This study aims to investigate the impact of ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) on vascular calcification in rats. The rationale behind studying ENPP1’s role in vascular calcification lies in its potential to modulate calcification processes. Understanding this relationship can offer insights into novel therapeutic avenues for addressing vascular calcification-related disorders. In this experiment, vascular smooth muscle cell (VSMC) calcification was induced using β-glycerophosphoric acid. Subsequently, recombinant AAV9-carrying ENPP1 was introduced into VSMCs to achieve both in vitro and in vivo overexpression of ENPP1. The findings indicate that ENPP1 overexpression significantly reduces calcium and phosphorus content in the aorta (P < 0.05). Alizarin red and von Kossa staining reveal notable reductions in calcium salt deposits in VSMCs and aorta, respectively. Notably, the expression levels of BMP-2, PINP, OC, and BALP were substantially decreased in VSMCs (P < 0.05), underscoring ENPP1’s role in impeding osteoblast-like transdifferentiation of VSMCs. Additionally, ENPP1 overexpression led to a significant increase in pyrophosphate (PPi) levels compared to control rats (P < 0.05). In conclusion, this study suggests that ENPP1 contributes to alleviating vascular calcification by elevating PPi levels and inhibiting the phenotypic transformation of VSMCs. These findings shed light on the potential therapeutic role of ENPP1 in mitigating vascular calcification-related complications.

目的 探讨虚拟导航(VBN)联合径向超声(EBUS)引导下经支气管镜肺活检(TBLB)在早期周围型肺癌诊断中的应用价值.方法 回顾性分析2016年6月至2019年9月于绍兴市人民医院呼吸内科住院或门诊就诊、胸部CT高度怀疑为周围型肺癌的患者188例,根据操作设备不同,分为经支气管镜肺活检组(TBLB组)、径向超声组(EBUS+TBLB组)及虚拟导航联合径向超声组(VBN+EBUS+TBLB组),评估三种不同检查方法的诊断阳性率、安全性,以及EBUS组及VBN+EBUS组操作时间.结果 TBLB组、EBUS组及VBN+EBUS组三组患者的诊断率分别为32.2％、64.3％及67.1％,差异有统计学意义(P<0.05),特别是直径为2～3 cm的病灶差异更为明显.亚组分析显示,诊断率与病变肺叶无关,VBN能明显缩短操作时间,超声探头在病灶内部或紧邻病灶诊断率高.结论 在TBLB的基础上联合VBN及EBUS在不增加并发症的情况下能大大提高周围型肺癌诊断的阳性率.

目的:探讨终末期肾病透析患者血清ENPP1水平与腹主动脉钙化之间的关系.方法:选取2019年09月—2020年02月期间在我院定期随访的透析患者124例(腹膜透析54例,血液透析70例),采用酶联免疫吸附法测定患者血清ENPP1浓度,用腹部侧位X线半定量积分法评估腹主动脉的血管钙化程度,根据评分对钙化严重程度进行分组,即无或轻度钙化组(AACS≤4)、中度钙化组(5≤AACS≤15)和重度钙化组(AACS≥16).结果:透析患者血清ENPP1平均水平为(7.68±1.67)ng/ml.腹膜透析和血液透析患者之间血清ENPP1水平差异均无统计学意义.无/轻度钙化者血清ENPP1水平为(8.98±1.70)ng/ml,中度钙化者血清ENPP1水平为(7.60±1.41)ng/ml,重度钙化者血清ENPP1水平为(5.88±1.34)ng/ml,差异有统计学意义.透析患者AACS评分与血清ENPP1值呈负相关(r=-0.70).结论:终末期肾病透析患者血清ENPP1水平与血管钙化的程度呈负相关,能够部分反应血管钙化的程度.

目的:克隆编码大鼠外核苷酸焦磷酸酶/磷酸二酯酶1(ENPP1)的全长cDNA片段,构建ENPP1重组腺相关病毒载体(AAV-ENPP1).方法:以大鼠血管平滑肌细胞mRNA为模板,通过RT-PCR扩增获得大鼠ENPP1基因大片段并克隆至pCDH载体中,经过EcoR I/Xho I酶切、连接、转化将该片段克隆至腺相关病毒载体pAAV-MCS中,酶切及DNA测序对阳性克隆进行鉴定.重组AAV-ENPP1经包装后转染目的血管平滑肌细胞,Western blot检测目的蛋白ENPP1的表达.结果:RT-PCR成功克隆出2721 bp的大鼠ENPP1基因大片段,并最终获得测序正确的pAAV/ENPP1克隆,Western blot检测显示目的蛋白ENPP1的表达升高.结论:成功构建大鼠ENPP1重组腺相关病毒载体.

