The aim of this study was to assess the mechanism of curcumin with chitosan nanoparticles in regulating the activity of podocytes in diabetic nephropathy through alleviating oxidative stress and inflammation. MCP-5 cells were cultivated in vitro after being randomly divided into four sets, including control set, high sugar set, curcumin set and nanometer set. Proliferation was detected and apoptotic condition was detected through testing activity of Caspase 3. The activities of malondialdehyde (MDA) and superoxide dismutase (SOD) were also detected, and also the ROS content. Expressions of TNF-α, IL-6 and IL-10 were detected through enzymelinked immunosorbent assay (ELISA) method, and mRNA and protein expression of podocin was detected. Results showed that the proliferation of podocytes was prompted in the curcumin set and set of curcumin with chitosan nanoparticles, while the activity of Caspase 3 was reduced. Moreover, the contents of MDA and ROS were reduced, while the SOD activity was increased. The presentation of TGF-β1, and secretions of TNF-α and IL-6 were reduced, while the secretion of IL-10 was increased and presentation of podocin was increased. The activity of podocytes in diabetic nephropathy was improved by curcumin with chitosan nanoparticles through alleviating the oxidative stress and inflammation. The apoptosis was reduced. The development of diabetic nephropathy could be therefore effectively improved.

目的：探讨还原型谷胱甘肽对缺血再灌注急性肾损伤（ AKI）模型大鼠的肾保护机制。方法将无特定病原体（ SPF）级雄性 SD大鼠48只随机分为假手术组（ SN）、造模组（ IN）和还原型谷胱甘肽治疗组（ IG），各16只，IG组在夹闭肾蒂前10 min颈静脉注射200 mg／ml的还原型谷胱甘肽，IN组给予同剂量的生理盐水，SN组仅进行假手术。术后6 h和12 h分别检测三组血肌酐（ SCR）和血尿素氮（ BUN）、血清白细胞介素（ IL）-6和肿瘤坏死因子（TNF）-α水平变化，术后6 h和12 h分批处死大鼠后取肾脏组织，检测三组丙二醛（MDA）和超氧化物歧化酶（SOD）活力。结果术后6 h IN组与IG组SCR和BUN水平均显著高于SN组（均P＜0.05），术后12 h IG组SCR和BUN水平均显著低于IN组（均P＜0.05）。术后6 h IN组与IG组IL-6水平均显著高于SN组，术后12 h IG组IL-6水平显著低于IN组（均P＜0.05）；术后6 h和12 h IN组TNF-α水平均显著高于SN组（P＞0.05），IG组TNF-α水平与SN组相比无统计学差异（P＞0.05）。术后6 h和12 h SN组与IG组SOD活力均显著高于IN组（P＜0.05），而SN组与IG组间比较无统计学差异（P＞0.05）；术后6 h和12 h IN组MDA活力均显著高于SN组与IG组，而SN组与 IG组间比较无统计学差异（P＞0.05）。结论还原型谷胱甘肽治疗缺血再灌注AKI大鼠疗效确切，能有效清除氧自由基和改善炎症状态，值得进一步研究。

