This study was to explore the relationship between cardiovascular health (CVH) and the risk of all-cause mortality in patients with osteoarthritis (OA). This cohort study retrieved the data of 3642 patients with OA aged ≥ 20 years from the 2007—2018 National Health and Nutrition Examination Survey (NHANES). CVH was evaluated based on Life’s Essential 8 (LE8) includes diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. The outcome of all-cause mortality was assessed using the death certificate records of participants from the National Death Index. Variables that might affect all-cause mortality were used as covariates. The weighted univariate COX proportional hazards model was used to explore the association between each covariate and all-cause mortality. The weighted univariate and multivariate COX proportional hazards models were used to explore the association between different CVH levels and all-cause mortality. A restricted cubic spline (RCS) curve was plotted to show the association between different CVH levels and all-cause mortality in OA patients. Hazard ratio (HR) and 95

Objective To investigate the mechanism of calcitriol on proteinuria induced by podocyte destruction by observing the correlation between the 1,25（OH） 2 VD 3 and Ang II-induced endoplasmic reticulum stress in podocytes.Methods The mus musculus Podocyte cell line（MPC5） was cultured in vitro and randomly divided into three groups, namely, the blank control group（A）, the Ang II group(B, treated with 10 -6 mol/L angiotensin II), and the 1,25（OH） 2 VD 3 combination group(C, treated with 10 -6 mol/L angiotensin II and 10 -8 mol/L 1,25（OH） 2 VD 3 ). The cells of each group were collected after 6 h, 12 h, 18 h and 24 h of the treatment. The mRNA expression and protein expression of glucose regulated protein（GRP78） and protein kinase like endoplasmic reticulum kinase（PERK） in samples of each group at different time points were detected by real-time quantitative PCR and immunofluorescence techniques.Results Compared with those in group A, the expression levels of GRP78 and PERK mRNA in group B increased significantly at all time points（P＜0.01）. Compared with those in group B, the expression levels of GRP78 and PERK mRNA in group C decreased significantly at all time points（P＜0.01 or＜0.05）, and the corresponding GRP78 and PERK protein expression levels were lower. The expression levels of GRP78 and PERK mRNA in the Ang II group were significantly increased at 12 h compared with those at 6 h（P＜0.01）. The expression levels of GRP78 PERK mRNA in the Ang II group increased significantly at 18 h compared with those at 12 h（P＜0.01 or＜0.05）, and the expression levels of GRP78 and PERK mRNA increased significantly at 18 h compared with 12 h（P＜0.01 or＜0.05）.Conclusion Ang II can induce endoplasmic reticulum stress in podocytes and the strength of ERs is related to the administration time. However, 1,25（OH） 2 VD 3 can protect podocytes by inhibiting Ang II-induced ERs in podocytes.

他克莫司治疗窗窄,个体间的药动学/药效学差异较大.以往研究表明临床指标和遗传因素可能是影响他克莫司剂量选择的重要因素,但这对个体差异的解释仍有限.近年来,微小RNA(miRNA)作为一种潜在的生物标志物和特异性治疗靶点受到广泛关注,该文汇总分析了与他克莫司代谢相关的miRNA研究进展,期望能够为该药临床个体化用药研究提供新的思路.目前关于miRNA与他克莫司相关性的研究,以miRNA对CYP3A5的影响居多,涉及miR-29a-3p、miR-99a-5p、miR-532-5p、miR-500a-5p等;与CYP3A4表达相关进而影响他克莫司药动学的miRNA,如miRNA-627-5p;作用于钙调磷酸酶进而影响他克莫司体内作用的miRNA,如miR-582-5p;肾移植患者尿液外泌体中与他克莫司剂量呈正相关的miRNA,如miR-155-5p和miR-223-3p,但这两种miRNA通过何种途径影响他克莫司浓度尚未阐明;可能与他克莫司体内不良反应相关的miRNA,如 miR-26b、miR-145、miR-183、miR-21-5p,miR-199a-5p 和 miR-214-3p、miR33a 有关.研究提示,miRNAs 能够在预测他克莫司疗效和不良反应方面提供新的生物标志物和干预靶点.

随着我国老龄化进程的加快,慢性非传染性疾病的健康管理问题愈加严峻,医学生作为慢病管理的首要一环,其慢病管理和防控能力的培养将越来越重要.该体系以创新性教育为导向,合理、科学地规划理论和实践教学,在理论教学中将课堂与互联网相结合,实践教学通过构建"三课堂"联动、"递进式"教学和医工结合的特色实践模式,打破传统教学模式的桎梏,推进慢病管理教学模式的改革,在提高学生动手能力和水平的同时,培养和提高了医学生实践创新能力、自主学习能力、科研能力和人文素养,有助于学生熟练掌握运动系统慢病管理方法,助力我国慢病管理工作的推进.

