• 【说话速率的变化对鼻气流和鼻感的影响。】 复制标题 收藏 收藏
    DOI:10.1159/000052677 复制DOI
    作者列表:Goberman AM,Selby JC,Gilbert HR
    BACKGROUND & AIMS: :The effects of variation in speaking rate on relative nasal airflow (percent nasal flow) and on the perception of nasality were examined. In addition, the effects of gender and speech rate elicitation techniques (metronome-controlled, self-controlled) were examined. Nineteen normal speakers each produced a stimulus phrase containing nonnasal sounds. Oral and nasal airflows were measured using the Rothenberg aerodynamic system. Results indicated that percent nasal flow and perception of nasality were both greater at slow speaking rates compared to normal and fast rates. Males were perceived as more nasal than females. The metronome-controlled rates were associated with greater nasality than the self-controlled rates. Discussion focuses on physiological correlates to these findings.
    背景与目标: : 检查了说话率的变化对相对鼻气流 (鼻气流百分比) 和对鼻知觉的影响。此外,还检查了性别和言语速率激发技术 (节拍器控制,自我控制) 的影响。19名普通演讲者各自产生一个包含非鼻音的刺激短语。使用Rothenberg空气动力学系统测量口腔和鼻气流。结果表明,与正常和快速速度相比,慢速说话时的鼻流量百分比和鼻感觉均更高。男性被认为比女性更鼻音。节拍器控制率比自我控制率更高。讨论的重点是与这些发现相关的生理学。
  • 【远端胆道梗阻术前引流: 内镜支架置入术或鼻胆管引流?】 复制标题 收藏 收藏
    DOI:10.5754/hge12621 复制DOI
    作者列表:Sugiyama H,Tsuyuguchi T,Sakai Y,Nisikawa T,Miyazaki M,Yokosuka O
    BACKGROUND & AIMS: BACKGROUND/AIMS:Few studies have compared endoscopic biliary stenting and endoscopic nasobiliary drainage for preoperative biliary drainage in patients with malignant distal biliary obstruction. We aimed to evaluate their safety and efficacy in such patients awaiting pancreaticoduodenectomy. METHODOLOGY:Seventy-six of 80 patients (40 with pancreatic cancer, 26 with distal bile duct cancer, and 14 with ampullary cancer) who underwent endoscopic preoperative biliary drainage were included, and we evaluated whether endoscopic biliary stenting or endoscopic nasobiliary drainage provided a safer and more effective drainage for patients awaiting pancreaticoduodenectomy. We also determined whether the type of cancer influenced tube dysfunction. RESULTS:No significant differences in the overall rate of catheter-related complications, the rate of tube dysfunction, or the median interval from preoperative biliary drainage to the time of tube dysfunction were observed between the two groups. Tube dysfunction was observed significantly more frequently in patients with pancreatic cancer than in those with distal bile duct or ampullary cancer. CONCLUSIONS:Both endoscopic biliary stenting and endoscopic nasobiliary drainage provided safe and effective drainage for patients awaiting pancreaticoduodenectomy. Tube dysfunction was associated with preoperative biliary drainage significantly earlier in patients with pancreatic cancer than in those with distal bile duct cancer or ampullary cancer.
    背景与目标:
  • 【预测急性ST段抬高型心肌梗死后微血管阻塞的多指标方法: 一项前瞻性观察性研究.】 复制标题 收藏 收藏
    DOI:10.1186/s12872-016-0415-z 复制DOI
    作者列表:Feistritzer HJ,Reinstadler SJ,Klug G,Reindl M,Wöhrer S,Brenner C,Mayr A,Mair J,Metzler B
    BACKGROUND & AIMS: BACKGROUND:Presence of microvascular obstruction (MVO) derived from cardiac magnetic resonance (CMR) imaging is among the strongest outcome predictors after ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the comparative predictive values of different biomarkers for the occurrence of MVO in a large cohort of reperfused STEMI patients. METHODS:This study included 128 STEMI patients. CMR imaging was performed within the first week after infarction to assess infarct characteristics, including MVO. Admission and peak concentrations of high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), aspartate transaminase (AST) and alanine transaminase (ALT) were measured. RESULTS:MVO was detected in 69 patients (54%). hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations showed similar prognostic value for the prediction of MVO (area under the curve (AUC) = 0.77, 0.77, 0.68, 0.79, 0.78 and 0.73, all p > 0.05), whereas the prognostic utility of NT-proBNP was weakly lower (AUC = 0.64, p < 0.05). Combination of these biomarkers did not increase predictive utility compared to hs-cTnT alone (p = 0.349). CONCLUSIONS:hs-cTnT, CK, hs-CRP, LDH, AST and ALT peak concentrations provided similar prognostic value for the prediction of MVO. The prognostic utility of NT-proBNP was lower. Combining these biomarkers could not further improve predictive utility compared to hs-cTnT alone.
