TGR5 Attenuated Liver Ischemia-Reperfusion Injury by Activating the Keap1-Nrf2 Signaling Pathway in Mice

Inflammation - Hepatic ischemia/reperfusion injury (IRI) still remains an unavoidable problem in hepatectomy. The inflammatory response plays an important role in its pathogenesis. The plasma...     

Efficacy and safety of tacrolimus versus corticosteroid as initial monotherapy in adult-onset minimal change disease: a meta-analysis

Objective

The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus corticosteroid as initial monotherapy in adult-onset minimal change disease (MCD) patients.

Methods

Databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from the inception to March 20, 2021. Eligible studies comparing TAC monotherapy and corticosteroid as initial monotherapy for adult-onset MCD patients were included. Data were analyzed using Review Manager Version 5.3.

Results

Four randomized controlled trials (RCTs) involving 196 patients were included in the meta-analysis. For initial monotherapy for adult-onset MCD, TAC and corticosteroid had similar complete remission (OR 1.06, 95% CI 0.47–2.41, P?=?0.89), total remission (OR 1.30, 95% CI 0.39–4.35, P?=?0.67), relapse rate (OR 0.63, 95% CI 0.28–1.42, P?=?0.26). Main drug-related adverse effects of two therapeutic regimens had no difference concerning infection (OR 0.54, 95% CI 0.23–1.27, P?=?0.15), glucose intolerance (OR 0.55, 95% CI 0.16–1.84, P?=?0.33) and acute renal failure (OR 1.37, 95% CI 0.36–7.31, P?=?0.71).

Conclusion

TAC monotherapy is comparable with corticosteroid monotherapy in initial therapy of MCD. To further confirm the conclusion, more large multicenter RCTs are necessary.

     

Progress in Intradermal and Transdermal Gene Therapy with Microneedles

Pharmaceutical Research - Gene therapy is one of the most widely studied treatments and has the potential to treat a variety of intractable diseases. The skin's limited permeability, as the...     

Efficacy and safety of tacrolimus monotherapy versus cyclophosphamide–corticosteroid combination therapy for idiopathic membranous nephropathy: A meta-analysis

ObjectiveThe objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus cyclophosphamide (CTX)-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients.MethodsDatabases including the PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from inception to October 20, 2020. Eligible studies comparing TAC monotherapy and CTX-corticosteroid combination therapy in IMN patients were included. Data were analyzed using Review Manager Version 5.3.ResultsNine studies were included in the meta-analysis. One randomized controlled trial and eight cohort studies involving 442 patients were identified. Compared with CTX-corticosteroid combination therapy for IMN, TAC monotherapy had higher complete remission (CR) at month 6 (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.35–3.50, P < .01). The 2 therapeutic regimens had similar partial remission (OR 0.69, 95% CI 0.45–1.04, P = .08), total remission (OR 1.38, 95% CI 0.85–2.23, P = 0.19) at month 6, and similar CR (OR 1.64, 95% CI 0.84–3.19, P = .15), partial remission (OR 0.71, 95% CI 0.37–1.38, P = 0.31), and total remission (OR 1.29, 95% CI 0.55–3.01, P = .56) after 1 year. The relapse rate of the TAC group was higher than that of the CTX group, but the difference was not statistically significant (OR 1.85, 95% CI 0.75–4.53, P = .18). There was no difference between the 2 therapeutic regimens concerning glucose intolerance (OR 1.15, 95% CI 0.61–2.14, P = .67), acute renal failure (OR 1.14, 95% CI 0.39–3.33, P = .81), or tremors (OR 4.39, 95% CI 0.75–25.67, P = .10). Incidences of gastrointestinal symptoms (OR 0.29, 95% CI 0.10–0.79, P = .02), infection (OR 0.18, 95% CI 0.08–0.39, P < 0.01), leukopenia (OR 0.14, 95% CI 0.04–0.51, P < .01), and abnormal aminotransferase (OR 0.31, 95% CI 0.13–0.77, P = .01) in the TAC group were all lower than those in the CTX group. Subgroup analysis showed that there was no significant difference between the TAC group and the CTX combined with corticosteroid 0.8 to 1 mg/kg/day group concerning CR at month 6 (P > .05). There was no significant difference between the TAC group and the CTX combined with corticosteroid 0.5 mg/kg/day group concerning abnormal aminotransferase (P > .05).ConclusionTAC monotherapy is comparable to CTX-corticosteroid combination therapy for renal remission in IMN patients. TAC monotherapy had a higher CR in the early stage and had fewer drug-related adverse effects. The relapse rate of TAC monotherapy was higher than that of CTX-corticosteroid combination therapy, but the difference was not significant.     

