Accurate detection of reemergent anti-donor ABO antibody is crucial for safe transfusion in ABO major incompatible HSCT patient after achieved the stages of full switch to donor type

Dynamic monitoring ABO chimera including erythroid ABO antigen and anti-A/B is crucial to not only assess the status of erythroid engraftment but also achieve personalized safety transfusion in patients post ABO incompatible hematopoietic stem cell transplantation. Transfusion support for ABO incompatible (ABOi) HSCT patients after achieved complete alteration to donor origin still remains cautious because the instant hematopoietic status on these transplant patients possibly returned to patient origin derived from early disease relapse and graft loss or failure. We reported that reemergent anti-B in a female patients (donor/patient: B/O) at the early phase after achievement complete donor type were not effectively found from partial automatic ABO blood grouping systems, which directly resulted in differential judgement of transplantation stage for about 15 days and disturbed the optimal recommendation on transfusion support. Meanwhile, the solely alteration of ABO chimera was found and earlier than changes of other markers such as MRD diagnosis, chimerism analysis by STR-PCR and sex chromosome assays, which can be an available predictors for bad transplant outcomes such as graft failure.     

2型糖尿病患者血清SUA和CysC水平与糖尿病视网膜病变的关系

目的：探讨血清尿酸(SUA)、胱抑素C(CysC)水平与糖尿病视网膜病变(DR)的关系。

方法：前瞻性研究。选取2019-05/2021-05本院收治无DR的2型糖尿病(T2DM)患者53例和DR患者83例，DR患者中包括非增殖型糖尿病视网膜病变(NPDR)47例、增殖型糖尿病视网膜病变(PDR)36例。另选取同期体检中心体检健康者48人作为对照组。比较受试者血清学指标，尿酸氧化酶法检测SUA水平，免疫比浊法检测血清CysC含量，Spearman相关性分析血清SUA、CysC与其他血清学指标的相关性，多因素线性逐步回归法分析血清SUA、CysC的影响因素，使用受试者工作特征曲线(ROC)分析血清SUA、CysC对DR预测效能。

结果：T2DM组、NPDR组和PDR组的体质量指数(BMI)、收缩压(SBP)均明显高于对照组(均P<0.05)，PDR组的SBP均明显高于T2DM组和NPDR组(均P<0.05)，NPDR组和PDR组糖尿病病程均明显高于T2DM组(均P<0.05)，PDR组糖尿病病程明显高于NPDR组(P<0.05)。对照组、T2DM组、NPDR组、PDR组纳入对象中空腹血糖(FPG)、糖化血红蛋白(HbA1c)、SUA、CysC水平呈逐渐明显升高趋势(均P<0.001)，PDR组的低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)水平明显高于对照组(均P<0.05)，而高密度脂蛋白胆固醇(HDL-C)水平明显低于对照组(P<0.05)。血清SUA水平与FPG、HbA1c、TC、TG水平呈正相关(r_s=0.564、0.631、0.513、0.408，P<0.001)，与HDL-C、LDL-C无相关性(r_s=-0.061、0.035，P>0.05)； 血清 CysC水平与FPG、HbA1c、TC、TG水平呈正相关(r_s=0.524、0.692、0.395、0.435，P<0.001)，与HDL-C、LDL-C无相关性(r_s=-0.012、0.049，P>0.05)，FPG、HbA1c、TC、TG是血清SUA、CysC水平影响因素(P<0.001)。SUA、CysC联合检测时曲线下面积(AUC)(0.892，95%CI：0.840～0.944，敏感性71.1%，特异性94.3%)显著高于其单独检测AUC\〖SUA(0.807，95%CI：0.735～0.879，敏感性69.9%，特异性75.5%)、CysC(0.763，95%CI：0.684～0.841，敏感性69.9%，特异性75.5%)\〗(均P<0.05)。