    背景与目标:
  • 【心脏静脉曲张引起流出道阻塞。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Salas Valien JS,Ribas Ariño MT,Palau Benavides MT,González Morán MA
    BACKGROUND & AIMS: :We report a case about a neonate who died of severe subaortic stenosis due to a giant vascular dilation of the left ventricular outflow tract. We emphasize the fatal result of this benign lesion and make differential diagnosis with haemangiomas and valvular blood cysts.
    背景与目标: : 我们报告了一例新生儿,该新生儿因左心室流出道的巨大血管扩张而死于严重的主动脉下狭窄。我们强调这种良性病变的致命结果,并与血管瘤和瓣膜性血囊肿鉴别诊断疾病。
  • 【慢性阻塞性肺疾病气流受限的部分可逆性和呼出气NO和痰嗜酸性粒细胞增多。】 复制标题 收藏 收藏
    DOI:10.1164/ajrccm.162.5.9910112 复制DOI
    作者列表:Papi A,Romagnoli M,Baraldo S,Braccioni F,Guzzinati I,Saetta M,Ciaccia A,Fabbri LM
    BACKGROUND & AIMS: :We investigated the relationship between the reversibility of airflow limitation, the concentration of nitric oxide (NO) in exhaled air, and the inflammatory cells in the sputum of patients with stable chronic obstructive pulmonary disease (COPD). We examined nine normal healthy control subjects and 20 nonatopic patients with COPD. Ten patients had no reversibility of airflow limitation (increase in FEV(1) of < 12% and < 200 ml after 200 microg of inhaled salbutamol), and 10 patients had partial reversibility of airflow limitation (increase in FEV(1) of < 12% but > 200 ml after 200 microg of inhaled salbutamol). Exhaled NO levels were higher in COPD patients with partial reversibility of airflow limitation than in those with no reversibility of airflow limitation (median 24 [interquartile range 15.3 to 32] ppb versus 8.9 [4.6 to 14.7] ppb; p < 0.01). Compared with healthy control subjects, only COPD patients with partial reversibility of airflow limitation had increased concentrations of sputum eosinophils. We conclude that, in patients with stable COPD, even a partial bronchodilator response to inhaled salbutamol is associated with increased exhaled NO and sputum eosinophilia, suggesting that these patients may have a different response to treatment than do those without reversible airflow limitation.