目的 探讨半月板修复研究的热点和趋势.方法 于Web of Science(WOS)核心合集,检索2011年1月1日至2021年12月31日所有半月板修复相关文献,用WOS自带分析功能及Citespace软件对检索结果进行描述性统计、共现、聚类及突现文献分析.结果 文献数量整体呈上升趋势;美国在论文数、引用量、研究机构及资助基金方面均有巨大优势,Smith nephew和Arthrex在此领域资助较多.论文涉及多学科,以临床学科为主.文献共现分析列出引用频次及中心性前10名文献共18篇(其中2篇为重复);聚类分析获得成员>10个的主要聚类7个;绘制聚类共现图谱和时间线图;列出前25篇突现引文.结论 半月板修复研究在近11年内呈上升趋势,其中半月板缝合是目前的研究热点,未来在生物打印半月板、组织工程和异体半月板混合物或半月板补片等方面将有更多技术和材料的突破.

目的 探讨"激越四段式"教学法在实验诊断学教学中的应用效果.方法 选取 2022 年 3-6 月某医学院校五年制临床医学专业的 2019 级三年级医学生共 146名作为研究对象,每组 73 名,分为"激越四段式"教学组和传统教学组,课程结束后对两组学生进行理论考核和临床思维能力测试,并采用调查问卷的形式对教学方法进行反馈.结果 "激越四段式"教学组所有学生对课堂评价为非常满意或满意,传统教学组仅有82.67%的学生对课堂评价为十分满意或满意,且"激越四段式"教学组十分满意度明显高于传统教学组,差异有统计学意义(P＜0.05)."激越四段式"教学组理论测试及临床思维分析能力测试成绩均高于传统教学组,差异有统计学意义(P＜0.05).教学效果评价上,"激越四段式"教学组在激发学习兴趣、查阅文献能力、自主学习及创新思辨能力方面,得分均明显高于传统教学组,差异有统计学意义(P＜0.05).结论 在实验诊断学的教学中采用"激越四段式"教学法,能够激发学生的主观能动性,培养学生自主学习和分析解决问题的能力,加深学生对知识的记忆和运用,有利于临床思维的培养.

Purpose This study was designed to investigate the clinicopathological features of idiopathic membranous nephropathy (IMN) with hyperuricemia (HUA), together with associated factors within 10 years in a single centre in Shandong Province. Methods In this cross-sectional study, we analysed the clinical and pathological data of 694 IMN patients in our hospital from January 2010 to December 2019. Based on serum uric acid (UA) level, the patients were divided into hyperuricemia (HUA) group ( n = 213) and normal serum uric acid (NUA) group ( n = 481). Multi-variate logistic regression analysis was conducted on to screen the associated factors of HUA. Results 213 (30.69%) IMN patient were complicated with HUA. Compared with the patients with NUA, significant increase was noticed in the proportion of patients showing edema, concurrent hypertensive disease or diabetes mellitus (DM), as well as the proportion of positive glomerular capillary loop IgM and positive C1q in the HUA group ( P < 0.05). In addition, significant increase was noticed in the 24 h urine protein, serum creatinine, triglycerides, complement C3 and complement C4 in HUA group compared with those of NUA group (all P < 0.05). With gender as a control factor, multi-variate logistic regression analysis showed positive glomerular capillary loops C1q, serum albumin, serum phosphorus were associated with IMN combined with HUA in male, while triglycerides and serum creatinine were associated with IMN combined with HUA in female counterparts. Conclusion About 30.69% of IMN patients had HUA, with a male predominance than female. In male patients with IMN, higher serum albumin level and serum phosphorus level were associated with higher incidence of HUA, while in female IMN patients, higher serum triglyceridemia and serum creatinine level were associated with higher incidence of HUA. Therefore, it can be targeted to prevent the occurrence of HUA in IMN.

Ferroptosis, a newly discovered non-apoptotic iron-dependent cell death pattern, plays an essential role in the development of acute kidney injury, tumors, liver disease, Parkinson's disease, and other diseases. More recently, it has been shown that ferroptosis is also involved in the development of diabetic kidney disease (DKD). In this paper, we review the mechanism of ferroptosis and its progress in DKD to provide a basis for the regulation using ferroptosis.

