Platelet Transfusion Strategies for MASPAT-Matched Platelet Transfusion Failed Patient with Allogeneic Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

OBJECTIVE@#To investigate the causes of ineffectiveness of platelet transfusion with monoclonal antibody solid phase platelet antibody test (MASPAT) matching in patients with allogeneic hematopoietic stem cell transplantation and explore the strategies of platelet transfusion.@*METHODS@#A case of donor-specific HLA antibodies (DSA) induced by transfusion which ultimately resulted in transplantation failure and ineffective platelet transfusion with MASPAT matching was selected, and the causes of ineffective platelet transfusion and platelet transfusion strategy were retrospectively analyzed.@*RESULTS@#The 32-year-old female patient was diagnosed as acute myeloid leukemia (high risk) in another hospital with the main symptoms of fever and leukopenia, who should be admitted for hematopoietic stem cell transplantation after remission by chemotherapy. In the course of chemotherapy, DSA was generated due to platelet transfusion, and had HLA gene loci incompatible with the donor of the first transplant, leading to the failure of the first transplant. The patient received platelet transfusion for several times before and after transplantation, and the results showed that the effective rate of MASPAT matched platelet transfusion was only 35.3%. Further analysis showed that the reason for the ineffective platelet transfusion was due to the missed detection of antibodies by MASPAT method. During the second hematopoietic stem cell transplantation, the DSA-negative donor was selected, and the matching platelets but ineffective transfusion during the primary transplantation were avoided. Finally, the patient was successfully transplanted and discharged from hospital.@*CONCLUSIONS@#DSA can cause graft failure or render the graft ineffective. For the platelet transfusion of patients with DSA, the platelet transfusion strategy with matching type only using MASPAT method will miss the detection of antibodies, resulting in invalid platelet transfusion.

Preliminary Study on Screening and Identification of Lewis a Antigen Mimic Epitope in Alpaca Phage Display Nanobody Library / 中国实验血液学杂志

OBJECTIVE@#To establish a new method for synthesizing Lewis blood group antigens, that is, the mimotopes of Lewis blood group antigens were screened by using an alpaca phage display nanobody library.@*METHODS@#We selected mimotopes of the Lewis a (lea) antigen by affinity panning of an alpaca phage display nanobody library using a monoclonal anti-lea antibody. Enzyme-linked immunosorbent assay (ELISA) was used to test the affinity of the positive clones for the monoclonal anti-lea antibody, and the high-affinity positive clones were selected for sequencing and synthesis. Finally, the sensitivity, specificity and reactivity of the synthesized lea mimotope in clinical samples were verified by ELISA.@*RESULTS@#A total of 96 phage clones were randomly selected, and 24 were positive. Fourteen positive clones with the highest affinity were selected for sequencing. The result showed that there were 5 different sequences, among which 3 sequences with the highest frequency, largest difference and highest affinity were selected for expression and synthesis. The sensitivity and specificity of lea mimic antigen by ELISA showed that, the minimum detection limit of gel microcolumn assay (GMA) and ELISA method were 25 times different, and the lea mimic antigen had no cross reacted with the other five unrelated monoclonal antibodies(P<0.001). Finally, 30 clinical plasma samples were analyzed. The mean absorbance of the 15 positive plasma samples was significantly higher than that of the 15 negative plasma samples (P=0.02). However, the positive signal values of the clinical samples were much lower than those of the monoclonal antibodies.@*CONCLUSION@#A new method of screening lea mimic antigen by using alpaca phage nanoantibody library has been established, which is expected to realize the screening of lea mimotopes, thus realizing the application of high-sensitivity detection methods such as ELISA and chemiluminescence in blood group antibody identification.

A Novel Lyophilized PRP-Loaded Gel Based on Chitosan and PEG with Hemostatic and Antibacterial Properties / 中国实验血液学杂志

