地沙坦治疗,观察组基于对照组使用百令片治疗,比较两组治疗前后血清胱抑素(Cys-C)、β2微球蛋白(β2-MG)、尿素氮(BUN)、肌酐(Cr)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、血糖、血压水平和不良反应的发生情况。结果:治疗后,两组血清Cys-C、β2-MG、BUN、Cr、IL-6、CRP、TNF-α、血糖和血压水平均较治疗前显著降低,且观察组血清Cys-C、β2-MG、BUN、Cr、IL-6、CRP、TNF-α和血压水平显著低于对照组,差异均具有统计学意义(P0.05)。结论:百令片联合坎地沙坦治疗可更有效改善糖尿病肾病患者的肾功能、血压和血糖水平,抑制其炎症反应,且安全性较好。     

前列地尔联合氯吡格雷治疗早期糖尿病肾病疗效观察

目的:观察前列地尔与氯吡格雷联合治疗早期糖尿病肾病(DN)的临床疗效。方法:选择我院2013年10月至2014年10月期间收治的早期DN患者120例为研究对象,采用随机数表法将患者随机分为观察组62例和对照组58例,两组患者均给予血管紧张素受体拮抗剂(ARB)或血管紧张素转化酶抑制剂(ACEI)类药物1个月后,对照组给予前列地尔治疗,观察组给予前列地尔联合氯吡格雷治疗,两组患者均进行20d的治疗,观察并比较两组患者治疗前后β2-微球蛋白(β2-MG)、尿微量白蛋白(U-malb)、高敏C反应蛋白(hs-CRP)、尿素氮(BUN)、血肌酐(Cr)、平均动脉压(MPA),全血低切边率、全血高切变率、血浆粘滞度、血小板聚集率的变化情况及不良反应的发生情况。结果:治疗前两组患者间各项指标比较差异均无统计学意义(P0.05);治疗后两组患者β2-MG、U-malb、hs-CRP、血浆粘滞度、全血粘滞度、血小板聚集率较治疗前均出现明显降低,且观察组患者各项指标均低于对照组,差异均有统计学意义(P0.05);治疗前后两组患者Cr、BUN、MPA水平均未发生明显变化(P0.05);两组患者均未发生严重并发症。结论:早期DN患者给予前列地尔联合氯吡格雷治疗可以降低其尿蛋白,减轻炎症反应,缓解疾病进展,具有明显的临床疗效。     

On the structure and dynamics of the complex of the nucleosome and the linker histone

Several different models of the linker histone (LH)–nucleosome complex have been proposed, but none of them has unambiguously revealed the position and binding sites of the LH on the nucleosome. Using Brownian dynamics-based docking together with normal mode analysis of the nucleosome to account for the flexibility of two flanking 10 bp long linker DNAs (L-DNA), we identified binding modes of the H5-LH globular domain (GH5) to the nucleosome. For a wide range of nucleosomal conformations with the L-DNA ends less than 65 Å apart, one dominant binding mode was identified for GH5 and found to be consistent with fluorescence recovery after photobleaching (FRAP) experiments. GH5 binds asymmetrically with respect to the nucleosomal dyad axis, fitting between the nucleosomal DNA and one of the L-DNAs. For greater distances between L-DNA ends, docking of GH5 to the L-DNA that is more restrained and less open becomes favored. These results suggest a selection mechanism by which GH5 preferentially binds one of the L-DNAs and thereby affects DNA dynamics and accessibility and contributes to formation of a particular chromatin fiber structure. The two binding modes identified would, respectively, favor a tight zigzag chromatin structure or a loose solenoid chromatin fiber.     