目的 探讨血栓弹力图(TEG)在评估全膝关节置换术(TKA)后下肢深静脉血栓形成(DVT)风险中的应用价值.方法 根据纳入、排除及退出标准,选取2018年1月—2020年1月在我科因膝关节骨关节炎行单侧TKA的患者316例.随访时间为90天,根据随访期内,经下肢血管彩超诊断是否发生DVT分为非血栓组(非DVT组)305例,血栓组(DVT组)11例.于术前1 d,术后第14天,采用血栓弹力仪检测TEG,记录TEG指标数据R值,K值,MA值,CI值,Al-pha角度及TDR值.结果 非DVT组与DVT组在性别、年龄、吸烟情况、手术时间或止血带时间方面差异无统计学意义(P>0.05);DVT组的体质量指数(BMI)高于非DVT组(P<0.01).术前非DVT组与DVT组R值、K值、Alpha角度、MA值、CI值及TDR值间差异无统计学意义.术后两组比较,DVT组术后R值、K值减小,Alpha角度、MA值和TDR值增加(P<0.01),差异均有统计学意义.ROC曲线分析:R值,K值,Alpha值,MA值及TDR值对DVT诊断的曲线下面积(AUC)分别为:0.95,0.77,0.91,0.97和0.99,约登指数分别为0.76,0.72,0.91,0.89和0.91.R值,K值,Alpha角度和MA值及TDR值的Cut-off分别为5.40 min,1.40 min,69.20°,67.10 mm和765.80.二元logistic回归:在R值,K值,MA值,CI值,Alpha角度及TDR值中,TDR值是唯一有可能有临床价值的血栓弹力图指标(OR:1.01;95％CI:1.00～1.02;P=0.021).结论 TEG在TKA后下肢DVT形成风险的评估中有一定应用价值,TDR值与下肢DVT形成有明显相关性,但在参数范围标准化方面尚需进一步研究.

目的 基于p38丝裂原活化蛋白激酶(MAPK)信号通路,探讨富马酸二甲酯对肾草酸钙结石大鼠肾功能及氧化应激的影响及其作用机制.方法 将30只SPF级SD雄性大鼠随机分为对照组、模型组、富马酸二甲酯组,每组10只.其中模型组、富马酸二甲酯组大鼠腹腔注射0.25％L-羟脯氨酸2.5 kg/(kg·d)复制肾草酸钙结石大鼠模型.富马酸二甲酯组大鼠腹腔注射富马酸二甲酯25 mg/(kg·d),连续28 d,对照组、模型组同时腹腔注射等量生理盐水.采用全自动生化分析仪检测大鼠尿蛋白、尿钙,以及血肌酐水平;HE染色检测大鼠肾组织草酸钙晶体形成情况;试剂盒检测血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)及活性氧簇(ROS)水平;Western bloting检测大鼠肾组织p38 MAPK通路蛋白相对表达量.结果 与对照组比较,模型组和富马酸二甲酯组大鼠肾组织SOD活性降低,草酸钙晶体含量、尿蛋白、尿钙、血肌酐及肾组织MDA、ROS水平,p-JNK、p-p38蛋白相对表达量升高(P<0.05);但富马酸二甲酯组大鼠SOD活性高于模型组(P<0.05),肾组织草酸钙晶体含量、尿蛋白、尿钙、血肌酐,肾组织MDA、ROS水平,p-JNK、p-p38蛋白相对表达量低于模型组(P<0.05).结论 富马酸二甲酯可能通过抑制p38 MAPK通路活化,抑制肾脏组织氧化应激反应,从而抑制肾草酸钙结石形成,进而保护肾功能.