目的 探讨甘露聚糖结合凝集素(MBL)途径激活对糖尿病肾病(DN)合并高血压的影响,并探讨左旋氨氯地平对DN合并高血压患者的保护作用.方法 选择2012年9月至12月泸州医学院附属医院肾内科就诊的DN合并高血压患者40例,按机数字表法分为试验组30例,对照组10例.两组均给予DN的常规治疗,试验组在常规治疗基础上口服左旋氨氯地平2.5mg,每日1次,如果2周后血压仍未降至正常(＞140/90mmHg,1mmHg=0.133kPa)则增加左旋氨氯地平用量至5mg,并联合应用降压药物;两组均连续用药90d.观察两组患者治疗前和治疗后30d和90d血压的变化及治疗前后血脂、肝肾功指标、外周血尿白蛋白排泄率(UAER)、MBL、糖化血红蛋白(HbA1c)、膜攻击复合物(MAC)的变化,并评价MBL与DN的相关性.结果 试验组治疗后30d、60d血压均较治疗前下降[收缩压(mmHg):157.4±8.6、145.6±7.5比167.6±11.4,舒张压(mmHg):90.6±6.9、83.9±5.8比98.6±7.9,均P＜0.05].两组治疗前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白-C(HDL-C)、低密度脂蛋白-C(LDL-C)、糖化血红蛋白(HbA1c)、血肌酐(SCr)水平比较差异均无统计学意义(均P＞0.05).两组治疗后UAER、MBL和MAC均较治疗前明显下降,且试验组的下降程度较对照组更显著[UAER(mg/24h)为200.3±69.8比467.2±87.3,MBL(μg/L)为410±120比519±98,MAC(pg/L)为60±20比80±18,均P＜0.05].相关性分析显示,血清MBL及尿MAC水平均与UAER呈正相关(rMBL/UAER=0.894,P=0.041;rMAC/UAER=0.908,P=0.032).结论 左旋氨氯地平对DN合并高血压患者具有保护作用,其机制与MBL途径相关.

国际糖尿病联盟(International Diabetes Federation)在2013年公布的最新糖尿病流行病学数据显示,全球20～79岁成年人中共有3.82亿糖尿病患者,其患病率高达8.3％.更严重的是预计到2035年,全世界将有5.92亿人被诊断为糖尿病,4.71亿人诊断为糖耐量受损.2013年糖尿病(20 ～ 79岁)患者数量在前10位的国家/地区中,中国糖尿病患者人数高达98.4百万,已成为世界上糖尿病患者最多的国家.

1 共识的特点 共识突出科学、全面、系统、个体化的综合治疗策略,分为3个阶段(第1阶段:DKD的预防;第2阶段:DKD的早期治疗;第3阶段:预防和延缓肾功能不全的发生或进展,治疗并发症),从多个方面进行阐述,体现"从防到治"的治疗理念,旨在体现"防治结合,延缓疾病进展",防止心血管疾病等严重并发症的发生[4].

目的 观察脂多糖(LPS)诱导的小鼠急性肝损伤模型肝组织中JNK信号通路(p-JNK和p-c-Jun)的表达变化,以探讨JNK信号通路在急性肝损伤中的作用和意义.方法 将小鼠随机分为对照组和LPS腹腔注射诱导的急性肝损伤模型组,分别于给药后1、2、4和30h处死小鼠,检测血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平.HE染色观察肝脏组织的病理变化.免疫组织化学染色、Western blot检测肝脏组织p-JNK和p-c-Jun蛋白的表达部位及强度.酶联免疫吸附(ELISA)法检测血清肿瘤坏死因子-α(TNF-α)及白介素1β(IL-1β)水平.结果 LPS腹腔注射后可导致小鼠血清ALT及AST水平升高,肝组织病理损伤进行性加重,p-JNK和p-c-Jun在肝细胞核大量表达.与对照组比较,模型组小鼠p-JNK和p-c-Jun蛋白水平于1h时显著升高并达峰值,此后逐渐下降,血清TNF-α及IL-1β水平在注射LPS 1h后明显升高,4h达峰值后逐渐下降.结论 JNK信号通路的活化在LPS诱导的小鼠急性肝损伤的发病过程中起重要作用,JNK信号通路可通过诱导TNF-α和IL-1β的表达参与急性肝损伤的发生与发展.

慢性肾脏病患者普遍存在高磷血症，同时高磷血症是慢性肾脏病患者血管钙化发生和进展的主要因素，并与心血管疾病发病率和病死率的增加密切相关。本文对高磷血症与慢性肾脏病血管钙化研究进展进行综述。

