Association of cardiac disease with the risk of post-lung transplantation mortality in Chinese recipients aged over 65 years / 医学前沿

The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation (LT) waiting list. A steady increase in the threshold at which age is taken into consideration for LT has been observed. This retrospective cohort study recruited 166 lung transplant recipients aged ≽ 65 years between January 2016 and October 2020 in the largest LT center in China. In the cohort, subgroups of patients aged 65-70 years (111 recipients, group 65-70) and ≽ 70 years (55 recipients, group ≽ 70) were included. Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years. A significantly higher percentage of coronary artery stenosis was observed in the group ≽ 70 (30.9% vs. 14.4% in group 65-70, P = 0.014). ECMO bridging to LT was performed in 5.4% (group 65-70) and 7.3% (group ≽ 70) of patients. Kaplan-Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality. After adjusting for potential confounders, cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality (HR 6.37, P = 0.0060). Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.

Current status and prospect of global development of lung transplantation / 器官移植

During the novel coronavirus pneumonia (COVID-19) pandemic from 2020 to 2021, lung transplantation entered a new stage of development worldwide. Globally, more than 70 000 cases of lung transplantation have been reported to the International Society for Heart and Lung Transplantation (ISHLT). With the development of medical techniques over time, the characteristics of lung transplant donors and recipients and the indications of pediatric lung transplantation recipients have undergone significant changes. Application of lung transplantation in the treatment of COVID-19-related acute respiratory distress syndrome (ARDS) has also captivated worldwide attention. Along with persistent development of lung transplantation, it will be integrated with more novel techniques to make breakthroughs in the fields of artificial lung and xenotransplantation. In this article, research progresses on the characteristics of lung transplant donors and recipients around the world were reviewed and the development trend was predicted, enabling patients with end-stage lung disease to obtain more benefits from the development of lung transplantation technique.

Research progress on the treatment for aging lung transplantation recipients with cardiovascular disease / 中国胸心血管外科临床杂志

@#As the aging proceeds worldwide, aging lung transplantation recipients have been increased dramatically. Aging population with end-stage lung diseases also have comorbidities, such as cardiovascular disease, which may impact the prognosis of lung transplantation. Recent researches on lung transplantation have explored the characteristics of aging recipients, strategy selection on transplantation and cardiovascular disease management, as well as risk factors for post-transplantation complications and death. However, researches on lung transplantation recipients with cardiac valve disease are just in the initial stage. With the advancement of transcatheter technique, more patients will be benefited. We summarized the advancement in this field and took an outlook for future clinical researches.

Development and prospect of clinical research on lung transplantation in post-COVID-19 era / 器官移植

Lung transplantation has been advanced for nearly half a century around the globe, and it has been developed rapidly for over 20 years in China. The field of lung transplantation in China has been gradually integrated into the international community. The outbreak of novel coronavirus pneumonia (COVID-19) in 2020 brought big challenges, as well as diverted the worldwide attention to the development of lung transplantation in China, accelerating international communication and cooperation. With the steadily deepening of clinical and basic research on lung transplantation for severe cases of COVID-19, organ transplant physicians have deepened the understanding and thinking of the maintenance of donors, selection of elderly and pediatric candidates, and perioperative management of recipients, as the future perspective of lung transplantation in China. For interdisciplinary research related to lung transplantation, it is necessary to carry out multi-center clinical trials with qualified study design and constantly promote the theoretic and practical innovation.

A report of 12 cases of pneumatosis cystoides intestinalis / 中华消化内镜杂志

Objective To investigate the characteristics and treatment for pneumatosis cystoides intestinalis (PCI). Methods Data of 12 PCI patients admitted to General Hospital of Tianjin Medical University from 1997 to 2015 were analyzed. The causes, endoscopic characteristics, therapeutic effects and prognosis were evaluated. Results Four cases were primary PCI due to long?term exposure to trichloroethylene or unknown reasons, while 8 other cases were secondary to Behcet's disease, connective tissue disease, emphysema, diabetes, therioma, etc. Endoscopic findings included bubble?like, linear,cobblestone?like, graped or beaded gas cysts, involving sigmoid in 6 cases, ascending colon in 3, descending colon in 2, duodenum in 2 and rectum in 1. After combination of medicinal and endoscopic treatment, symptoms of 8 patients were relieved, and the condition of 2 patients improved, while 2 patients died of malignancy. Conclusion Pneumatosis intestinalis is a rare disease, usually secondary to other diseases, which can be diagnosed by colonoscopy and ultrasonic endoscopy. Pathogenesis of PCI is still unclear. Single PCI can be cured with endoscopic resection. Multiple PCI can be managed with cyst clipping, antibiotics and intestinal flora regulator. Treatment of the original disease and early detection of complications can improve the prognosis and reduce recurrence of PCI.