OBJECTIVE:To investigate the correlation between serum ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) level and severity of abdominal vascular calcification in end-stage renal disease (ESRD) patients receiving dialysis.METHODS:A total of 124 patients were consecutively enrolled into the study in our local institution. Based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines and recommendations, abdomen lateral X-ray was used to determine abdominal aortic calcification score (AACS) for each patient at enrollment. Patients were divided into three groups based on AACS: no or mild calcification group, moderate calcification group, and severe calcification group. The relationships between ENPP1 levels and AACS were assessed by Spearman analysis and the value of ENPP1 in predicting severity of abdominal aortic calcification was evaluated by receiver operating characteristic (ROC).RESULTS:The level of ENPP1 in dialysis patients was (7.68 ± 1.67) ng/ml. There was no significant difference in serum ENPP1 level between peritoneal dialysis patients and hemodialysis patients (p > 0.05). The AACS of dialysis patients was negatively correlated with ENPP1 value (r = -0.70). Compared to no/mild calcification patients, the levels of serum ENPP1 in patients with moderate/severe calcification were decreased significantly (p < 0.01). The severity of vascular calcification was correlated with serum ENPP1 value, the severer the vascular calcification, the lower the serum ENPP1 level, and the difference was statistically significant (all p < 0.05). The area under ROC curve of ENPP1 was 0.90, the corresponding sensitivity was 0.86, and the specificity was 0.87.CONCLUSION:Levels of serum ENPP1 in non-diabetic ESRD patients are negatively related to the severity of abdominal aortic vascular calcification.

随着医疗水平的提高和患者对医疗质量的高要求,全麻支气管镜下高频电圈套切除气道肿瘤的优势逐渐体现出来.我院采用该方法 治疗中心气道肿物狭窄12例,取得满意效果,报道如下: 1 临床资料 1.1一般资料 2016年9月至2017年10月我院收治的中心气道肿物狭窄患者12例,均经术前支气管镜或胸部增强CT确诊,有不同程度的呼吸困难.男9例,女3例.年龄30～68岁,平均50岁.

1 病历摘要 患者,男性,30岁,因"反复咳嗽咳痰8月余,再发伴发热3天"于2017年6月14日入院.患者于8个月前无明显诱因下出现咳嗽,咳少量白痰,感胸部不适,右侧卧位时明显,曾到当地医院就诊,予抗感染治疗(具体不详),症状仍有,咳痰有所减少.

目的探讨经支气管镜冷冻法摘取成人难取性气道异物的临床效果.方法选取成人难取性气道异物患者9例,所有患者先通过支气管镜常规方法(异物钳等)取异物10min以上,未成功取出异物或残留部分异物,后改为经支气管镜冷冻法摘取难取性气道异物.结果经支气管镜冷冻法均成功取出全部气道异物,平均操作时间(6±2)min.气道异物种类分别为虾7例,田螺壳1例,玉米1例.取出异物后,患者咳嗽、咳痰、气促、痰血等症状明显好转.复查胸部CT原有肺部炎症吸收.支气管镜复查可见支气管腔通畅,未发现气道软化及瘢痕现象.患者均未出现气道穿孔、大出血、气胸、纵隔气肿等严重并发症.结论经支气管镜冷冻法摘取成人气道难取性异物安全有效.

肺动脉高压是以肺动脉血管阻力进行性升高为主要特征的一组疾病,发生机制复杂,肺源性心脏病是其终末阶段.趋化因子CX3CL1(fractalkine,FKN)是趋化因子CX3C亚族的惟一成员,具有可溶形式及膜结合形式,既有趋化性蛋白的功能也有细胞黏附分子的功能,还具有促进平滑肌细胞增殖的生长因子作用[1].本研究通过野百合碱诱导的肺动脉高压大鼠模型观察肺动脉高压发展过程中FKN的表达变化,探讨FKN在肺动脉高压形成过程中的作用和可能的机制.