OBJECTIVE@#A dynamic gel loaded with lyophilized platelet-rich plasma-chitosan/difunctionalized polyethylene glycol (LPRP-CP) was prepared to investigate its hemostatic antibacterial and promoting wound healing of scald wounds through in vitro and in vivo experiments.@*METHODS@#In this study, normal gauze/blank tablet (Ctrl), LPRP-CP, Chitosan HUCHUANG Powder(Chito P)and ChitoGauze XP PRO group (Chito G group) were set. The hemostatic effect and promoting healing effect of the four groups of materials were evaluated by establishing rabbit ear artery hemorrhage model and superficial Ⅱ° scalded model of skin on the back. The hemostatic time and bleeding amount were calculated and the gross and histological results of scald healing were observed. The antibacterial effect of the four groups of materials was evaluated by antibacterial test in vitro.@*RESULTS@#In the rabbit ear arterial hemorrhage model, the hemostasis of all materials was successful. The hemostatic time of Ctrl, Chito P, LPRP-CP and Chito G groups was 213.33±38.30, 118.33±24.01, 115.00±8.37 and 111.67±11.69 s, respectively. The blood loss was 1233.83±992.27, 346.67±176.00, 193.33±121.47 and 147.50±80.66 mg, respectively. Compared with Ctrl, the hemostasis time of LPRP-CP, Chito P and Chito G group was significantly shorter (P<0.001), and the amount of blood loss of LPRP-CP and Chito G group was decreased (P<0.05). Compared with LPRP-CP, there were no significant differences in hemostatic time and blood loss between Chito P and Chito G group (P>0.05). In the model of superficial Ⅱ° scalded on the back of rabbit, the wound healing rate of LPRP-CP was faster than that of the other three groups at the same time, and the healing effect was perfect. In the antibacterial test in vitro, only LPRP-CP had better anti-S. aureus effect, and all groups had no anti-E. coli effect.@*CONCLUSION@#LPRP-CP is an excellent hemostatic material for superficial wounds, and has certain antibacterial and wound healing effects, which has a wide academic value and research prospects.

Research progress on ATP citrate lyase (ACLY) inhibitors for decreasing blood lipids / 药学学报

Cardiovascular disease is a principal cause of morbidity and death in the world. Although drug therapy has made great progress in the past few decades, there are still many deficiencies in the prevention and treatment of cardiovascular disease. Dyslipidemia is still a common risk feature and is not sufficiently controlled. A growing body of evidence suggests that the occurrence and development of cardiovascular disease is associated with many associated risk factors, such as higher low-density lipoprotein levels, lower high-density lipoprotein levels and high triglyceride levels. A number of clinical trials in patients with dyslipidemia have shown that actively decreasing low density lipoprotein cholesterol can significantly decrease cardiovascular events. ATP citrate lyase (ACLY) is a cytoplasmic homo-tetrameric enzyme. In the presence of adenosine triphosphate (ATP), ACLY catalyzes the conversion of citric acid and coenzyme A to acetyl-CoA and oxalyl acetate. ACLY is the main enzyme for the production of cytoplasmic acetyl-CoA, and cytoplasmic acetyl-CoA is the precursor required for de novo synthesis of cholesterol and fatty acids. Therefore, it is possible to reduce the production of acetyl-CoA and reduce the levels of cholesterol and triglycerides by inhibiting ACLY. ACLY can be used as a molecular target for reducing blood lipids, and there are an increasing number of studies on ACLY inhibitors. In this paper, the structure and mechanism of ACLY and its relationship with lipid metabolism are briefly introduced, and we review some current ACLY inhibitors.

Epidemiological analysis of syphilis in Jiading District of Shanghai, 2014-2018 / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of syphilis in Jiading District of Shanghai from 2014 to 2018, and to provide a scientific basis for the development of future syphilis prevention and control work. Methods According to the date of onset, all syphilis cases in the infectious disease report information management system from 2014 to 2018, and their epidemic characteristics were analyzed using descriptive epidemiological methods. Results A total of 2 992 cases of syphilis were reported in Jiading District from 2014 to 2018, with an average annual incidence of 38.89/100 000. The overall incidence showed a downward trend year by year. Recessive syphilis was the main cause, and the incidence increased year by year. Fetal syphilis was relatively small and the incidence decreased year by year. The composition ratios of recessive syphilis, primary syphilis, secondary syphilis, and tertiary syphilis in different years were significantly different, and the differences were statistically significant (χ2=26.955, P2=17.793, P=0.0012=12.701, P=0.0130.05). 20~39 years old had the highest incidence rate of syphilis. The areas with high incidence were mainly concentrated in the old urban area of Jiading Center and areas with high population density. The occupational distribution was mainly concentrated in young and middle-aged household workers and unemployed people, workers and elderly retirees. Conclusion In recent years, the syphilis epidemic in Jiading District of Shanghai has shown a downward trend. However, the situation of prevention and control was still severe. It is necessary to continue to improve the level of syphilis detection, and to detect and treat syphilis early. Meanwhile, it is important to strengthen publicity and education in key areas and key populations, and increase awareness of disease prevention to reduce the incidence of syphilis.