Application value of immunoglobulin G4 detection in unexplained liver injuries / 中华消化杂志

Objective To investigate the expression level of immunoglobulin G (IgG)4 cells in patients previously diagnosed as unexplained liver injuries,and to analyze whether these patients could be diagnosed as immunoglobulin G4-related disease (IgG4-RD).The clinical characteristics of patients with IgG4 positive cells infiltration in liver tissues who did not met IgG4-RD diagnosis criteria were also analyzed.Methods From August 2010 to July 2016,33 patients with unexplained liver injuries even after liver biopsy were enrolled.Immunostaining of IgG and IgG4 in liver tissue slices was performed.Whether the patients met the IgG4-RD diagnosis criteria was analyzed.Also,the relation between IgG4 positive cell infiltration in liver tissues and serum parameters (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptadase (GGT),IgG),the classification of liver inflammation and stage of liver fibrosis were analyzed.Chi-square,Fisher exact probability method,t test and Wilcoxon rank and inspection were used for statistical analysis.Results Among 33 patients with unexplained liver injuries,average age of onset of the disease was (50.48 ± 14.52) years old.Ten patients (30.3 ％) presented with different degree of IgG4 positive cells infiltration in liver.In one patient,the IgG4 positive cell number in liver tissue was over 10/high-powered field (HPF),IgG4+ / IgG+ ratio was over 40％,the serum IgG4 increased and low density nodules in the left hepatic lobe level,which met the diagnostic criteria of IgG4-RD.Serum parameters of liver function of this patient were as follows:ALT 948 U/L,AST 658 U/L,ALP 176 U/L,GGT 197 U/L,TBil 21.5 μmol/L,DBil 10.0 μmol/L.According to whether there were IgG4 positive cells infiltration in liver tissues,33 patients were divided into IgG4 positive cells infiltration group (IgG4 positive group,10 cases) and no IgG4 positive cells infiltration group (IgG4 negative group,23 cases).The medium levels of ALT,AST,ALP and GGT in the IgG4 positive group and the IgG4 negative group were 26.0 U/L vs 31.0 U/L,28.5 U/L vs 32.0 U/L,114.0 U/L vs 77.0 U/L,65.0 U/L vs 36.0 U/L,respectively and there were no statistically significant differences (Z=-0.098,-0.216,-0.862,-0.705;all P＞0.05).The serum IgG level of the IgG4 positive group was higher than that of the IgG4 negative group (17.15 g/L vs 13.65 g/L),and the difference was statistically significant (Z=-1.776,P =0.035).Conclusions IgG4-RD may be the reason of liver injury.There are no significant differences in clinical charateristics,serum parameters and inflammation degree in liver tissue between patients with or without IgG4 positive cells infiltration.

Value of serum autoantibodies in the diagnosis of anti-mitochondrial antibody-negative primary biliary cirrhosis / 中华消化杂志

Objective To compare clinical biochemical and pathological characters among antimitochondrial antibody-negative primary biliary cirrhosis (AMA PBC),AMA positive PBC (AMA+ PBC)and autoimmune hepatitis (AIH),and try to find serum biomarkers in the diagnosis of AMA-PBC.Methods From January 2005 to May 2013,23 patients with AMA-PBC,102 patients with AMA+ PBC and 55 patients with AIH were collected.Clinical features of patients were observed.Biochemical indexes (total bilirubin (TBil),direct bilirubin (DBil),alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyltransferase (GGT) and globulin) were tested.Immunological indexes immunoglobulin ((Ig)G,IgM and IgA) were also measured.Antinuclear amibody,anti smooth muscle antibody (SMA) and AMA were detected by indirect immunofluorescence.Soluble acidic phosphorylation nucleoprotein antibody and anti-nuclear membrane glycoprotein antibody were detected by Western blotting.Non parameter test was for non normal distributed measurement data and grade data comparison.The cut off value,sensitivity and specificity of IgM in the diagnosis of PBC were calculated with receiver operating characteristic (ROC) curve.The sensitivity and specificity of soluble acidic phosphorylation nucleoprotein antibody and anti-nuclear membrane glycoprotein antibody in the diagnosis of PBC were analyzed with fourfold table.Results The rates of fatigue and jaundice of AMA-PBC group (39.1％,9/23 ; 43.5 ％,10/23) were both higher than those of AIH group (16.4 ％,9/55; 14.5 ％,8/55),and the differences were statistically significant (x2 =4.735 and 7.648,both P＜ 0.05).The levels of ALP and GGT of AMA PBC group were higher than those of AIH group,and the levels of ALT and AST were lower than those of AIH group (Z=-4.577,-4.257,-2.820 and -2.055,all P＜0.05).The level of IgM of AMA PBC group (417(270,610) mg/L) was higher than that of AIH group (97(69,195) mg/L),however lower than that of AMA+ PBC group (546(419,704) mg/L),and the differences were statistically significant (Z=-4.362 and-0.210,both P＜0.05).The level of IgG of AMA PBC group was lower than that of AIH group (Z=-2.202,P＜0.05).The positive rates of antinuclear antibody and SMA of AMA PBC group (95.7％ (22/23),8.7％ (2/23)) were both higher than those of AMA+ PBC group (33.3％(34/102),1.0％(1/102)),and the differences were statistically significant (x2 =29.474 and 4.769,both P＜0.05).The positive rates of soluble acidic phosphorylation nucleoprotein antibody and anti nuclear membrane glycoprotein antibody of AMA PBC group (60.9％,14/23; 30.4％,7/23) were both higher than those of AIH group (2.0％,1/55; 0),and the differences were statistically significant (x2=36.409 and 24.329,both P＜0.05).The karyotype of antinuclear antibody of AMA PBC and AMA+ PBC group mainly was granules pattern (60.9 ％,14/23;75.5％,77/102),however of AIH group was mainly homogeneous pattern (38.2％,21/55).If the cut off value of IgM was 277 mg/L,the sensitivity and specificity of IgM in the diagnosis of PBC was 72.2％ and 94.4 ％.The sensitivity and specificity of soluble acidic phosphorylation nucleoprotein antibody in the diagnosis of PBC was 24.1％ and 97.2％.The sensitivity and specificity of anti-nuclear membrane glycoprotein antibody was 35.2 ％ and 100.0 ％.The sensitivity and specificity of any one of anti-nuclear membrane glycoprotein antibody positive,soluble acidic phosphorylation nucleoprotein antibody positive or IgM＞277 mg/L in the diagnosis of PBC was 88.9％ and 94.4％.Conclusions AMA-PBC and AMA+ PBC have similar clinical manifestations and serum biochemical test results.Antinuclear antibody and/or SMA positive is the feature of AMA-PBC and which should be distinguished with AIH.The sensitivity and specificity of any one of the followiags:anti nuclear membrane glycoprotein antibody positive,soluble acidic phosphorylation nucleoprotein antibody positive or IgM＞277 mg/L is high in the diagnosis of PBC.