目的 探讨三七总皂甙(panax notoginseng saponins,PNS)通过Smads信号通路减缓慢性肾衰竭(chronic renal failure,CRF)大鼠肾间质纤维化进程的作用.方法 60只大鼠随机留取10只设为假手术组,其余50只采用5/6肾切除术复制CRF模型,将建模成功的44只大鼠随机分为慢性肾衰竭组、尿毒清组、三七总皂甙低剂量组(LPNS组)、三七总皂甙高剂量组(HPNS组),每组11只.尿毒清组灌胃2.2 g·kg-1的尿毒清溶液,三七总皂甙低剂量组和三七总皂甙高剂量组灌胃25、100 mg· kg-1的三七总皂甙溶液,假手术组和慢性肾衰竭组灌胃等量生理盐水溶液,连续4周.干预结束后,检测各组肾功能指标:血肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白,HE和Masson染色观察残余肾组织病理学改变及肾组织纤维化面积占比,RT-qPCR和Western Blot法检测残余肾组织中转化生长因子β1(TGF-β1)、Smad2/3、Smad6 mRNA表达量及TGF-β1、Smad2/3、p-Smad2/3、Smad6蛋白表达量.结果 与慢性肾衰竭组比较,尿毒清组、三七总皂甙低剂量组、三七总皂甙高剂量组血肌酐、尿素氮、24 h尿蛋白水平均降低,三七总皂甙高剂量组低于三七总皂甙低剂量组和尿毒清组(均P＜ 0.05).HE染色显示,慢性肾衰竭组可见肾小球、肾小管明显病变,肾间质纤维化增生,大量炎性细胞浸润;尿毒清组、三七总皂甙低剂量组、三七总皂甙高剂量组上述病变减轻,其中三七总皂甙高剂量组病变最轻.与慢性肾衰竭组比较,尿毒清组、三七总皂甙低剂量组、三七总皂甙高剂量组肾组织纤维化面积占比、TGF-β1 mRNA相对表达量及TGF-β1、p-Smad2/3蛋白相对表达量均降低,三七总皂甙高剂量组低于三七总皂甙低剂量组和尿毒清组(均P＜ 0.05).与慢性肾衰竭组比较,尿毒清组、三七总皂甙低剂量组、三七总皂甙高剂量组Smad6 mRNA和蛋白相对表达量升高,三七总皂甙高剂量组高于三七总皂甙低剂量组和尿毒清组(均P＜0.05).结论 三七总皂甙可有效减缓慢性肾衰竭大鼠肾间质纤维化进程,可能通过抑制Smad2/3磷酸化水平,激活Smad6发挥调控作用.

目的 评价PDCA循环理论在关节镜手术培训中的应用效果.方法 选取2016年1月—2018年12月在骨关节外科轮转的42名进修医师及规范化培训医师作为研究对象,以随机分组法,将其分为实验组和对照组,每组各21名学员.实验组在PDCA方法指导下进行培训,对照组按照常规方法进行培训.对比实验组和对照组关节镜手术情况评分、学员满意度.结果 通过培训,两组学员关节镜手术情况评分均得到了提高(P<0.05),实验组提高更为显著(P<0.05),两组间满意度的差异没有统计学意义(P>0.05).结论 在关节镜手术培训证中,PDCA可以提高学员关节镜手术能力,同时不影响学员满意度,有应用价值.

目的:分析来氟米特联合中小剂量泼尼松治疗老年慢性肾小球肾炎的效果.方法:2016年1月-2019年12月收治老年慢性肾小球肾炎患者126例,随机分为两组,各63例.对照组采用泼尼松药物治疗;观察组采用来氟米特联合小剂量泼尼松治疗.比较两组治疗效果.结果:观察组治疗12个月后尿蛋白、血尿素氮(BUN)、肌酐(SCr)等指标水平均优于对照组,差异有统计学意义(P<0.05);观察组治疗3个月、6个月及12个月临床症状缓解率均明显高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05).结论:采用来氟米特联合中小剂量泼尼松治疗老年慢性肾小球肾炎,相比于单一应用泼尼松治疗的效果更加明显,能够有效降低尿蛋白量,提高患者治疗有效率,且用药期间不增加不良反应发生率.

Objective To investigate the protective effects of astragalosides Ⅳ (ASI) on high glucose-induced renal proximal tubular epithelial cells (NRK-52E).Methods NRK-52E were cultured and divided randomly into three groups:control group,high glucose group (HG in short),ASI groups (with various doses).Cells were treated with increasing concentrations of ASI (20,40,80 and 100 μg/ml) for 24 h in high glucose and we also stimulated cells in ASI 100 μg/ml with high glucose for various lengths of time.The apoptosis rate was detected by flow cytometric analysis.The mRNA and protein expression of transforming growth factor-β1 (TGF-β1),a-smooth muscle actin (α-SMA),Smad2,Smad3 and their phosphorylated forms were detected by real-time polymerase chain reaction (PCR) and Western blot,respectively.Results Compared with the control group,apoptosis was increased in the high glucose group (P ＜ 0.01).However,ASI inhibited high glucose-induced cell apoptosis in a dose-dependent manner,with a maximal inhibitory effect achieved at 100 μg/ml (P ＜ 0.05).The significant inhibition caused by ASI was observed at 8h after the start of pretreatment (P ＜ 0.05) and increased in a time-dependent manner.ASI can inhibit the expression of TGF-β1,α-SMA,Smad2,Smad3 both at mRNA and protein level.Conclusions ASI inhibited NRK-52E cells apoptosis induced by high glucose and reduced expression of TGF-β1,α-SMA,Smad2,Smad3 both at the mRNA and protein level in NRK-52E cells,thus delayed epithelial-to-mesenchymal transition progress.