AIM: To observe the change of CX3CL1/fractalkine(FKN) in the rats with monocrotaline-induced pulmonary hypertension,and to study the intervention of puerarin.METHODS: The pulmonary hypertension model was established in vivo by intraperitoneal injection of monocrotaline.Thirty male Sprague-Dawley rats(270-310 g) were randomly divided into 3 groups: control group(C),monocrotaline model group(M)and puerarin treatment group(M+P).The mean pulmonary arterial pressure(mPAP),mean right ventricular pressure(mRVP),mean carotid arterial pressure(mCAP) and the weight ratio of right ventricle(RV) to left ventricle plus septum(LV+S) [RV/(LV+S)]were also detected.The structural changes of pulmonary arterioles were observed under optical microscope.Remodeling of lung blood vessels was determined by measuring the ratio of vessel wall area to total area(WA/TA) and the medium thickness of pulmonary artery(PAMT).The concentration of soluble fractalkine(sFKN) in plasma was measured by ELISA.The expression of FKN in the pulmonary artery wall was measured by immunohistochemistry.The mRNA level of FKN in the lung tissues was detected by RT-PCR.RESULTS: mPAP,mRVP,RV/(LV+S),WA/TA and PAMT in M group were higher than those in C group(P0.01).RV/(LV+S),WA/TA and PAMT in M+P group were significantly lower than those in M group(P0.01).No significant difference of mCAP among the 3 groups was observed.The levels of sFKN,FKN mRNA and FKN protein in M group were higher than those in C group(P0.01),and the above data in M+P group were lower than those in M group(P0.05).The serum level of sFKN had a positive correlation with PAMT and RV/(LV+S)(r=0.719,r=0.685,respectively,P0.01).CONCLUSION: Puerarin down-regulates the expression of FKN and suppresses the development of pulmonary hypertension and pulmonary vessel remodeling.

Objective To analyze systemically and unitarily the change proteins in the lung tissue when pulmonary hypertension forms through pulmonary tissue proteomic analysis between pulmonary hypertention rats induced by monocrotaline and normal rats. Methods Forty SD male rats were divided into four groups:normal group(group N), solvent control group(group C),2 week of monocrotaline(group M2), 3 week of monocrotaline (group M3). Mean pulmonary arterial pressure (mPAP), mean carotid arterial pressure(mCAP) ,weight ratio of right ventricle to left ventricle plus septum [ RV/(LV+ S)], thickness of pulmonary arterial media smooth cell layer(PAMT) were measured. Two-dimensional get eleetrophoresis of the total proteins from four groups, gel enzymolysis, MALDI-TOP-TOF-MS and retrieval databank in NCBInr were made. Results There were no significance in mPAP, RV/(LV+ S), PAMT of group N and group C. mPAP, RV/(LV+ S), PAMT of group N, group M2,group M3 rose up one by one( P <0.05 or P< 0. 01),which indicated that the pulmonary hypertention gradually formed, pneumoangiogram rebuilded, the right ventricle hypertrophy speared, and the rat model of pulmonary hypertention established successfully. The MALDI-TOF-TOF-MS discovered that there was hardly any expression of calreticulin precursor in group N and group C, and there was great expression in group M3. It could make great function in the development of pulmonary hypertension and pneumoangiogram rebuilding. Conclusions Calreticulin precursor could be related to the development of pulmonary hypertension and neumoangiogram rebuilding,it worths deep study.

目的:对临床诊断为泌尿生殖道炎症的患者进行支原体培养鉴定并药敏分析,了解目前支原体感染耐药情况。方法:对662例泌尿生殖道炎症患者行泌尿生殖道分泌物拭子支原体培养并做12种抗生素药物敏感性鉴定。结果:662例泌尿生殖道炎症患者中支原体感染率为31.72%,其中解脲支原体、人型支原体及两者混合感染的感染率分别为27.19%、1.36%、3.17%。在感染率最高的解脲支原体中对交沙霉素、强力霉素、美满霉素敏感性较强,敏感率分别为88.33%、87.22%、81.67%,对环丙沙星、氧氟沙星、左氧氟沙星敏感性较差,敏感率分别为7.78%、11.67%、13.33%,对其余几种抗生素都有不同程度的耐药。结论:临床上泌尿生殖道炎症患者多伴有支原体的合并感染,支原体对多种抗生素出现耐药,有必要行支原体培养鉴定和药敏测定指导临床用药。

Objective:To compare the diagnostic value of some clinical parameters of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and look for a simple way to diagnose this disease. Methods: The case history, clinical scale, Epworth sleeping scale(ESS) and body parameters of the OSAHS patients diagnosed by PSG and snoring disease patients were recorded respectively. Multi-variable ROC curve would be used to screen the most valuable clinical parameters which were used with forward conditional Logistic regression analysis. Results: ESS, neck circumference, min SpO2, and history of diabetes mellitus had good predictive value for diagnosis. Combination of the four parameters and useing the Logistic regression equation model were a good and new diagnostic method. Sensitivity is 76%, spesificity 96%, maximum Youden index 0.714, and area under ROC curve 0.926. Conclusion: Combination of multi-parameters is better than single one in OSAHS diagnosis, and can be used in simple clinical diagnosis.