Effects and mechanism of natural product gochnatiolide A on proliferation and apoptosis of human prostate cancer DU145 cells / 中草药

Objective: To investigate the effects and mechanism of gochnatiolide A from Ainsliaea in anti-prostate cancer. Methods: The activities of gochnatiolide A on the proliferation of DU145 cells were tested by CCK-8 and colony formation experiments. Apoptosis morphological changes of cells were observed by DAPI staining. The apoptosis and cell cycle were evaluated by flow cytometry. The expressions of cleaved Poly ADP ribose polymerase (cleaved-PARP), cleaved cystein-containing aspartate specific protease 9 (cleaved Caspase-9), tumor suppressor protein (p53), b cell lymphoma-2 (Bcl-2), transcription factors-κB p65 (NF-κB p65) and IκB kinase α, β (IKKα, IKKβ) proteins in DU145 cells were investigated by Western blotting. Results: The natural product gochnatiolide A significantly inhibited the proliferation of prostate cancer DU145 cells, with IC50 values of 4.15, 2.80 and 1.74 μmol/L at 12 h, 24 h, and 48 h, respectively. Meanwhile, gochnatiolide A promoted DU145 cells apoptosis and induced cell cycle arrest at G2 and S phases in a concentration dependent manner. In addition, gochnatiolide A also up-regulated apoptosis proteins cleaved-PARP, cleaved Caspase-9 and p53 proteins, and down-regulated Bcl-2 protein. Comparing the control group, the expression of NF-κB p65, IKKα and IKKβ proteins in the NF-κB pathway were decreased after treatment with gochnatiolide A. Conclusion: The natural product gochnatiolide A remarkably inhibited the proliferation and promoted apoptosis in DU145 cells, and the possible mechanism was related to the inhibition of NF-κB pathway.

Morphological parameters of corneal endothelium in patients with rhegmatogenous retinal detachment complicated with choroidal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the changes of morphological parameters of corneal endothelial cell in patients with choroidal detachment following rhegmatogenous retinal detachment(RDD-CHD). <p>METHODS: Seventy patients(70 eyes)with RDD-CHD were collected consecutively. In patients with RDD-CHD, thirty-eight cases(38 eyes)not with high myopia were enrolled in group A; 32 cases(32 eyes)associated with high myopia were enrolled in group B. Thirty-six normal controls(36 eyes)were enrolled in group C. We measured the related morphological parameters of corneal endothelial cells in all subjects using corneal specular microscope. The parameters of corneal endothelial cells included minimum size of cell area(S_min), maximum size of cell area(S_max), average size of cell area, standard deviation of cell area(SD), coefficient of variability cell area(CV), cell density of corneal endothelial cells(CD)and hexagonality(HG). <p>RESULTS: There were statistically differences in the CD(<i>P</i><0.001)and hexagonality(<i>P</i><0.001)between the patients with RDD-CHD and normal subjects. There were statistically differences in the CD between groups A and B(<i>P</i><0.05), between groups A and C(<i>P</i><0.05), between groups B and C(<i>P</i><0.001). SD correlated with axis length(<i>r</i>_s=-0.426, <i>P</i><0.01); CV correlated with axis length(<i>r</i>_s=0.494, <i>P</i><0.01), CD correlated with intraocular pressure(<i>r</i>_s=-0.025, <i>P</i><0.05), CD correlated with axis length(<i>r</i>_s=0.368, <i>P</i><0.05), HG correlated with course(<i>r</i>_s=0.552, <i>P</i><0.05). In patients with RDD-CHD, SD correlated with axis length(<i>r</i>_s=0.236, <i>P</i><0.05); CV correlated with axis length(<i>r</i>_s=0.159, <i>P</i><0.05), HG correlated with course(<i>r</i>_s=0.142, <i>P</i><0.05), S_max correlated with intraocular pressure(<i>r</i>_s=-0.314, <i>P</i><0.01).<p>CONCLUSION: The valus of HG and CD of corneal endothelial cells in patients with RDD-CHD were both lower than that of the normal subjects. Axis length, course and intraocular pressure might influence the morphological parameters of corneal endothelium in RDD-CHD patients.