    背景与目标: : 我们研究了稳定的慢性阻塞性肺疾病 (COPD) 患者气流受限的可逆性,呼出空气中一氧化氮 (NO) 的浓度与痰液中炎症细胞之间的关系。我们检查了9名正常健康对照受试者和20名COPD非特应性患者。10例患者没有气流限制的可逆性 (吸入沙丁胺醇200微克后FEV(1) 增加 <12% 和 <200毫升),10例患者有气流限制的部分可逆性 (吸入沙丁胺醇200微克后FEV(1) 增加 <12% 但> 200毫升)。在具有部分气流受限可逆性的COPD患者中,呼出的NO水平高于没有气流受限可逆性的患者 (中位数24 [四分位距15.3 32] ppb与8.9 [4.6至14.7] ppb; p <0.01)。与健康对照组相比,只有气流受限部分可逆性的COPD患者痰嗜酸性粒细胞浓度升高。我们得出的结论是,在稳定期COPD患者中,即使对吸入沙丁胺醇的部分支气管扩张剂反应也与呼出气NO和痰嗜酸性粒细胞增多有关,这表明这些患者对治疗的反应可能与没有可逆气流受限的患者不同。
  • 【由右侧巨大精囊伴同侧上尿路功能障碍引起的射精管阻塞: 胚胎畸形。】 复制标题 收藏 收藏
    DOI:10.1016/j.fertnstert.2007.03.009 复制DOI
    作者列表:Pace G,Galatioto GP,Gualà L,Ranieri G,Vicentini C
    BACKGROUND & AIMS: OBJECTIVE:To report our experience with TURED in infertile men with EDO associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract. DESIGN:Retrospective clinical study. SETTING:Infertile men in an hospital environment. PATIENT(S):Seven patients affected by Zinner syndrome, from March to September 2005, were selected. INTERVENTION(S):Underwent TURED. MAIN OUTCOME MEASURE(S):Semen analysis, endocrine profile, transrectal ultrasonography and seminal vesicles aspiration, excretory urography, computerized tomography (CT), or magnetic resonance imaging (MRI). RESULT(S):Before surgery, the patients experienced a decreased intensity and force of ejaculation and a low motile sperm count. The detection of the ipsilateral upper urinary tract malformation by the patients was incidental. After surgery, all patients reported having a projectile ejaculation, an increase in the average postoperative volume, and of the total motile sperm count. CONCLUSION(S):A seminal vesicle cyst combined with ipsilateral renal agenesis, described as Zinner syndrome, is a rare urological anomaly. It is frequently asymptomatic or else characterized by infertility, symptoms of bladder irritation, or pain in the scrotum and perineum. In selected patients, TURED can improve semen quality with subsequent ability to impregnate. The upper urinary tract malformation should be treated in symptomatic cases only.
    背景与目标:
  • 【衰老对短期膀胱部分梗阻兔生化标志物反应的影响。】 复制标题 收藏 收藏
    DOI:10.1007/s11010-007-9571-x 复制DOI
    作者列表:Guven A,Lin WY,Leggett RE,Kogan BA,Levin RM,Mannikarottu A
    BACKGROUND & AIMS: PURPOSE:Partial bladder outlet obstruction (PBOO) results in marked biochemical alterations in the bladder. In this study, we focused on comparison of thapsigargin sensitive sarco/endoplasmic reticulum Ca(2+) ATPase activity (SERCA) and Citrate Synthase after short term PBOO in young versus old rabbits. MATERIALS AND METHODS:A total of 20 young and 20 mature male rabbits were divided into 4 sub-groups of 5 rabbits each (4 obstructed and 1 sham-control rabbit). The rabbits in the groups were evaluated after 1, 3, 7, and 14 days of obstruction, respectively. The activities of SERCA and citrate synthase were examined as markers for sarcoplasmic reticular calcium storage and release and mitochondrial function, respectively. RESULTS:The SERCA activity of bladder body smooth muscle in the young animals increased at 7 and 14 days. For the old rabbits, the SERCA activity decreased significantly by 1 day and remained this level throughout the course of obstruction, and was significantly lower than young at all time periods. The citrate synthase activity in the young animals decreased over the 1-7 days, and then returned toward control level by 14 days following obstruction. In the old animals, citrate synthase activity of bladder body smooth muscle progressively decreased over the course of the study, and was significantly lower in the old than the young animals after 14 days obstructed. CONCLUSION:The urinary bladders of the young rabbits have a considerable greater ability to adapt to PBOO than do those of the old rabbits. The deterioration of mitochondrial and SR function may be important mechanisms underlying geriatric voiding dysfunction.