目的探讨年龄、肥胖、颈围等临床相关易患因素与不同性别阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情和程度的关系。方法对因睡眠打鼾就诊的422例患者行身体参数测量,检测整夜多导睡眠图,分析不同性别患者年龄、颈围、主客观评分、最低血氧饱和度、氧减指数与睡眠呼吸暂停低通气指数(AHI)的关系。结果不论男女性别,OSAHS组与鼾症组各指标比较差异均有显著性,与AHI呈一定相关关系(P<0.05)。两组主观评估(ESS)、最低氧饱和度、氧减指数比较差异有显著性,与AHI有较强的相关性(P<0.05),男性OSAHS者与鼾症者比较年龄差异不明显,颈围明显偏大,而女性OSAHS者年龄较鼾症者大,颈围与AHI无关。结论超重和腹部脂肪蓄积的打鼾者有更大的呼吸暂停的危险性,年龄和颈围在对病情评估和预测时受性别影响较大,ESS、最低氧饱和度或氧减指数(ODI)可作为病情预测的简易指标。

腺苷是一种在体内广泛存在的神经调质,特别在中枢神经系统中发挥着重要的作用。腺苷通过其不同类型的受体对睡眠、学习记忆、抑郁和焦虑等多种生理和病理过程产生影响。转基因技术的研究,使腺苷受体有可能成为治疗神经精神疾病的新靶点。

Objective To study the clinical characteristics of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and look for a simple way to assess the patient’s condition. Methods 419 patients snoring during sleep were examined by all-night polysomnography and nocturnal oxygen saturation monitor. Then we analyzed the clinical characteristics of the patients divided into 4 groups according to apnea-hypopnea index (AHI). Results The morbidity rate is 84.0% in the snorers. There were significant difference among Epworth Sleep Scale (ESS), Clinical Scale (CS), AHI, blood pressure, obesity parameters, min-SpO2 and oxygen desaturation index (ODI) in patients of each group of OSAHS and simple snoring disease. We used stepwise multiple linear regression to analyze the commonly used clinical parameters, and find that ODI, min-SpO2, and ESS were statistical significant correlation with AHI (R=0.862). Conclusions OSAHS has a high morbidity rate in outpatients with snoring. Age and obesity are liability factors of OSAHS. With the development of OSAHS, blood pressure and blood oxygen will become worse and worse. ODI, min-SpO2 and ESS can be used to assess the pathogenetic condition, even make a primary diagnosis.

The obstructive sleep apnea-hypopnea syndrome(OSAHS)is considered as a complex genetic disorder with high mor- bidity and mortality.More and more evidence indicate that it has familial aggregation and genetic predisposition.Some gene phenotypes related to upper airway anomalies,abnormal breathing control,obesity,hypertension and insulin resistance might act to increase suscepti- bility to OSAHS.This article reviews current knowledge about a genetic approach to the causes and risk factors for sleep apnea.

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是由多种致病因素引起的发病率高、危险性大的疾病.OSAHS患者多伴有高血压、肥胖、胰岛素抵抗、糖尿病、冠心病等,被认为是一种全身性疾病,其发病机制与代谢综合征(MS)有重叠,可能涉及到共同的基因及环境因素.本文综述了两者在临床表现和发病机制等方面的关系.

目的:观察肺血栓栓塞症的各种临床资料并对其进行统计,为更好地诊断、治疗提供依据。方法:对两院确诊的肺血栓栓塞症病例详细的临床表现、实验室检查情况、危险因素、治疗方案及结果、误诊情况进行统计分析。结果:70例病例符合肺血栓栓塞症诊断与治疗指南的临床表现、辅检、治疗方案等。结论:肺血栓栓塞症具有高发病率、易误诊、病死率高的特点,临床医师对缺乏典型临床表现的病人应进行全面地诊断及鉴别诊断,寻找合适有效的检查来明确病因。