Genetic and epigenetic predispositions underlying cardiovascular outcomes among patients treated with clopidogrel and aspirin / 中国药理学与毒理学杂志

Coronary artery disease (CAD)is a major cause of death and disability worldwide, and consumes a considerable amount of medical resources every year.Clopidogrel is a first-line antiplate-let therapy for CHD, butit is associated with substantial variability in PK and pharmacodynamics re-sponse. To date, gene variants explain only a smallproportion of the variability.The study aimed to identify new genetic loci-modifying antiplatelet response to clopidogrel in Chinese patients with CAD by a systematic analysis combining antiplatelet effects and PK, and further to investigate the PON1 gene promoter DNA methylation and genetic variations possibly influencing clinical outcomes in pa-tients undergoing PCI. We identified novel variants in two transporter genes (SLC14A2rs12456693, ATP-binding cassette [ABC]A1 rs2487032) and in N6AMT1 (rs2254638) associated with P2Y12 reac-tion unit (PRU) and plasma active metabolite (H4) concentration. These new variants dramatically im-proved the predictability of PRU variability to 37.7％. The associations between these loci and PK pa-rameters of clopidogrel and H4 were observed in additional patients, and its function on the activation of clopidogrel was validated in liver S9 fractions (P<0.05). Rs2254638 was further identified to exert a marginal risk effect formajor adverse cardiac events in an independent cohort.Multivariate logistic regression analysis indicated that PON1methylation level at CpG site-161 (OR=0.95; 95％ CI=0.92–0.98;P<0.01)and the use of angiotensin converting enzyme inhibitors(OR=0.48;95％ CI=0.26–0.89;P<0.01) were associated with decreased risk of bleeding events. In conclusion, new genetic variants were systematically identified as risk factors for the reduced efficacy of clopidogrel treatment.The ab-normal expression of DNA methylation-regulating key genes in the pharmacokinetic and pharmacody-namics pathways of clopidogrel and aspirin may modify clinical outcomes in dual antiplatelet-treated pa-tients undergoing PCI.

Comparison of percutaneous and open pedicle screw system in the treatment of multilevel thoracolumbar fractures: the accuracy of screw placement / 中国组织工程研究

BACKGROUND: Multilevel thoracolumbar fractures are mainly treated with percutaneous pedicle screw and open pedicle screw system, but the treatment effect of different systems and the accuracy rate of screw placement are controversial, resulting in the lack of uniform standards for choosing the treatment method. OBJECTIVE: To evaluate the effect of percutaneous pedicle screw and open pedicle screw system in the treatment of multilevel thoracolumbar fractures and to evaluate the accuracy of the screw placement. METHODS: Totally 90 patients with multilevel thoracolumbar fractures were divided into open pedicle screw group (n=43 cases) and percutaneous pedicle screw group (n=47) according to different surgical methods. Open pedicle screw group was treated with open pedicle screw treatment, and percutaneous pedicle screw group was treated with percutaneous pedicle screw. Comprehensive effects were analyzed by comparing perioperative indicators (operation time, postoperative drainage volume, and incision length) imaging index (anterior vertebral height percentage, posterior vertebral height percentage, sagittal Cobb angle), postoperative complications, and pedicle screw accuracy. RESULTS AND CONCLUSION: (1) The amount of bleeding, postoperative drainage volume, and incision length were less (shorter) in the percutaneous pedicle screw group compared with the open pedicle screw group (P < 0.05). However, operation time and the number of undergoing fluoroscopy were longer (more) in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). (2) Anterior vertebral height percentage and posterior vertebral height percentage were higher in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). Sagittal Cobb angle was smaller in the percutaneous pedicle screw group than in the open pedicle screw group (P < 0.05). (3) At 2 months after surgery, the complication rate was significantly lower in the percutaneous pedicle screw group (4%) than in the open pedicle screw group (14%) (P < 0.05). (4) The accuracy rate of pedicle screw was significantly higher in the percutaneous pedicle screw group (92.1%; 279 screws) than in the open pedicle screw group (77.0%; 257 screws) (P < 0.05). (5) Results indicated that percutaneous pedicle screw fixation is characterized by less trauma and rapid recovery in the treatment of multilevel thoracolumbar fractures. It is helpful for the reduction of the injured vertebra, the maintenance of vertebral height; the safety and the accuracy of screw placement are high.

Clinical Observation of Intensive Treatment with Antibiotics and Chinese Medicine Fule Tablets for Treatment of Pelvic Inflammatory Disease / 广州中医药大学学报

