脐血干细胞移植干预妊娠期高血压模型大鼠的作用

BACKGROUND:With the depth understanding of mesenchymal stem cells, mesenchymal stem cells are found to exert a prominent effect on immune regulation and anti-inflammation. OBJECTIVE:To investigate the therapeutic effect of umbilical cord blood stem cell transplantation on endotoxin-induced hypertension in pregnant rats. METHODS:Twenty-four pregnant Sprague-Dawley rats were randomized into three groups with eight rats in each group: control, model and experimental groups. Endotoxin-induced hypertension models were made in the model and experimental groups. Meanwhile, rats were given intravenous injection of umbilical cord blood stem cell suspension (1 mL) in the experimental groups and the same volume of normal saline in the control and model groups. Therapeutic effects of umbilical cord blood stem cell transplantation were observed through detection of systolic blood pressure, urine protein level, serum white blood cell quantity and Ang II and ET-1 expression. RESULTS AND CONCLUSION:Compared with the control group, the systolic blood pressure, urine protein level and serum white blood cell quantity of rats were increased significantly in the model group, and over time, endotoxin continuously promoted these parameters in the model group. After cell transplantation, a significant reduction in systolic blood pressure, urine protein level and serum white blood cell quantity of rats was found in the experimental group compared with the model group (P < 0.05). After modeling, the expression levels of Ang II and ET-1 were decreased significantly, while these levels were increased significantly after cell transplantation (P < 0.05). These findings indicate that umbilical cord blood stem cell transplantation may have a certain therapeutic effect on gestational hypertension in rats, which may be realized by regulating the secretion of endothelial injury-related factors.     

Lack of Evidence to Support Thromboprophylaxis in Hospitalized Medical Patients with Cancer

Background

The administration of anticoagulant thromboprophylaxis for all patients with cancer who are hospitalized for acute medical illness is considered standard practice and strongly recommended in clinical guidelines. These recommendations are extrapolated from randomized controlled prophylaxis trials not specifically conducted in cancer cohorts. Because hospitalized patients with cancer constitute a unique population with increased risk of venous thromboembolic events and major hemorrhage, validation of the efficacy and safety of primary thromboprophylaxis in this population is critical. We sought to summarize the rates of venous thromboembolic events and major bleeding episodes among hospitalized patients with cancer who were receiving anticoagulant therapy compared with placebo.

Methods

A systematic literature search strategy was conducted using MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials. Two reviewers independently extracted data onto standardized forms. The primary end points were all venous thromboembolic events. Secondary end points included major bleeding episodes and symptomatic venous thromboembolic events. Pooled analysis with relative risk using a random effect model was used as the primary measurement.

Results

A total of 242 citations were identified by the literature search. Of these, 3 placebo-controlled randomized trials included venous thromboembolic events as a primary outcome and were analyzed according to cancer subgroups. The pooled relative risk of venous thromboembolic events was 0.91 (95% confidence interval, 0.21-4.0; I²: 68%) among hospitalized patients with cancer who were receiving thromboprophylaxis compared with placebo. None of the trials reported the rates of symptomatic venous thromboembolic events or major bleeding episodes according to cancer status.

Conclusions

The risks and benefits of primary thromboprophylaxis with anticoagulant therapy in hospitalized patients with cancer are not known. This is especially relevant because numerous Medicare-type pay-for-performance incentives mandate prophylaxis specifically in patients with cancer.     

过敏原特异性T细胞检测方法的研究进展

追踪T细胞数量和功能的变化在临床诊断和评估过敏原免疫治疗疗效等方面具有重要的参考价值。本文综述了羧基荧光素琥珀碱亚胺酯连续稀释法、酶联免疫斑点检测法、胞内细胞因子染色法和微阵列免疫传感器等过敏原特异性T细胞检测方法和临床应用的研究进展,为选择和发展合适的检测方法并应用于临床提供参考。     

The evolutionary origin of the major histocompatibility complex: Polymorphism of class II α chain genes in the cartilaginous fish