术前中性粒细胞与淋巴细胞比值在临床评估急性胆管炎伴胆总管结石患者病情中的价值

目的探讨术前中性粒细胞与淋巴细胞比值(NLR)对急性胆管炎伴胆总管结石患者手术预后评估的临床意义。 方法选取江苏大学附属武进人民医院普外科2016年1月至2019年6月收治的急性胆管炎伴胆总管结石行手术治疗的患者60例为研究对象进行回顾性研究，其中男性27例，女性33例；年龄46～88岁，平均(67.93±11.46)岁。术前NLR <5.435患者作为低NLR组(31例)，NLR≥5.435患者作为高NLR组(29例)。比较两组患者术前白细胞计数、C反应蛋白、谷草转氨酶、谷氨酰转肽酶水平；同时分析两组住院总天数、术后住院天数、住院总费用等。 结果低NLR组白细胞计数低于高NLR组[(6.28±1.66)×10⁹/L比(10.59±3.55)×10⁹/L，P<0.05 ]；低NLR组C反应蛋白水平低于高NLR组[(57.63±47.68)ug/mL比(81.38±38.25)ug/mL，P<0.05 ]；低NLR组谷草转氨酶水平低于高NRL组[(96.17±71.25)U/L比(281.90±438.30)U/L，P<0.05]；低NLR组谷氨酰转肽酶水平均低于高NLR组[(297.57±255.97)U/L比(509.70±462.06)U/L，P<0.05]，差异有统计学意义(P<0. 05)。低NLR组住院总天数[(13.34±4.55)d比(15.49±3.94)d，P<0.05]、术后住院天数[(10.07±2.80)d比(11.6±3.41)d，P<0.05]及住院总费用[(26 984.78±4 316.30)元比(30 875.35＝±4 305.50)元，P<0.05]等均低于高NLR组，差异有统计学意义(P<0. 05)。 结论急性胆管炎伴胆管结石患者外周血NLR值与其炎症感染程度呈正相关，临床上可将NLR作为对其病情及手术预后进行评估的指标。     

腹腔镜胃十二指肠穿孔修补术的学习曲线

目的评价腹腔镜下胃十二指肠溃疡穿孔修补术的手术效果以及在不同阶段的差异,探讨其学习曲线。 方法回顾性分析常州市武进人民普通外科2015年10月至2017年12月收治的44例胃十二指肠溃疡穿孔修补术的患者资料,其中男性25例,女性19例;年龄28～78岁,平均(44.2±8.8)岁。将患者按照施行手术方式分为腹腔镜手术组(33例)和开腹手术组(11例,Ⅳ组)。依据进行腹腔镜手术时间早晚,将腹腔镜手术组依次又分为三组(Ⅰ组(2015年10月至2016年9月),Ⅱ组(2016年10月至2017年5月),Ⅲ组(2017年6月至2017年12月),每组11例)。对比各组手术出血量、手术时间、中转开腹率、术后住院时间、术后抗生素时间、住院费用、术后下床活动时间、胃肠功能恢复时间和术后并发症发生率等相关指标,分析不同阶段的手术效果,判断腹腔镜下胃十二指肠穿孔修补术的学习曲线。 结果腹腔镜成熟组(Ⅲ组)与开腹手术组相比,手术时间[(55.8±10.2)min比(72.3±9.4)min]、术中出血量[(15.1±5.1)mL比(50.7±8.6)mL]、术后抗生素时间[(5.6±0.3)d比(8.2±0.4)d]、下床活动时间[(31.9±1.4)h比(53.8±3.7)h]、术后住院时间[(6.5±0.4)d比(9.3±0.8)d]、胃肠活动时间[(3.5±0.4)d比(4.5±0.4)d]及住院费用[(12 892±1 120)元比(14 273±1 328)元]均低,差异均有统计学意义(P均<0.05)。腹腔镜手术组的组间比较结果显示：Ⅲ组较Ⅰ、Ⅱ组的手术时间明显缩短[(55.8±10.2)min比(72.7±11.2)min;(55.8±10.2)min比(65.5±9.2)min],出血量也明显减少[(15.1±5.1)mL比(25.3±5.2)mL;(15.1±5.1)mL比(21.6±4.3)mL],差异均有统计学意义(P均<0.05),表明通过学习曲线后相关指标能明显优化。术者的手术频数从0.85台/月(Ⅰ组),逐步增加到2.5台/月(Ⅲ组)。 结论腹腔镜下胃十二指肠穿孔修补术能有效降低患者术后并发症发生率,有创伤小、安全可靠、术后恢复快等优点,值得临床推广。     