Objective To investigate the short-term clinical effect of intensive treatment with antibiotics and Chinese medicine Fule Tablets for pelvic inflammatory disease (PID). Methods A total of 240 PID patients were randomly divided into observation group and control group,120 cases in each group. The observation group was given oral use of antibiotics (Cefodizime or Cefixime Granules + Ornidazole)for 14 days (d1-d14)and Fule Tablets orally for 30 days(d1-d30). The control group was only given oral use of antibiotics(Cefodizime or Cefixime Granules+Ornidazole)for 14 days (d1-d14). Visual Analogue Scale (VAS)scores for lower abdominal pain, tenderness of the uterus or adnexal region, body temperature, vaginal secretions, and ultrasonogram were observed after treatment for 7, 14 and 30 days in both groups. And the therapeutic effect was also evaluated. Results(1)After treatment,VAS scores for lower abdominal pain,tenderness of the uterus or adnexal region, fever, vaginal secretions, pelvic hydrops, adnexal thickening or adnexal mass in the two groups were much improved after treatment (P < 0.05 compared with those before treatment),and the improvement of VAS scores for lower abdominal pain,tenderness of the uterus or adnexal region,vaginal secretions,and pelvic hydrops in the observation group on day 30 was superior to that in the control group (P < 0.05). (2)After treatment for 7,14 days,the differences of the therapeutic effect between the two groups were insignificant(P>0.05). After treatment for 30 days,the therapeutic effect of the observation group was much stronger than that in the control group (P < 0.05). Conclusion The intensive treatment with antibiotics and Chinese medicine Fule Tablets has stronger effect for the treatment of PID than antibiotics alone, which is effective on relieving clinical symptoms and signs,shortening the course of disease,and reducing or preventing the occurrence of sequelae.

Impacts on hepatorenal functions and the blood indexes for practitioners occupationally exposed to acrylonitrile / 上海预防医学

Objective To investigate the health effects on practitioners occupationally exposed to acrylonitrile and to provide scientific bases for the study of toxicological effects of acrylonitrile on human bodies. Methods 465 medical practitioners exposed to acrylonitrile and ( a control group of ) 488 medical practitioners unexposed to acrylonitrile were selected .Age, smoking habits , alcoholic habits and other relevant factors are well-considered in selecting these two groups and all of them had lived in Ningbo for at least three years .Blood samples were collected to measure the level of Alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST ) , alkaline phosphatase ( ALP ) , pancreatic acyl transferase (GGT), total bilirubin (STB), blood urea (UREA), blood uric acid (UA), serum creatinine (SCr), total protein ( TP ) , albumin ( Alb ) , globulin ( Glb ) , ratio of Alb to Glb ( A/G ) , white blood cell ( WBC ) , red blood cell ( RBC ) , platelet ( PLT ) and hemoglobin ( Hb ) .These serum biochemical indices of the two groups were compared to find the differences thereof and to examine the effect of work years on various above-mentioned indices for medical practitioners exposed to acrylonitrile . Results The levels of ALT(t=-2.77,P=0.006), AST(t=-5.74,P<0.001), UREA(t=3.51,P<0.001), UA (t=-3.51,P<0.001)and SCr(t=-7.62,P<0.001)for medical practitioners exposed to acrylonitrile were all significantly higher than those for the control group; however, the levels of ALP(t=18.87,P<0.001), Alb(t=6.92,P<0.001), Glb(t=7.99,P<0.001), A/G(t=11.93,P<0.001), and WBC (t=4.48,P<0.001) were all lower than those for the control group , with the exposure time exhibiting positive correlations with ALT(r=0.564,P<0.001)and AST(r=0.493,P<0.001). Conclusion Acrylonitrile has certain health effects on the hepatorenal function as well as the routine blood test results of medical practitioners occupationally exposed to acrylonitrile .

Safety of intravenous thrombolysis in cerebral microbleeds patients with prior antiplatelet therapy / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the safety of intravenous thrombolysis (IVT) in cerebral microbleeds (CMBs) patients with prior antiplatelet therapy.</p><p><b>METHODS</b>Four hundred and forty nine patients with acute ischemic stroke aged (66.8 ± 12.9) years, including 298 males and 151 females, underwent susceptibility-weighted imaging (SWI) examination and MRI-guided IVT therapy between June 2009 and June 2015. The presence of CMBs, previous antiplatelet therapy, HT subtypes according to ECASS II criteria and functional outcome based on modified Rankin scale (mRS) at 3 months were analyzed in logistic regression model.</p><p><b>RESULTS</b>Total 934 CMBs were detected in 172 (38.3%) patients, among whom 63 (14.0%) previously received antiplatelet therapy. All patients received intravenous recombinant tissue-plasminogen activator (rt-PA) for thrombolysis with the onset-to needle time of (229.0 ± 103.7) min. The pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 10 (IQR 5-15). Logistic regression analysis indicated that prior antiplatelet use increased neither risk of parenchymal hematoma (PH) (OR=0.809,95% CI:0.201-3.262, P=0.766) nor adverse functional outcome (OR=1.517, 95% CI:0.504-4.568, P=0.459) in patients with CMBs; while in patients with multiple CMBs (≥ 3) prior antiplatelet use increased risk of hemorrhagic transformation (OR=9.737, 95% CI: 1.364-69.494, P=0.023), but not adverse functional outcome (OR=1.697, 95% CI:0.275-10.487, P=0.569).</p><p><b>CONCLUSION</b>The study indicates that in patients with CMBs, thrombolytic therapy should not be excluded due to the prior use of antiplatelet; however, the larger prospective studies are needed in future for patients with multiple CMBs.</p>