目的 探讨JNK信号通路激活在脂多糖(LPS)诱导的急性肾损伤(AKI)发病中的作用.方法 48只小鼠随机分为对照组和AKI组,分别检测血清尿素氮、肌酐以及胱抑素C,HE染色观察肾组织病理改变,免疫组化、West-ern blot检测肾组织p-JNK和p-c-Jun蛋白表达部位及强度,ELISA检测血中肿瘤坏死因子-α(TNF-α)及白介素1β(IL-1β)水平.结果 小鼠腹腔注射LPS后,血清尿素氮、肌酐、胱抑素C均较对照组均明显升高,肾组织病理损伤呈进行性加重.正常小鼠各时间点可见p-JNK和p-c-Jun在肾小管、肾小球系膜区有微量表达.AKI组小鼠p-JNK及p-c-Jun在肾小管等部位大量表达.与对照组相比,AKI组p-JNK和p-c-Jun蛋白水平在1h后即开始升高,以造模4h时增高最明显,30 h时逐渐下降.与之相应,血中TNF-α和IL-1β水平亦明显升高,于4h达峰值后逐渐下降.结论 JNK信号通路激活在LPS诱导的AKI发病中起重要作用,JNK信号通路活化后可诱发TNF-α和IL-1 β等炎性因子的表达,继而介导AKI的发生和发展.

目的：分析10例二硫化碳（ CS2）致肾功能损伤患者的临床及病理特点。方法选择CS2致肾功能损伤患者10例，回顾性分析其临床资料，总结其临床表现、实验室检查及肾组织病理特点。结果本组患者均为青壮年男性，临床表现以蛋白尿为主，其中尿微量白蛋白升高8例、24小时尿蛋白升高7例、血胱抑素C升高6例、血肌酐升高5例、血尿素氮升高4例、血尿酸升高3例；血清免疫球蛋白IgA升高2例，血清免疫相关抗体、免疫球蛋白IgG、IgM和补体C3、C4均无明显异常；血红蛋白下降4例，余肾外指标均无明显异常。病理特点：光镜下均可见肾小球系膜细胞、系膜基质弥漫性增生和肾小管萎缩，淋巴细胞及单核细胞浸润。电镜下均可见系膜细胞和系膜基质增生，系膜区均未见确切电子致密物沉积；均可见肾小管萎缩，伴上皮细胞空泡变性。免疫荧光检查均无明显IgA、IgG等免疫球蛋白及C3、C4等补体及HBsAg、HBcAg等乙肝标志物抗原的沉积。结论 CS2致肾功能损伤患者的临床表现以蛋白尿为主，病理特点以肾小球系膜细胞、系膜基质弥漫性增生和肾小管萎缩为主，免疫荧光显示基本无免疫球蛋白及补体沉积。

This study aims to investigate effects of Piwil2 on autohpagy in a DN rat model. Sixty health SD rats were selected and divided into four group, including normal group, control, DN and Piwil2 therapy group. DN model (DN group) was established by injecting the streptozotocin (50 mg/kg) into rats. Piwil2 therapy group was injected with viral plasmid carrying Piwil2 mRNA to DN rats. The urinary protein concentrations were determined by placing the animals in individual metabolic cages for a timed urine collection every 8 weeks. Blood and soleus muscle samples were collected after animals were sacrificed. Blood glucose was examined by using commercial detection kits. Western blot assay was employed to examine expression of Beclin 1 and LC3 (LC3 I and LC3 II) protein. Results indicated that urinary protein levels were remarkably higher in DN group compared to Normal and Control group (P<0.05). Blood glucose values were also increased in DN group compared to Normal and Control group (P<0.05). Body weights decreased significantly in DN rats compared to Normal group and Control group (P<0.05). Expression of Beclin 1 protein and LC3 proteins was significantly decreased in DN group compared to Normal and Control group (P<0.05). However, Piwil2 transfection could enhance level of Beclin 1 and LC3 protein significantly compared to DN group. In conclusion, the Tiwil 2 mRNA transfection could obviously enhance the autophagy biomarker, including Beclin 1 and LC3 protein, which indicates that the Tiwil 2 treatment has improved the autophagy in diabetic nephropathy rats.