Infections after organ transplantation and immune response

Organ transplantation has provided another chance of survival for end-stage organ failure patients. Yet, transplant rejection is still a main challenging factor. Immunosuppressive drugs have been used to avoid rejection and suppress the immune response against allografts. Thus, immunosuppressants increase the risk of infection in immunocompromised organ transplant recipients. The infection risk reflects the relationship between the nature and severity of immunosuppression and infectious diseases. Furthermore, immunosuppressants show an immunological impact on the genetics of innate and adaptive immune responses. This effect usually reactivates the post-transplant infection in the donor and recipient tissues since T-cell activation has a substantial role in allograft rejection. Meanwhile, different infections have been found to activate the T-cells into CD₄⁺ helper T-cell subset and CD₈⁺ cytotoxic T-lymphocyte that affect the infection and the allograft. Therefore, the best management and preventive strategies of immunosuppression, antimicrobial prophylaxis, and intensive medical care are required for successful organ transplantation. This review addresses the activation of immune responses against different infections in immunocompromised individuals after organ transplantation.     

52例症状性颅内动脉粥样硬化性狭窄个体化血管内治疗的回顾性分析

目的　评估症状性颅内动脉粥样硬化性狭窄（sICAS）患者个体化血管内治疗的安全性和有效性。方法　回顾性收集2019年01月至2022年12月在我院接受个体化血管内治疗的sICAS患者的临床资料,分析血管重建成功率、围手术期并发症发生率和死亡情况,以及随访期间复发性缺血性脑卒中（IS）、短暂性脑缺血发作（TIA）、死亡和血管再狭窄的发生率。结果　52例sICAS患者共有55处病变,均接受血管内治疗。患者平均年龄为（62.94±9.04）岁。术前病变血管狭窄程度为90%（80%,99%）,狭窄长度为8（5,11）mm。采用的手术方式分别为球囊扩张式支架植入术（25例,27个病变）、自膨式支架植入术（19例,20个病变）、单纯球囊扩张血管成形术（8例,8个病变）。术后残余狭窄程度为10%（0,20%）,较术前降低且差异有统计学意义（P<0.001）。血管重建成功率为94.23%（49/52）,围手术期并发症发生率为3.85%（2/52）。临床随访时间为12（12,18）个月,影像学随访时间为10（6,12）个月,血管再狭窄发生率为7.69%（4/52）,复发性IS发生率为1.92%（1/52）,无患者死亡。结论　个体化血管内治疗对sICAS可能是安全、有效的,其可提高血管重建成功率,降低围手术期并发症、远期IS复发和再狭窄风险。     

利用酵母双杂交系统筛选NKD1结合蛋白质

目的:酵母双杂交技术筛选结肠癌细胞中与裸角质层同源蛋白1(naked cuticle homolog 1,NKD1)相互结合的蛋白质,从而进一步了解NKD1.方法:以结肠癌细胞SW480的cDNA为模板,克隆NKD1基因,并将其成功构建在pGBKT7诱饵载体上.利用酵母双杂交技术从结肠癌SW480细胞文库进行筛选.结果...     

Low-site versus traditional peritoneal dialysis catheterization: A meta-analysis

Background:The objective of this study was to compare the complications of low-site peritoneal dialysis (PD) catheter placement and traditional open surgery in peritoneal dialysis catheter insertion.Methods:The following databases were searched from inception to September 6, 2019: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang. Eligible studies comparing low-site PD catheter placement and traditional open surgery in peritoneal dialysis catheter insertion were included. The data were analyzed using Review Manager Version 5.3.Results:Seven studies were included in the meta-analysis. A total of 504 patients were included in the low-site PD catheter placement group, and 325 patients were included in the traditional open surgery group. Compared with traditional open surgery, low-site PD catheter placement had a lower incidence rate of catheter displacement (odds ratios [OR] 0.11, 95% CI 0.05–0.22, P < .01) and noncatheter displacement dysfunction (OR 0.11, 95% CI 0.04–0.31, P < .01). However, there was no difference between the 2 catheter insertion methods concerning bleeding (OR 0.53, 95% CI 0.23–1.22, P = .13), PD fluid leakage (OR 0.40, 95% CI 0.15–1.10, P = .07), hypogastralgia (OR 0.95, 95% CI 0.32–2.80, P = .93), peritonitis (OR 0.70, 95% CI 0.32–1.54, P = .38), or exit-site and tunnel infections (OR 0.39, 95% CI 0.14–1.03, P = .06).Conclusion:Low-site PD catheter placement reduced the risk of catheter displacement and noncatheter displacement dysfunction and did not increase the risk of bleeding, PD fluid leakage, hypogastralgia, peritonitis, or exit site and tunnel infections. Additional large multicenter randomized controlled trials are needed to confirm these conclusions.