    背景与目标:
  • 【Brd4抑制通过阻断TGF-β 介导的Nox4表达来减轻单侧输尿管梗阻诱导的纤维化。】 复制标题 收藏 收藏
    DOI:10.1016/j.redox.2016.12.031 复制DOI
    作者列表:Zhou B,Mu J,Gong Y,Lu C,Zhao Y,He T,Qin Z
    BACKGROUND & AIMS: :Uncovering new therapeutic targets for renal fibrosis holds promise for the treatment of chronic kidney diseases. Bromodomain and extra-terminal (BET) protein inhibitors have been shown to effectively ameliorate pathological fibrotic responses. However, the pharmacological effects and underlying mechanisms of these inhibitors in renal fibrosis remain elusive. In this study, we determined that the inhibition of Brd4, a BET family member, with a selective potent chemical inhibitor, JQ1, could prevent the development of renal fibrosis and block the progression of fibrosis in rats that have undergone unilateral ureteral obstruction (UUO). Inhibiting Brd4 with either JQ1 or genetic knockdown resulted in decreased expression of fibrotic genes such as α-smooth muscle actin, collagen IV and fibronectin both in UUO-induced fibrosis and upon TGF-β1 stimulation in HK-2 cells. Brd4 inhibition also suppressed the oxidative stress induced by UUO in vivo or by TGF-β1 in HK-2 cells. Moreover, Nox4, which is constitutively active in renal cells and is involved in the generation of hydrogen peroxide, was up-regulated during UUO-mediated fibrosis and induced by TGF-β1 in HK-2 cells, and this up-regulation could be blunted by Brd4 inhibition. Consistently, Nox4-mediated ROS generation and fibrotic gene expression were attenuated upon Brd4 inhibition. Further, the transcriptional activity of Nox4 was suppressed by JQ1 or siRNA against Brd4. Additionally, Smad3 and ERK1/2 phosphorylation, which are upstream signals of Nox4 expression, were inhibited both in JQ1-administered UUO rats and Brd4-inhibited HK-2 cells. In conclusion, these results indicated that the inhibition of Brd4 might protect against renal fibrosis by blocking the TGF-β-Nox4-ROS-fibrosis axis, suggesting that Brd4 could be a promising therapeutic target.
    背景与目标: : 发现肾脏纤维化的新治疗靶点有望治疗慢性肾脏疾病。溴结构域和末端外 (BET) 蛋白抑制剂已被证明可以有效改善病理性纤维化反应。然而,这些抑制剂在肾纤维化中的药理作用和潜在机制仍然难以捉摸。在这项研究中,我们确定BET家族成员Brd4与选择性强效化学抑制剂JQ1的抑制作用可以防止发生单侧输尿管梗阻 (UUO) 的大鼠肾脏纤维化的发展并阻断纤维化的进展。在UUO诱导的纤维化和TGF-β1刺激HK-2细胞中,用JQ1或基因敲除抑制Brd4导致纤维化基因如 α-平滑肌肌动蛋白,ⅳ 型胶原和纤连蛋白的表达降低。Brd4抑制也抑制了UUO在体内或TGF-β1在HK-2细胞中诱导的氧化应激。此外,Nox4在肾细胞中具有组成性活性并参与过氧化氢的产生,在UUO介导的纤维化过程中被上调,并由TGF-β1在HK-2细胞中诱导,这种上调可能被Brd4抑制抑制。一致地,Nox4-mediated ROS的产生和纤维化基因表达在Brd4抑制下减弱。此外,针对brd4的JQ1或siRNA抑制了Nox4的转录活性。此外,作为Nox4表达的上游信号的Smad3和ERK1/2磷酸化在JQ1-administered UUO大鼠和Brd4-inhibited HK-2细胞中均被抑制。总之,这些结果表明,Brd4的抑制可能通过阻断tgf-β-nox4-ros纤维化轴来预防肾脏纤维化,这表明Brd4可能是一个有希望的治疗靶标。
  • 【伴有肠梗阻的下腹线嵌顿疝。】 复制标题 收藏 收藏
    DOI:10.1016/j.asjsur.2020.05.012 复制DOI
    作者列表:Xie TH,Fu Y,Ren XX,Zhang J
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【食道梗阻成人嗜酸性食管炎的患病率。】 复制标题 收藏 收藏
    DOI:10.1097/01.mcg.0000225590.08825.77 复制DOI
    作者列表:Kerlin P,Jones D,Remedios M,Campbell C
    BACKGROUND & AIMS: BACKGROUND AND GOALS:Acute food bolus impaction is a common emergency in gastrointestinal practice. Management previously used the endoscope with an overtube to allow retrieval of the bolus per os. The push technique using air insufflation and gentle pressure on the bolus provides an alternative approach. Esophageal mucosal biopsy at the time of the initial endoscopy has not been a part of traditional practice. In view of the increasing recognition of eosinophilic esophagitis (EE) as a cause of dysphagia and food bolus obstruction in adults the etiology needs to be reassessed. STUDY:Forty-three consecutive adults presenting with acute dysphagia secondary to food bolus obstruction of the esophagus were studied. The bolus was advanced into the stomach with the push technique or removed per os with a retrieval net. Protocol biopsies from the proximal and distal esophagus were obtained in 29 patients. Biopsies were contraindicated or not obtained in the remainder. RESULTS:Forty-one patients were successfully treated at endoscopy. Two subjects with a food bolus impacted at the crico-pharyngeal region required general anesthesia with endotracheal intubation for safe removal. Of 29 patients biopsied, 15 had peptic esophageal stricture as the cause. Fourteen patients (all males, mean age 32 y, range 19 to 62 y) had EE identified histologically. This represents 50% of those biopsied. Patients with EE had typical endoscopic features of linear furrows, mucosal rings, or narrow bore esophagus. Most had prior episodes of food bolus obstruction. CONCLUSIONS:Food bolus obstruction can be safely managed by the push technique. EE is an important cause of food bolus obstruction that can be suspected on history and endoscopic appearance and confirmed on histology.