Vascular calcification (VC)is a common pathological change for atherosclerosis,old age, diabetes mellitus,and chronic kidney diseases (CKD),etc,and is highly associated with increased morbidity and mortality of cardiovascular disease (CVD).Now VC has been confirmed as a complex biological process regulated by multiple factors;inflammation may be involved in the formation and progress of VC through a direct or indirect manner.The relationship between inflammation and VC is reviewed in this paper.

Objective To investigate the protective effect and mechanism of MST1 inhibition on kidney tissue in diabetic rats,and to find a new therapeutic target for diabetic nephropathy.Methods Total of 54 male SD rats enrolled in this study were divided into 3 groups including normal control (group A,n=18),MST1 inhibition group (Group B,n=18) and diabetes group (group C,n=18).Diabetes was induced by a single streptozotocin (STZ,50 mg/kg) injection in group B and group C.rats in group B received lentiviral vector contain Mst1 interference RNA (shRNA) and the rats in group C received empty vector.The end of 4th,8th and 12th week after modeling were considered as time points in this study.At each time point,the level of 24 hours urine protein (24-HUP),blood glucose and serum creatinine were examined.Pathological changes were observed with HE stain; Injury of podocyte and glomerular basement membrane (GBM) were examined with transmission electron microscope (TEM).The intensity and location of MST1 in kidney tissue were detected by immunohistochemistry.The level of MST1,Phosphorylated-MST1,nephrin,Caspase-3 and FasL were detected by western bloting.Results (1) At the starting point,there were no significant differences among groups in terms of weight,activity,eating and drinking.Since the end of 72nd hour after modeling,the levels of glucose in both group B and group C,compared to those in group A,significantly increased (P ＜ 0.05).There was no significant difference between group B and group C for glucose level at each time point (P ＞ 0.05); the level of 24-HUP increased significantly since the end of 4th week after modeling,and the level in group C was higher than its counterpart in group B at the same point (P ＜ 0.05); (2) There was no significant pathological lesion observed in group A.Without obvious K-W nodular changes,mesangial proliferation was observed in group B and group C.It was shown by TEM that podocyte fusion and thickening of the GBM could be found in group B and group C.The pathological change in group B was better than that in group C; (3) Compared to group A,it was shown by western blot that the levels of MST1,Phosphorylated-MST1,Caspase-3 and FasL in group B and group C were significantly higher (P ＜ 0.05),and the levels of nephrin in group B and group C were significantly lower (P ＜ 0.05) since the end of 4th week after modeling.Meanwhile,the levels of MST1,Phosphorylated-MST1,Caspase-3 and FasL in group B were significantly lower than that in group C at each time point (P ＜ 0.05),the level of nephrin in group B was significantly higher than the one in group C; (4) It was shown by immunohistochemistry that there was low MST1 expression in normal condition,especially in cytoplasm of tubular epithelial cells.The level of MST1 in group B and group C significantly increased after modeling,and the change could be the same as Western blot shown.Conclusions MST1 pathway could be involved in kidney injury induced by diabetes.MST1 inhibition could alleviate the kidney injury in STZ-induced diabetes animal model.

Objective To study the effects of L-carnitine on intradialytic hypotension(IH) and the levels of C-reactive protein(CRP) in maintenance hemodialysis patients. Methods A total of 32 hemodialysis patients with regular IH,who were en-rolled in the hospital from January 2011 to December 2013 ,were selected and divided into four groups after standard hemodialy-sis,8 cases in each group:standard hemodialysis group with 1-week standard hemodialysis (hemodialysis temperature:37 ℃, sodium concentration:140 mmol/L );sequential sodium group with the sodium concentration in dialysate in the first 3 h was 150 mmol/L,then reduced to 135 mmol/L in the last 1 h);low temperature hemodialysis group with the dialysate temperature was 35.5℃in the whole process of hemodialysis;and L-carnitine group with intravenous injection of 1.0 mg L-carnitine after standard hemodialysis,2 times a week for 12 weeks. The occurrence rate of hypertension and serum CRP level among the groups were com-pared after 12-week observation. Results 12 weeks later,the occurrence rate of hypotension in the L-carnitine group[16.0%(40/250)] was lower than that in the standard hemodialysis group[90.0%(225/250)],low temperature hemodialysis group[20.0%(48/240)] and sequential sodium group[50.0%(120/240)],with statistically significant difference(P<0.01 or 0.05). The serum CRP level in L-carnitine group after treatment was lower than that before treatment,and the difference had statistical significance(P<0.05), but there was no statistical significant difference of the other three groups before and after treatment (P>0.05). Conclusion L-car-nitine can decrease the occurrence rate of hypotension in hemodialysis effectively and reduce the serum CRP level .