Older age is not related to hemorrhagic transformation and favorable outcomes in patients with wake-up ischemic stroke undergoing intravenous thrombolytic therapy / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate factors related to hemorrhagic transformation and favorable outcomes in wake-up ischemic stroke (WUIS) patients undergoing intravenous thrombolytic therapy.</p><p><b>METHODS</b>Clinical data of 600 patients undergoing multimodal image-guided intravenous recombinant tissue plasminogen activator (rt-PA) therapy in Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine center from May 2009 to May 2015 were retrospectively analyzed. Among 600 patients, 68 were diagnosed as WUIS including 17 cases aged 80 or older. Hemorrhagic transformation within the first 24 h after thrombolysis was assessed according to ECASS II criteria. Favorable outcome was defined as three-month modified Rankin Scale (mRS) 0-3. Univariate and binary logistic regression were used to analyze the risk factors of hemorrhagic transformation and poor clinical outcomes in WUIS patients.</p><p><b>RESULTS</b>Univariate analysis showed that WUIS patients aged ≥ 80 years had a lower rate in males (41.2% vs 76.5%, P=0.007), smokers (11.8% vs 43.1%, P=0.019) and favorable outcome (52.9% vs 78.4%, P=0.043); and a higher rate of cardiac embolism (64.7% vs 35.3%, P=0.034) compared with those aged <80 years. Binary logistic regression showed that age was not an independent risk factor for favorable outcome (OR=0.524, 95% CI:0.141-1.953, P=0.336) or hemorrhagic transformation (OR=1.039, 95% CI: 0.972-1.111, P=0.262).</p><p><b>CONCLUSION</b>Older age is not related to the favorable outcome or hemorrhagic transformation in WUIS patients undergoing multimodal image-guided intravenous thrombolytic therapy.</p>

Association of β-adrenergic receptor genes polymorphisms with incidence of subsequent cardiovascular events in Han Chinese patients with coronary artery disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sequence variants in the β-adrenergic receptor (ADRB) genes have a close relationship with the development of coronary artery disease (CAD) and the patient's prognosis. However, there is a lack of data on the role of the variants in ADRBs genes in Han Chinese patients with CAD. We aimed to investigate the association of genetic variants in the ADRB1 and ADRB2 genes with the incidence of major adverse cardiac event (MACE) in Han Chinese patients with CAD.</p><p><b>METHODS</b>A total of 545 Han Chinese patients with CAD undergoing percutaneous coronary intervention (PCI) were recruited to the study and followed for one year. Three variant sites in ADRB1 (rs1801253) and ADRB2 (rs1042713 and rs1042714) were genotyped. The effect of the ADRB1 and ADRB2 genotypes on MACE within one year was assessed.</p><p><b>RESULTS</b>There were 47 cases of MACE during follow-up. There was no significant difference in the incidence of MACE among patients carrying different genotypes of the three variants in ADRB1 and ADRB2 (Log-rank, all P > 0.05). Cox regression analysis showed no association between three variants in ADRB1 and ADRB2 genes and the incidence of MACE during one-year follow-up, the adjusted hazard ratios (95% confidence interval) for rs1801253, rs1042713 and rs1042714 were 1.05 (0.54-2.02), 1.24 (0.58-2.64) and 1.66 (0.81-3.42), respectively.</p><p><b>CONCLUSION</b>Our data did not support a relationship between the three polymorphisms of ADRB1 (rs1801253) and ADRB2 (rs1042713 and rs1042714) genes and risk of subsequent cardiovascular events after PCI in Han Chinese patients with CAD.</p>