目的 观察不同浓度葡萄糖腹膜透析液(dextrose)、艾考糊精腹膜透析液(icodextrin)对大鼠腹膜间皮细胞血管内皮生长因子(VEGF)及其受体VEGFR1、VEGFR2、sFlt-1合成的影响.方法 分离、培养SD雄性大鼠腹膜间皮细胞(RPMCs),第二代细胞用于实验研究.实验分为5组,分别以不同腹膜透析液〔1.50％dextrose(低糖组)、2.50％dextrose(中糖组)、4.25％dextrose(高糖组)、7.50％icodextrin组(糊精组)〕进行刺激培养,无血清DMEM为阴性对照(对照组).RT-PCR法检测VEGF及其受体VEGFR1、VEGFR2、sFlt-1 mRNA表达,Western印迹法检测RPMCs的VEGFR1、VEGFR2蛋白表达;酶联免疫吸附试验(ELISA)检测细胞培养上清中VEGF及sFlt-1表达.结果 各组均见VEGFR1、VEGFR2、sFlt-1 mRNA和蛋白表达.在核酸和蛋白水平,中糖组、高糖组VEGFR1表达明显高于低糖组、糊精组及对照组(P<0.01,P<0.05);中糖组、高糖组VEGFR2表达显著低于低糖组、糊精组及对照组(均P<0.01);低糖组VEGFR2蛋白表达显著低于对照组(P<0.01).在核酸水平,中糖组、高糖组VEGF、sFlt-1表达明显高于对照组(P<0.01);RPMCs培养上清液中,VEGF、sFlt-1蛋白表达强弱趋势与RT-PCR一致.结论 正常培养的RPMCs表达VEGFR1、VEGFR2及sFlt-1.腹膜透析液,尤其是高浓度dextrose,能明显上调VEGF、VEGFR1及sFlt-1的表达,但下调VEGFR2的表达,提示其可通过调节VEGF受体从而调节VEGF系统,这可能是导致长期腹膜透析过程中腹膜血管增生的机制之一.icodextrin的生物相容性可能优于高浓度dextrose.

病例资料患者:男,59岁,因"双下肢水肿20 d,腰痛4 d,发热1d"于2015年9月10日入院。患者入院前20 d曾伤及右足趾出现皮肤破损,随后出现双下肢水肿,在当地医院查血生化示肌酐75. 6μmol/L,予以利尿消肿等治疗（具体不详）后双下肢水肿消退,破损处愈合。入院前4 d患者出现腰痛,为持续性钝痛,尿色深,无肉眼血尿,到我院门诊查血生化示丙氨酸转氨酶130. 5 U/L,天冬氨酸转氨酶108. 9 U/L,白蛋白32. 4 g/L,尿素氮12. 5 mmol/L,肌酐153. 5μmol/L,尿常规

系统性红斑狼疮( systemic lupus erythematosus , SLE)是一种多因素参与的系统性自身免疫性疾病.患者突出表现有多种自身抗体并通过免疫复合物等途径造成全身多系统受累,以急性心肌梗死( acute myocardial infarction ,AMI)起病的较为少见,本文报道1例以AMI为首发表现,病程中出现Evans综合征及深静脉血栓形成的SLE 1例.

目的 研究维生素E抑制环磷酰胺所致肾小管上皮细胞毒性作用的影响.方法 通过MTT和中性彗星实验,分别观察环磷酰胺单独或与维生素E联合应用时对肾小管上皮细胞生存率及DNA损伤的作用.结果 与对照组相比,1、3mol/L环磷酰胺处理肾小管上皮细胞12h后可显著降低细胞生存率,并可造成细胞的DNA损伤(P<0.05);与环磷酰胺处理组相比,1mmol/L维生素E显著降低了环磷酰胺致肾小管上皮细胞DNA损伤的作用(P<0.05),但对环磷酰胺降低肾小管上皮细胞生存率的作用无明显影响(P>0.05).结论 维生素E对抗环磷酰胺致肾小管上皮细胞DNA损伤的作用.