Objective To assess the correlaion between plasma S- adenosylhomocysteine(SAH) and DNA methylation in patients with chronic kidney disease( CKD). Methods Forty- three patients with CKD and 36 healthy volunteers were included in this study. Plasma Hcy and SAH levels were measured by ELISA and continuous cycle enzyme colorimetric method,respectively. DNA methylation was assessed using HPLC. Results The plasma SAH in CKD patients was significantly higher than that in the healthy controls while DNA methylation decreased. Plasma SAH was negatively correlated with global DNA methylation in patients with CKD. Conclusion High plasma SAH concentration may relate to impaired DNA methylation and mediates the development of cardiovascular complications in patients with CKD.

Objective To investigate the effect of high glucose on MST1 (mammalian sterile 20-like kinase 1)expression in primary glomerular podocytes.Methods Primary podocytes cultured from healthy SD rat kidneys after gradient centrifugation were divided into normal group (cultured with glucose of 5 mmol/L)and high glucose group (cultured with glucose of 25 mmol/L).The cell properties were verified with flow cytometry and immunofluorescence.The time points for observation were after 12,24,48,and 72 hours of cell culture.And immunofluorescence and Western blotting method were used for detecting MST1 and caspase-3 expression.Multiple-group comparison was performed with single factor analysis of variance, while two groups were compared with Q test.Results (1)It was shown by flow cytometry that 93.18% of the podocytes cultured expressed nephrin protein,suggesting that stable culture of primary podocytes was successful.Besides,indirect immunofluorescence staining showed that the podocytes stably expressed nephrin and WT-1 proteins.(2)Immunofluorescence staining showed a small amount of MST1 expression in podocytes of the normal group mainly locating in the cytoplasm,while the expression of MST1 increased in the high glucose group,and more nuclear expression began to appear after 48 h of treatment.(3)Western blotting showed that the levels of caspase-3 and MST1 were significantly higher in the high glucose group than in the normal group (F =84.989,312.407,P <0.001 ).Furthermore,after 48 h of treatment, cleaved form of MST1 was observed in the high glucose group,which also increased with the time of treatment.Conclusions The dysfunction of MST1 pathway may be involved in the pathogenesis of diabetic nephropathy.

中心静脉置管是目前血液透析患者建立临时性血管通路的最常用方法,具有操作简便、快捷、创伤小及血流量大等优点,但也可能导致一些严重甚至致命的并发症(如大静脉穿通伤).我院收治1例左颈内静脉置管穿通无名静脉后继发血胸、纵膈血肿的患者并成功诊治,结合相关病例进行复习,现报道如下.

终末期肾衰竭（end stage renal disease，ESRD）患者往往合并不同程度的肾性贫血，严重影响患者的生活质量。20世纪80年代，人们首次利用基因工程技术合成重组人促红细胞生成素（recombinant human erythropoietin，rHuEPO）并将其应用于临床，成为肾性贫血治疗史上的里程碑。然而，在其使用过程中，人们逐渐发现促红细胞生成素（EPO）一些罕见的不良反应，如导致纯红细胞再生障碍性贫血（pure red cells aplasia， PRCA）。本科发现1例使用 EPO诱发 PRCA的病例，现报道如下。

To fully understand the characteristics of international students and importance, practicality and usefulness of internal medicine, many targeted measures were taken, including im-proving language level of teachers and students, applying case-based learning method and evidence-based medicine and strengthening the cultivation of humanistic spirit and professional ethics. Quality of internal medicine for international students was improved , which provided new ideas for clinical teaching reform.