T cells recognize antigen (Ag) in the form of peptides bound to the major histocompatibility complex (MHC) molecule. One of the important issues in evolutionary immunology is to identify the stage in phylogeny when this mode of Ag recognition emerged. At present, there is a considerable controversy as to whether the cartilaginous fish have the bona fide MHC. In our previous study, we showed that the nurse shark, a member of the cartilaginous fish, has (a) gene(s) capable of encoding MHC class II a chains. In the present study, we examined the polymorphism of nurse shark MHC class II a chain genes designated Gici-DAA and Gici-DBA using the polymerase chain reaction. The Gici-DAA and Gici-DBA genes had six and five alleles, respectively, and individual alleles usually differed by multiple nucleotides. In addition, most of the nucleotide substitutions were located at the putative Ag-binding sites, where non-synonymous substitutions occurred more frequently than synonymous substitutions. The fact that the Gici-DAA and Gici-DBA genes display a polymorphism pattern essentially similar to that of mammalian MHC genes playing a major role in Ag presentation suggests that the cartilaginous fish have the bona fide MHC. Thus, the MHC-peptide-based T cell recognition system appears to have arisen at or before the emergence of the cartilaginous fish.     

氨苄西林预报粪肠球菌和屎肠球菌亚胺培南敏感性的可行性研究

目的 评价氨苄西林预报粪肠球菌和屎肠球菌亚胺培南敏感性的可行性。方法 收集23家医院的127株粪肠球菌和124株屎肠球菌非重复临床分离株。采用微量肉汤稀释法和纸片扩散法测定粪肠球菌和屎肠球菌对青霉素、氨苄西林、亚胺培南的敏感性。结果 纸片扩散法青霉素和氨苄西林均敏感或均耐药的粪肠球菌,微量肉汤稀释法氨苄西林-亚胺培南的分类一致率（CA）均为100.0%,未出现非常重大误差（VME）和重大误差（ME）;纸片扩散法青霉素和氨苄西林均耐药的粪肠球菌,微量肉汤稀释法氨苄西林-亚胺培南的CA为77.8%,ME占22.2%;青霉素耐药、氨苄西林敏感的粪肠球菌,微量肉汤稀释法氨苄西林-亚胺培南的CA为57.1%,纸片扩散法的CA为81.8%。结论 氨苄西林预报粪肠球菌和屎肠球菌亚胺培南敏感性的可靠性优于青霉素,但氨苄西林的敏感性不能用于预报青霉素耐药、氨苄西林敏感表型粪肠球菌和屎肠球菌的亚胺培南敏感性;青霉素敏感可预报粪肠球菌和屎肠球菌对氨苄西林敏感。     

Effects of pioglitazone on cardiovascular events and all-cause mortality in patients with type 2 diabetes: A meta-analysis of randomized controlled trials

AimIn 2019, the Italian Society of Diabetology and the Italian Association of Clinical Diabetologists nominated an expert panel to develop guidelines for drug treatment of type 2 diabetes. After identifying the effects of glucose-lowering agents on major adverse cardiovascular events (MACEs), all-cause mortality, and hospitalization for heart failure (HHF) as critical outcomes, the experts decided to perform a systematic review and meta-analysis on the effect of pioglitazone with this respect.Data synthesisA MEDLINE database search was performed to identify RCTs, up to June 1st, 2021, with duration≥52 weeks, in which pioglitazone was compared with either placebo or active comparators. The principal endpoints were MACE and HHF (restricted for RCT reporting MACEs within their outcomes), all-cause mortality (irrespective of the inclusion of MACEs among the pre-specified outcomes). Mantel-Haenszel odds ratio (MH–OR) with 95% Confidence Interval (95% CI) was calculated for all the endpoints considered.Eight RCTs were included in the analysis for MACEs and HF (5048 and 5117 patients in the pioglitazone and control group, respectively), and 24 in that for all-cause mortality (10,682 and 9674 patients). Pioglitazone neither significantly increased nor reduced the risk of MACE, all-cause mortality, and HHF in comparison with placebo/active comparators (MH–OR: 0.90, 95% CI 0.78–1.03, 0.91, 95% CI 0.77, 1.09, and 1.16, 95% CI 0.73, 1.83, respectively). Pioglitazone was associated with a significant reduction of MACE in patients with prior cardiovascular events (MH–OR 0.84, 95% CI 0.72–0.99).ConclusionsThis meta-analysis showed no significant effects of pioglitazone on incident MACE, all-cause mortality, and HHF.     