Anthropology and genetics of the caucasus peoples and the problem of the origin of the caucasoids

The electrophoretical polymorphisms of some blood proteins were studied in the Talysh population of Pirasora situated in South-East Azerbaidjan. We calculated the gene frequencies of these polymorphisms and determined the genetic distances between the Talyshes and some Iranian populations of North, Central and South Iran, Afghans, and three populations of Azerbaijan. The Talyshes are very close to Iranians of Shiraz, whereas they are distant from the Azerbaijanians. Anthropological investigations showed that the Caucasoids and Mongoloids lived in the Aragvi Basin since the Eneolithic period. This was stated by Alexeev (1974), who emphasized the mixture of the Caucasus populations from ancient times on. We calculated the genetic distances between the Caucasus populations and numerous populations of other geographic regions, considering 28 alleles of 12 loci of blood group, serum protein and red cell enzyme polymorphisms and constructed the dendrogram of these populations. The position of the Caucasus populations in the dendrogram corresponds on principle to the earlier anthropological observations. The clustering of the Caucasoid populations corresponds completely with anthropological and historical data, and supports our earlier hypothesis (Nazarova 1999) concerning the differentiation of Caucasoids, Northern Mongoloids and Amerinds from the populations, which inhabitated Asia in palaeolithic times.     

Kinematics and dynamics of the temporomandibular joint and of the movements of the mandible

In order to analyze the complicated movements of the mandible as the open-closing movement and the protrusio are, it is useful to evaluate the basic kinematic principles and reduce them to simple technical constructions. Both the open-closing movement and the protrusio could be reduced to 4-bar links, which were used to simulate the movements with help of a computer. Besides, the polodes and the curves of points in the muscular attachments could be constructed. The 2 entirely different 4-bar links have 3 things in common: The resting system - cranium, the moving system - mandibula, and 1 of the 2 arms connecting these 2 systems - the ligamentum laterale. As this ligament is taut during movements it can be considered a "guiding ligament" representing 1 of the 3 determining components of the mandibular movements. The other of the 2 arms has no anatomical equivalent; this arm, however, is "replaced" by the 2 other determining components of the mandibular movements: the joint and the muscles. The curves, which the Caput mandibulae describes, are practically identical for the open-closing movement and the protrusio despite of the different 4-bar links and these curves exactly correspond to the Discus articularis, taut by the upper part of the M. pterygoideus lateralis. The muscles do not only just move the mandibula, but they are also the component, which can choose between the different mandibular movements. By means of the curves, which points in the muscular attachments describe, the function of the masticatory muscles could be analyzed exactly.     

Serology and systematics of the Ebenales and the Theales

The systematic position ofthe Ebenaceae, Sapotaceae, Styracaceae, Ochnaceae, Stachyuraceae, Dipterocarpaceae, Clusiaceae and Hypericaceae has been investigated using serological comparisons of sets of antigenic determinants. The results show that the Sytracaceae and Sapotaceae are undoubtedly more closely associated with the Actinidiaeceae and Theaceae, respectively, than with each other. We found no corresponding determinants betnween antigen systems from the Ebenaceae and systems from any other family whose relations to this family have been proposed. As discovered previously, investigations of antigen systems from the Ochnaceae, Dipterocarpaceae, Stachyuraceae, Clusiaceae and Hypericaceae are against the idea of a natural order “Theales” in which these families, or at least some of them, are combined with the Theaceae and Actinidiaceae. This paper completes our previous investigations which largely support a superorder Ericanae sensu Ehrendorfer and Takhtajan. We propose to include the Actinidiaceae and Theaceae in this superorder, assigning them a central position laong with the Sapotaceae and Sytracaeae on one side and the Primulales and Ericales on the other. Another most interesting finding is that there are corresponding determinants between antigen systems from the members of the Ericanae and representatives of the Polemoniaceae and Loasaceae.     