    背景与目标:
  • 【盐酸氨基葡萄糖通过减弱TGF-β 信号传导对单侧输尿管梗阻诱导的肾纤维化具有保护作用。】 复制标题 收藏 收藏
    DOI:10.1007/s00109-013-1086-1 复制DOI
    作者列表:Park J,Lee SY,Ooshima A,Yang KM,Kang JM,Kim YW,Kim SJ
    BACKGROUND & AIMS: UNLABELLED:Renal fibrosis is a common consequence of unilateral ureteral obstruction, which provides a useful model to investigate the pathogenesis of obstructive nephropathy and progressive renal fibrosis. Transforming growth factor (TGF-β1) has been recognized as a key mediator in renal fibrosis by stimulating matrix-producing fibrogenic cells and promoting extracellular matrix deposition. Therefore, considerable efforts have been made to regulate TGF-β signaling for antifibrotic therapy. Here, we investigated the mode of action of glucosamine hydrochloride (GS-HCl) on TGF-β1-induced renal fibrosis. In the obstructed kidneys and TGF-β1-treated renal cells, GS-HCl significantly decreased renal expression of α-smooth muscle actin, collagen I, and fibronectin. By investigating the inhibitory mechanism of GS-HCl on renal fibrosis, we found that GS-HCl suppressed TGF-β signaling by inhibiting N-linked glycosylation of the type II TGF-β receptor (TβRII), leading to an inefficient trafficking of TβRII to the membrane surface. Defective N-glycosylation of TβRII further suppressed the TGF-β1-binding to TβRII, thereby decreasing TGF-β signaling. Notably, GS-HCl treatment significantly reduced TGF-β1-induced up-regulation of Smad2/3 phosphorylation and transcriptional activity in vivo and in vitro. Taken together, GS-HCl-mediated regulation of TGF-β signaling exerted an antifibrotic effect, thereby ameliorating renal fibrosis. Our study suggests that GS-HCl would be a promising agent for therapeutic intervention for preventing TGF-β1-induced renal fibrosis in kidney diseases. KEY MESSAGE:Glucosamine-mediated attenuation of TGF-β signaling ameliorates renal fibrosis in vivo TGF-β1-induced fibrogenic action is reduced by glucosamine in vitro N-glycosylation of the type II TGF-β receptor is suppressed by glucosamine Glucosamine-induced defective N-glycosylation of TβRII decreases TGF-β signaling.