Trans-umbilical NOTES for abdominal adhesion lysis using a flexible endoscope: a case report / 中华消化内镜杂志

Objective To evaluate the feasibility and safety of trans-umbilical NOTES to perform abdominal adhesion lysis using a flexible endoscope.Methods A 42-year-old female was admitted to our hospital with a complain of abdominal pain due to abdominal adhesion after hysterectomy.A gastroscope (GIF-2TQ260M,Olympus)was inserted into the peritoneal cavity through an incision(1.5 cm)of the umbilical opening.Pneumoperitoneum was established by the endoscopic air supply system using CO2 instead of air.Abdominal exploration showed that omentum and bowel were stuck to the scar of the low central peritoneum incision.Separation of the abdominal wall adhesions was performed with an IT knife and a hook knife respectively.After most of the adhesions were separated,bleeding was found from the isolated adhesion wound of the omentum and bowel.Hemorrhaged blood vessel was difficult to be found with the flexible gastroscope.Then a 5 mm Trocar was placed at the left lower abdomen and laparoscopic assistance was adopted to search the bleeding point.However,no bleeding site was found and the hemorrhage was stopped automatically.Residual adhesion lysis was conducted with laparoscopic assist.After the procedure,the umbilical incision was closed with absorbable suture,but lower left abdominal incision was left without suturing.Results The operation time was 40 minutes.The patient suffered from minus pain from the umbilical incision without need of treatment.She had normal diet and got out of bed after reconsious.She was discharged 2 days after the procedure without any complaints.Conclusion Trans-umbilical NOTES using a flexible endoscope for peritoneal adhesion lysis is safe and feasible,but the effectiveness remains to be further confirmed.

Lithium Carbonate Modulation of Delayed Rectifier Potassium Channel Involves Protein Kinase C/Mitogen-activated Protein Kinase Signaling in Hippocampus of Rats / 生物化学与生物物理进展

Lithium carbonate could be used to treat or prevent brain damage following traumatic injury and neurodegenerative diseases.It has been shown that its protective effect is related to protein kinase C (PKC) and extracellular signal-related kinase (ERK).It was demonstrated that PDBu,a PKC activator,inhibited amplitudes of delayed rectifier potassium current (It,) and produced a hyperpolarizing shift in the activation-voltage curve.The responses to PDBu were inhibited by lithium carbonate (50μmol/L).Further studies showed that when pretreated with MEK/ERK inhibitor U0126 (20 μmol/L),although PDBu significantly reduced IK,lithium did not reverse the effect of PDBu.Thus,the results suggested that PKC signaling cascades,along with MAPK (mitogen-activated protein kinase) pathway,were required in the phosphorylation of potassium channel,which was presented by regulation of potassium channel characteristic.AC-cAMP and their eross-talk with GC-cGMP pathway could also modulate the effect of lithium on PKC activation,which could be one of underlying mechanisms likely related to neuroprotective effect of lithium.