人类基因组及后基因组研究进展及其应用与开发研究现状

人类对自身基因组的研究,随着人类基因组工作草图的绘制完成和对基因功能研究的深入已加快进入了实质性、关键性的开发利用阶段。本文概述了人类基因组及后基因组的研究进展及依此开展基因治疗及基因（组）药物研制等应用开发研究的现状。     

Biophysics and Structure of the Patch and the Gigaseal

Interpreting channel behavior in patches requires an understanding of patch structure and dynamics, especially in studies of mechanosensitive channels. High resolution optical studies show that patch formation occurs via blebbing that disrupts normal membrane structure and redistributes in situ components including ion channels. There is a 1-2 μm region of the seal below the patch where proteins are excluded and this may consist of extracted lipids that form the gigaseal. Patch domes often have complex geometries with inhomogeneous stresses due to the membrane-glass adhesion energy (E_a), cytoskeletal forces, and possible lipid subdomains. The resting tension in the patch dome ranges from 1-4 mN/m, a significant fraction of the lytic tension of a bilayer (∼10 mN/m). Thus, all patch experiments are conducted under substantial, and uneven, resting tension that may alter the kinetics of many channels. E_a seems dominated by van der Waals attraction overlaid with a normally repulsive Coulombic force. High ionic strength pipette saline increased E_a and, surprisingly, increased cytoskeletal rigidity in cell-attached patches. Low pH pipette saline also increased E_a and reduced the seal selectivity for cations, presumably by neutralizing the membrane surface charge. The seal is a negatively charged, cation selective, space with a resistance of ∼7 gigohm/μm in 100 mM KCl, and the high resistivity of the space may result from the presence of high viscosity glycoproteins. Patches creep up the pipette over time with voltage independent and voltage dependent components. Voltage-independent creep is expected from the capillary attraction of E_a and the flow of fresh lipids from the cell. Voltage-dependent creep seems to arise from electroosmosis in the seal. Neutralization of negative charges on the seal membrane with low pH decreased the creep rate and reversed the direction of creep at positive pipette potentials.     

On the Microanatomy of the Brain and the Innervation and Homologues of the Cephalic Appendages of Hesionidae and Syllidae (Polychaeta)

Abstract Earlier papers dealing with the anatomy of the hesionids and syllids were studied. Thereby it was found that information about the structure of the central nervous system was meagre. As a result, the anterior end appendages, especially the large, laterloventral ones of the Syllidae, have been differently interpreted. This prompted a re-investigation. The circum-oesophageal connectives, the brain commissures and the innervation of the alimentary canal and the cephalic appendages of a number of hesionid and syllid species were studied. The results, summarized in schematic diagrams, were compared with corresponding observations in other polychaete families. Among other things, it was concluded that not only the latero-ventral cephalic appendages of the hesionids but also those of the syllids are homologous with the palps of the nereids and of many other “errant” and “sedentary” families.     

Comparison of the Effects of Flexion and Extension of the Thumb and Fingers on the Position and Cross-Sectional Area of the Median Nerve

Objective

To assess the separate effects of thumb and finger extension/flexion on median nerve position and cross-sectional area.

Methods

Ultrasonography was used to assess median nerve transverse position and cross-sectional area within the carpal tunnel at rest and its movement during volitional flexion of the individual digits of the hand. Both wrists of 165 normal subjects (11 men, 4 women, mean age, 28.6, range, 22 to 38) were studied.

Results

Thumb flexion resulted in transverse movement of the median nerve in radial direction (1.2±0.6 mm), whereas flexion of the fingers produced transverse movement in ulnar direction, which was most pronounced during flexion of the index and middle fingers (3.2±0.9 and 3.1±1.0 mm, respectively). Lesser but still statistically significant movements were noted with flexion of the ring finger (2.0±0.8 mm) and little finger (1.2±0.5 mm). Flexion of the thumb or individual fingers did not change median nerve cross-sectional area (8.5±1.1 mm²).

Conclusions

Volitional flexion of the thumb and individual fingers, particularly the index and middle fingers, produced significant transverse movement of the median nerve within the carpal tunnel but did not alter the cross-sectional area of the nerve. The importance of these findings on the understanding of the pathogenesis of the carpal tunnel syndrome and its treatment remains to be investigated.