    背景与目标:
  • 【主动脉medtronic-hall瓣膜患者的Pannus急性阻塞: 30年的经验。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2013.07.019 复制DOI
    作者列表:Ellensen VS,Andersen KS,Vitale N,Davidsen ES,Segadal L,Haaverstad R
    BACKGROUND & AIMS: BACKGROUND:Acute dysfunction of mechanical aortic valve prostheses is a life-threatening adverse event. Pannus overgrowth, which is fibroelastic hyperplasia originating from the periannular area, is one cause of dysfunction. The aim of this study was to determine the annual incidence of readmittance resulting from acute obstruction caused by pannus during 30 years of observation in patients with Medtronic-Hall aortic valve prostheses and to analyze the risk factors associated with pannus development. METHODS:From 1982 to 2004, 1,187 patients in our department underwent aortic valve replacement with Medtronic-Hall mechanical monoleaflet valve prostheses. As of December 31, 2012, 27 of these patients (2.3%) had presented with acute valve dysfunction caused by pannus obstruction. RESULTS:The annual incidence of pannus was 0.7 per 1,000. The median time from the primary operation to prosthetic dysfunction was 11.1 years (range, 1.2 to 26.8 years). Of the 20 patients who underwent reoperation, 2 died. Seven patients died before reoperation. Women had a higher risk for the development of obstructing pannus, and patients with pannus obstruction were younger. Valve size was not an independent risk factor. CONCLUSIONS:Women and younger patients are at higher risk for pannus development. When acute dysfunction by pannus is suspected in a mechanical aortic valve, an immediate echocardiogram and an emergency aortic valve replacement should be carried out because of the potential of a fatal outcome.
    背景与目标:
  • 【机器人辅助卵巢静脉切除术治疗间歇性输尿管梗阻。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2008-04-01
    来源期刊:JSLS
    DOI: 复制DOI
    作者列表:Badger WJ,De EJ,Kaufman RP Jr
    BACKGROUND & AIMS: :With the increasing popularity of robotically assisted procedures, new indications for robotically assisted surgery are being examined. Although open and laparoscopic surgical management of intermittent ureteral obstruction from ovarian vein syndrome has been reported previously, we report the first use of robotic assistance for ureterolysis and ovarian vein excision.
    背景与目标: : 随着机器人辅助手术的日益普及,正在研究机器人辅助手术的新适应症。尽管以前已经报道过开放和腹腔镜手术治疗卵巢静脉综合征引起的间歇性输尿管梗阻,但我们报道了首次使用机器人辅助技术进行输尿管松解和卵巢静脉切除术。
  • 【大鼠的慢性输尿管阻塞抑制肾小管Bcl-2并刺激细胞凋亡。】 复制标题 收藏 收藏
    DOI:10.1159/000020657 复制DOI
    作者列表:Chevalier RL,Smith CD,Wolstenholme J,Krajewski S,Reed JC
    BACKGROUND & AIMS: :Unilateral ureteral obstruction (UUO) results in widespread tubular apoptosis in obstructed kidneys of both adults and neonates. The oncoprotein bcl-2 inhibits many forms of apoptosis, whereas the related protein bax promotes apoptosis. To evaluate the interaction of bcl-2, bax, and apoptosis in the renal response to UUO, adult and neonatal rats were subjected to UUO or sham operation, and kidneys were harvested 14 days later. Apoptotic cells were identified by the Tunel technique, and the distribution of bcl-2 and bax was determined by immunochemistry. In both adults and neonates, tubular and interstitial apoptosis was present in the obstructed kidney, but not in intact kidneys. In both adults and neonates, there was diffuse tubular bcl-2 and bax staining of sham-operated and intact kidneys. While bcl-2 was increased in scattered nonapoptotic tubules of the obstructed kidney, there was minimal staining of dilated apoptotic tubules. These results are consistent with the premise that bcl-2 normally suppresses renal tubular apoptosis. The distribution of bax staining in tubules of the obstructed kidney overlapped that of bcl-2. We conclude that chronic UUO inhibits bcl-2 expression in selected tubules of the obstructed kidney which contributes to activation of apoptosis and progressive renal damage in either neonatal or adult kidneys. Dysregulation of apoptosis may be a response to renal injury similar to that underlying the development of cystic kidney disease or renal dysplasia.