MicroRNAs expression in normal and dissected aortic tissue / 中华心血管病杂志

<p><b>OBJECTIVES</b>To investigate if there is altered microRNAs (miRNAs) expression in aortic dissection (Debakey Type A) and normal aorta tissue.</p><p><b>METHODS</b>Total RNA was exacted from aorta of 5 patients with aortic dissection (AD) and four patients without aortic diseases (NA). miRNAs of the aortic tissues were analyzed by miRNA microarray. Reverse transcription polymerase chain reaction (RT-PCR) was performed to verify the expression of miRNAs in larger sample size (AD = 11 and NA = 9).</p><p><b>RESULTS</b>hsa-miR-146b-5p_st, hsa-miR-19a_st and hsa-miR-505_st were significantly upregulated while hsa-miR-1268_st and hsa-miR-939_st were significantly downregulated [fold change > 2, q-value (%) ≤ 5] in AD group compared with NA group. RT-PCR verified hsa-miR-146b-5p_st miRNAs change in AD group.</p><p><b>CONCLUSIONS</b>Altered miRNAs expression might play an essential role in the pathogenesis of aortic dissection formation and hsa-miR-146b-5p_st might serve as a new diagnosis biomarker of aortic dissection.</p>

Progress in genetic and epigenetic research on in-stent restenosis after percutaneous coronary interventions / 中华医学遗传学杂志

Coronary heart disease is one of the most important causes of death in human, and consumes vast medical resources. Percutaneous coronary intervention (PCI) has been a significant breakthrough for its treatment. However, clinical application has been hampered by in-stent restenosis (ISR). Although drug eluting stent (DES) has reduced the occurrence of restenosis, incidence of ISR is still about 5% to 10%. The main reasons for restenosis after PCI are hyperplasia of vascular endothelial cells and smooth muscle cell migration. The exact mechanism of personalized differences in restenosis is not clear yet, but there may be a variety of risk factors. In addition to aging, smoking and diabetes, an increasing number of studies have found that genetic and epigenetic factors play an important role in ISR. In this article, authors have reviewed genetic and epigenetic factors on the progression of ISR, which may help to determine the genetic risk factors in patients with ISR after PCI.

Expression of stromal cell-derived factor-1 in mouse retina with oxygen-induced retinopathy / 中华实验眼科杂志

Background The development of retinopathy of prematurity(ROP) is associated with many regulatory cytokines related to neovascularization;however,the retinal expression and regulated mechanism of stromal cell-derived factor-1 (SDF-1) in mouse model of oxygen-induced retinopathy (OIR) remain uncertain.Objective This study was to investigate the expression of SDF-1 in retina of mouse model of OIR.Methods Forty 7-day-old C57BL/6J mice were divided into OIR group and control group.In OIR group,20 mice were exposed to 75% oxygen for 5 days and then to room air for 5 days.In control group,20 mice were raised in room air.The expression of SDF-1 in retina of mice was studied by immunochemistry and quantified by real time reverse transcriptase polymerase chain reaction (RT-PCR).Results The positive immunohistochemical staining for SDF-1 was found mainly locating at the ganglion cell layer in 12-day-old mice of OIR group;the stronger positive immunohistochemical staining for SDF-1 was noted mainly locating at the ganglion cell layer,vascular endothelial cells of inner retina,neovascular endothelial cells in 17-day-old mice of OIR group;the delicate positive immunohistochemical staining for SDF-1 was both found mainly locating at the inner retina and being around the retinal vascular in 12-day-old mice of control group and 17-day-old mice of control group.The expression of SDF-1 mRNA in 17-day-old mice of OIR group was higher than that of 12-day-old mice of OIR group (t=8.072,P＜0.05)and 17-day-old mice of control group(t=10.026,P＜0.05),respectively.The expression of SDF-1 mRNA in 12-day-old mice of OIR group was lower than that of 12-day-old mice of control group (t=4.336,P＜0.05).Conclusion SDF-1 might improve the onset of retinal neovascularization of OIR.