结论：随着DR病情严重程度加重而血清SUA、CysC水平逐渐升高。血清SUA、CysC联合检测可提高DR诊断预测效能。     

扶正化瘀方含药血清对肝星状细胞activinA/smad信号通路活化的影响

目的　探讨扶正化瘀方含药血清对肝星状细胞（HSC）激活素A（activinA）/smad信号通路活化的影响。方法　20只SD大鼠按照随机数字表法分为对照组及扶正化瘀（Fzhy）-低、中、高剂量含药血清组，每组5只，分别以蒸馏水，0.75、1.5、3.0 g/kg扶正化瘀溶液（扶正化瘀胶囊药物粉末与蒸馏水配制）灌胃1次/d，连续3 d，取血制备空白血清（对照组）和含药血清。以大鼠HSC-T6细胞为研究对象，分别用5%、10%、20%体积分数的各组含药血清培养细胞。CCK-8检测细胞存活率，选取细胞存活率在50%左右的体积分数重新分为对照组及Fzhy-低、中、高剂量组。流式细胞术检测细胞周期及凋亡率、线粒体膜电位变化和活性氧（ROS）水平；实时荧光定量聚合酶链反应检测细胞中activinA、smad3、samd7、核因子（NF）-κB的mRNA水平；蛋白质印迹法检测细胞中activinⅡA受体（ActRⅡA）、smad3、NF-κB p65、胱天蛋白酶（caspase）-3的蛋白水平。结果　各扶正化瘀含药血清组的细胞存活率均低于对照组（P＜0.05），选择体积分数为10%的含药血清进行后续实验。对照组和各扶正化瘀方含药血清组细胞周期和凋亡率差异均无统计学意义。对照组及Fzhy-低、中、高剂量组细胞内ROS水平及线粒体膜电位水平降低比例逐次升高（P＜0.05）。与对照组比较，Fzhy-中、高剂量组smad3 mRNA表达水平降低，smad7 mRNA升高，Fzhy-低、中、高剂量组NF-κB、activinA mRNA，smad3、NF-κB p65、ActRⅡA蛋白表达水平降低，Fzhy-低剂量组、中剂量组caspase-3蛋白表达水平升高（P＜0.05）；与Fzhy-低剂量组相比，Fzhy-中、高剂量组smad3 mRNA表达水平降低，Fzhy-中剂量组activinA及smad7 mRNA升高（P＜0.05）。结论　扶正化瘀方含药血清可通过影响HSC-T6细胞增殖、参与细胞的氧化应激以及调节细胞activinA/smad信号转导通路来实现抗纤维化作用。     

HLA-B evolutionary divergence is associated with outcomes after SARS-CoV-2 infection

We examined the correlation between class I HLA evolutionary divergence (HED), a surrogate for the capacity to present different peptides, and the outcomes of 234 adult inpatients with confirmed SARS-CoV-2 infection. Genomic DNA was extracted from peripheral blood and genotyped by next-generation sequencing (NGS). HED scores for HLA class I (HLA-A, -B, and -C) genotypes were calculated using Grantham’s distance. Higher HED scores for HLA-B, but not HLA-A or -C, are significantly associated with a decreased probability of poor outcomes including ICU admission, mechanical ventilation, and death (OR = 0.93; P = 0.04) in the univariate analysis. In the multivariate analysis, increased HLA-B HED score, younger age, and no comorbidity were independently associated with favorable outcomes (P = 0.02, P = 0.01, and P = 0.05, respectively). This finding is consistent with the notion that broader peptide repertoires presented by class I HLA may be beneficial in infection control.     

Medication Adherence App for Food Pantry Clients With Diabetes: A Feasibility Study

Low-income food pantry clients are unable to adhere to the diet and physical activity recommendations of the American Diabetes Association. The aim of the study is to test the feasibility of using a mobile phone app to improve diabetes medication adherence. Clients with uncontrolled type 2 diabetes were enrolled in a mobile phone app featuring 70 days of text message reminders and incentives. The app and the 4-item Morisky Medication Adherence Scale evaluated medication adherence. Clinically significant medication adherence of 93% was achieved with use of the app. Phone app use is feasible among urban low-income clients to improve medication adherence.