    背景与目标: : 单侧输尿管梗阻 (UUO) 导致成人和新生儿阻塞肾脏中广泛的肾小管凋亡。癌蛋白bcl-2抑制许多形式的凋亡,而相关蛋白bax促进凋亡。为了评估bcl-2,bax和细胞凋亡在肾脏对UUO的反应中的相互作用,对成年和新生大鼠进行UUO或假手术,并在14天后收获肾脏。通过Tunel技术鉴定凋亡细胞,并通过免疫化学确定bcl-2和bax的分布。在成年人和新生儿中,阻塞的肾脏中存在肾小管和间质凋亡,但在完整的肾脏中不存在。在成人和新生儿中,假手术和完整肾脏均存在弥漫性肾小管bcl-2和bax染色。虽然阻塞的肾脏中分散的非凋亡小管的bcl-2增加,但扩张的凋亡小管的染色却很少。这些结果与bcl-2正常抑制肾小管凋亡的前提相符。bax染色在阻塞的肾脏小管中的分布与bcl-2的分布重叠。我们得出的结论是,慢性UUO抑制了阻塞肾脏选定肾小管中的bcl-2表达,这有助于激活新生或成年肾脏的凋亡和进行性肾损伤。细胞凋亡失调可能是对肾损伤的反应,类似于囊性肾脏疾病或肾发育不良的潜在反应。
  • 【肥厚型心肌病双腔起搏对左心室流出道梗阻和舒张功能的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9149(97)89344-7 复制DOI
    作者列表:Betocchi S,Losi MA,Piscione F,Boccalatte M,Pace L,Golino P,Perrone-Filardi P,Briguori C,Franculli F,Pappone C,Salvatore M,Chiariello M
    BACKGROUND & AIMS: :Hypertrophic cardiomyopathy (HC) is characterized by impaired diastolic function and, in about 1/4 of patients, left ventricular (LV) outflow tract obstruction. Atrioventricular (AV) pacing diminishes LV outflow tract gradient in HC, but impairs diastolic function in the experimental animal and in different categories of patients. To investigate the effects of AV pacing on hemodynamics and LV function in obstructive HC, 16 patients with HC were studied by cardiac catheterization and simultaneous radionuclide angiography during atrial and AV pacing. The resting LV outflow tract gradient decreased with AV pacing from 60 +/- 34 to 38 +/- 37 mm Hg (mean +/- SD; p <0.001). Regional ejection fraction decreased significantly at the septal level from 0.81 +/- 0.21% to 0.69 +/- 0.27% (p <0.01). Pulmonary artery wedge pressure increased from 10 +/- 5 to 15 +/- 6 mm Hg (p <0.001). AV pacing induced asynchrony (i.e., the coefficient of variation of the time to end-systole increased from 7 +/- 4% to 14 +/- 10% (p <0.01). The time constant of isovolumetric relaxation (t) increased from 58 +/- 24 to 74 +/- 33 ms (p <0.02), and peak filling rate decreased from 491 +/- 221 to 416 +/- 184 ml/s (p <0.05). Thus, AV pacing greatly diminishes resting obstruction through a reduction in septal ejection fraction (i.e., an increase in LV outflow tract width in systole), but impairs active diastolic function and increases filling pressures. These latter effects are potentially detrimental in patients with HC in whom diastolic dysfunction is present.
    背景与目标: 肥厚型心肌病 (HC) 的特征是舒张功能受损,在约1/4的患者中,左心室 (LV) 流出道阻塞。房室 (AV) 起搏会减少HC的LV流出道梯度,但会损害实验动物和不同类别患者的舒张功能。为探讨AV起搏对梗阻性HC血流动力学和LV功能的影响,对16例HC患者在心房和AV起搏期间进行了心导管检查和同时进行的放射性核素血管造影研究。静息左室流出道梯度随AV起搏从60 +/- 34降至38 +/-37毫米Hg (平均值 +/- SD; p <0.001)。区域射血分数在间隔水平上从0.81 +/- 0.21% 显著降低到0.69 +/- 0.27% (p <0.01)。肺动脉楔压从10 +/- 5增加到15 +/-6毫米Hg (p <0.001)。AV起搏引起的异步 (即,收缩末期时间的变异系数从7 +/- 4% 增加到14 +/- 10% (p <0.01)。等容松弛时间常数 (t) 从58 +/- 24增加到74 +/- 33 ms (p <0.02),峰值填充率从491 +/- 221降至416 +/-184毫升/s (p <0.05)。因此,AV起搏通过减少间隔射血分数 (即收缩期左室流出道宽度的增加) 大大减少静息阻塞,但是会损害主动舒张功能并增加充盈压力。这些后一种作用对于存在舒张功能障碍的HC患者可能是有害的。

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