TAXUS支架治疗急性冠状动脉综合症的疗效评价

目的评价紫杉醇洗脱冠状动脉支架(TAXUStmBoston公司产品)应用于急性冠状动脉综合症病人的临床疗效及安全性。方法自2003年5月至2004年12月接受TAXUS支架治疗的94例急性冠状动脉综合症患者,观察术后即刻效果、术后6个月心脏性死亡、心肌梗塞、再次血管重建及冠状动脉造影复查情况。病例中包括ST段抬高的急性心肌梗塞27例,非ST段抬高的急性心肌梗死8例,不稳定心绞痛59例。结果支架植入成功率为99%,术中和随访期间无死亡,术后1例出现亚急性血栓,1例晚期血栓致心肌梗塞,另有5例随访中进行了血管重建术,6个月主要心脏不良事件(MACE)发生率7.4%。术后6～7个月23例的冠状动脉造影复查再狭窄率为13.0%(支架内为8.6%),靶病变重建率为2.7%。结论应用TAXUS支架治疗急性冠状动脉综合症是安全和有效的,支架内再狭窄率明显低于普通金属支架。     

早发冠心病患者的预后研究

目的研究早发冠心病患者经药物洗脱支架和(或)口服药物治疗后的近中期预后。方法经冠状动脉造影确诊的282例早发冠心病患者(男<55岁,女<65岁)按治疗方式的不同被分为早发冠心病介入治疗组(植入紫杉醇或雷帕霉素洗脱支架+药物治疗)177例和早发冠心病药物治疗组(单纯药物治疗)105例,分别对两组患者进行临床资料的收集比较和为期半年及一年的随访(包括主要心血管不良事件和冠心病的二级预防用药等)研究。结果早发冠心病介入治疗组的男性比例、以急性冠状动脉综合征方式起病的比例、多支病变比例、肌钙蛋白水平、住院天数及阿司匹林和氯吡格雷服用率均高于早发冠心病药物治疗组(P<0.05);与早发冠心病药物治疗组相比,早发冠心病介入治疗组的二级预防(包括二级预防用药的依从性及危险因素的控制)较好,但早发冠心病介入治疗组仍有较高的再发心绞痛和复合心血管不良事件的发生率(P<0.05)。Logistic回归分析显示,肥胖、急性冠状动脉综合征、减低的左心室射血分数可以预测早发冠心病患者在随访一年期间的复合心血管不良事件的发生。结论行药物洗脱支架植入联合药物治疗的早发冠心病患者须强化冠心病的二级预防。     

≥75岁急诊心房颤动患者的预后分析——中国急诊心房颤动研究的亚组分析

目的:了解老年（年龄≥75岁）急诊心房颤动（房颤）患者的预后情况,分析不良预后的危险因素。方法:2009年至2011年在全国20家医院连续入选急诊就诊、年龄≥75岁房颤患者为本研究对象,收集患者基线资料和治疗情况,并进行1年随访,主要终点事件为全因死亡,次要终点事件为心血管死亡、卒中、大出血事件及主要不良事件。应用单因素和多因素Cox回归模型分析上述事件的独立危险因素。结果:共入选766例老年急诊房颤患者,年龄(80.76±4.66)岁,女性占56.9%。1年的全因病死率为24.3%,心血管病死率为12.8%,卒中发生率为10.6%,主要不良事件发生率33.6%,再入院率32%。多因素Cox回归模型分析显示年龄（ HR1.073,95% CI 1.042~1.105）、心率（ HR 1.008,95% CI 1.002~1.013）、痴呆/认知障碍史（ HR 1.849,95% CI 1.016~3.365）、既往慢性阻塞性肺疾病史（ HR 1.824,95% CI 1.303~2.551）为老年房颤患者1年死亡的独立危险因素。女性（ HR 1.664,95% CI 1.036~2.675）、高血压病史（ HR 2.035,95% CI 1.080~3.836）、痴呆/认知障碍史（ HR 2.773,95% CI 1.220~6.302）、为老年房颤患者1年卒中的独立危险因素。 结论:老年急诊房颤患者的预后较差,年龄、心率、痴呆/认知障碍史、慢性阻塞性肺疾病史是老年急诊房颤患者1年全因死亡和主要不良事件的独立危险因素;女性、高血压病史、痴呆/认知障碍史为老年急诊房颤患者1年卒中的独立危险因素。