Impact of CYP2C9 and VKORC1 polymorphism on warfarin response during initiation of therapy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate potential contributions of genetic variants of cytochrome P-450 2C9 (CYP2C9) and vitamin K expoxide reductase (VKORC1) to the anticoagulation response during the initiation of warfarin therapy in the Han Chinese population.</p><p><b>METHODS</b>A total of 798 Han Chinese patients received long-term warfarin anticoagulant therapy orally after valve replacement in our hospital between 2000 and 2008 were included in this study. Nine single nucleotide polymorphism (SNP) loci [rs12572351 G > A, rs9332146 G > A, rs4917639 G > T, rs1057910 A > C (CYP2C9(*)3), rs1934967 G > T, rs1934968 G > A, rs9923231 C > T (VKORC1-1639 G > A), rs2359612 G > A and rs10871454 C > T] in 2 genes including CYP2C9 and VKORC1, which were possibly correlated with warfarin pharmacokinetics and pharmacodynamics through literature retrieval, were selected and analyzed. Warfarin steady-state dose requirement, time to the INR (the international normalized ratio) within the therapeutic range and percent of the INR of more than 3.5 were compared among genotype subgroups. SNaPshot technique was used to detect gene SNPs; Hardy-Weinberg genetic equilibrium test was used to test population representativeness.</p><p><b>RESULTS</b>CYP2C9(*)3 genotype did not affect the required warfarin dose while it was associated with increased risk of bleeding when treated with routine dosage regimen during the initiation of treatment. The allelic mutation frequency at VKORC1 gene rs10871454G > A and VKORC1-1639G > A SNP loci was 92.04% and 88.03%, respectively and rs10871454 was in perfect linkage disequilibrium with-1639. Patients with VKORC1 rs10871454 genetic mutation required lower warfarin dose in the first 28 days of therapy. VKORC1-1639 genetic polymorphism was also associated with shorter time to the INR within the therapeutic range and increased risk of over-anticoagulation.</p><p><b>CONCLUSION</b>Detecting genetic polymorphism of CYP2C9 and VKORC1 could guide clinical use of warfarin to reduce the risk of adverse reactions including bleeding in patients receiving chronic anticoagulation therapy.</p>

Clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement: a single center-based survey / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement and compare the effect and safety of different anticoagulant intensities.</p><p><b>METHODS</b>A total of 845 Chinese patients receiving oral warfarin for anticoagulant treatment after prosthetic heart valve replacement in Guangdong General Hospital between 2000 and 2008 were enrolled in this survey. The general data, clinical data, medications, international normalized ratio (INR) and results of echocardiogram of these patients were followed up to observe the incidence of complication of thrombo-embolism and such adverse effect as hemorrhage.</p><p><b>RESULTS</b>All the patients were of Han nationality, and Cantonese accounted for 88.04%. The daily mean maintenance dose of warfarin was 2.92∓0.88 mg in these patients with a median INR of 2.09∓0.39. Of these patients, 44.62% received low-intensity anticoagulant treatment with warfarin with the INR maintained between 1.5 and 2.0, and 56.45% had standard anticoagulant intensity with the INR maintained between 2.0 and 3.0. The total incidence of thrombo-embolism was 4.14%. Severe hemorrhage occurred in 14 cases (1.66%), most frequently in the alimentary tract. The events of hemorrhage were correlated to the type of prosthetic heart valve replacement, occurring more frequently in patients with mechanical prosthetic heart valve replacement than in those with biological ones. No significant difference was found in the incidence of thrombo-embolism and server hemorrhage between the two groups receiving low and standard intensity therapy anticoagulant.</p><p><b>CONCLUSION</b>The effect and safety of low-intensity anticoagulant treatment are comparable to that of standard intensity treatment in Chinese Han patients, and anticoagulation treatment with warfarin is effective and safe to maintain the INR between 1.8-3.0.</p>

Analysis of the diagnosis and treatment of recurrent vulvovaginal candidiasis in 80 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the appropriate therapy for treating recurrent vulvovaginal candidiasis (RVVC).</p><p><b>METHODS</b>Individual consolidated and maintenance therapy were chosen according to fungal culture of vaginal secretion and antifungal drug sensitivity per month as one therapy duration. Drugs were used orally and vaginally together to consolidate the therapy. Oral drugs were fluconazole (0.15 qw after 0.15 q3d for 2 times) or ketoconazole (0.2, bid for 3 days ) or itraconazole (0.2 bid for 3 days ). After Nystain (400 000 unit qn for 7 days ) or clotrimazole(0.1 qn for 7 days) or amphotericin B (0.01 qn for 6 days ) being vaginally used, Living preparation of lactobacillus (0.25 qn for 5 days) was vaginally used. The therapy was continued for 2 to 5 therapy durations after the symptoms disappeared with negative fungal culture.</p><p><b>RESULTS</b>Among 80 cases of RVVC, C. albicans was mostly detected (74%), C. glabrata was 20%. The susceptivity to candidas of oral agents revealed that the sensitive rare of ketoconazole, fluconazole and itraconazole were (91.3%), (81.3%) and (62.5%), respectively. As for vaginal agents, nystain and amphotericin B were 100% sensitive, clotrimazole was 92.5%sensitive, miconazole was 55.0% sensitive. The remote cure of 3 and 6 therapy durations after discontinuing for 12 months was 78.9% and 90.4%</p><p><b>CONCLUSION</b>The predominant pathogen in RVVC is C. albicans. The effective measures to cure RVVC are to choose sensitive drugs for individual consolidated, maintenance therapy and restore vaginal acidic environment.</p>