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.     

Jejunal adenocarcinoma after biliopancreatic diversion. Report of a case

The effects of bariatric surgery on the development of gastrointestinal cancers remain ill defined. We present a case of jejunal adenocarcinoma developing 19 years after biliopancreatic diversion (BPD) procedure according to Scopinaro’s technique. The patient developed a marked distension of the biliopancreatic limb caused by a jejunal mass, evolving towards the so called “duodenal blowout”. Emergency jejunal resection of the biliopancreatic limb, with creation of a new end-to-side jejunal-ileal anastomosis was necessary. The histological examination resulted in a moderately-differentiated ulcerated adenocarcinoma, with reactive lymph nodes and tumor-free resection margins. Tumors of the gastrointestinal system can arise following malabsorptive operations for morbid obesity, and they may be difficult to diagnose, since the symptoms are often attributed to the anatomical-functional changes resulting from this type of surgery. The case reported herein suggests that there is a need for surveillance in patients complaining of digestive symptoms after malabsorptive bariatric surgery.     

3D打印骨折模型在复杂骨盆骨折手术中的治疗方法及效果探讨

目的:探讨复杂骨盆骨折手术治疗中3D打印骨折模型的应用方法及效果。方法:选取医院收治的60例复杂骨盆骨折患者,按照随机数表法将其分为对照组和观察组,每组30例。对照组行传统CT指导下手术治疗,观察组行3D打印仿真骨盆模型体外模拟术后,应用腹直肌旁切口钢板内固定术治疗。比较两组手术时间、住院时间和骨折愈合时间,以及术中出血量、并发症发生率和骨盆功能恢复优良率。结果:观察组手术时间、住院时间及骨折愈合时间短于对照组,术中出血量少于对照组,差异有统计学意义(t=2.721,t=2.458,t=2.791,t=4.450;P<0.05);观察组和对照组并发症发生率分别为3.33%和10.00%,差异无统计学意义(x²=0.267,P>0.05);观察组和对照组骨盆功能恢复优良率分别为96.67%和73.33%,观察组明显高于对照组,差异有统计学意义(x²=4.705,P<0.05)。结论:复杂骨盆骨折手术中应用3D打印骨折模型可缩短手术时间、住院时间,减少出血量,促进骨折愈合,可改善骨盆功能且并发症少。     

The role of serotonin within the microbiota-gut-brain axis in the development of Alzheimer’s disease: A narrative review

Alzheimer’s disease (AD) is the most common cause of dementia, accounting for more than 50 million patients worldwide. Current evidence suggests the exact mechanism behind this devastating disease to be of multifactorial origin, which seriously complicates the quest for an effective disease-modifying therapy, as well as impedes the search for strategic preventative measures. Of interest, preclinical studies point to serotonergic alterations, either induced via selective serotonin reuptake inhibitors or serotonin receptor (ant)agonists, in mitigating AD brain neuropathology next to its clinical symptoms, the latter being supported by a handful of human intervention trials. Additionally, a substantial amount of preclinical trials highlight the potential of diet, fecal microbiota transplantations, as well as pre- and probiotics in modulating the brain’s serotonergic neurotransmitter system, starting from the gut. Whether such interventions could truly prevent, reverse or slow down AD progression likewise, should be initially tested in preclinical studies with AD mouse models, including sufficient analytical measurements both in gut and brain. Thereafter, its potential therapeutic effect could be confirmed in rigorously randomized controlled trials in humans, preferentially across the Alzheimer’s continuum, but especially from the prodromal up to the mild stages, where both high adherence to such therapies, as well as sufficient room for noticeable enhancement are feasible still. In the end, such studies might aid in the development of a comprehensive approach to tackle this complex multifactorial disease, since serotonin and its derivatives across the microbiota-gut-brain axis might serve as possible biomarkers of disease progression, next to forming a valuable target in AD drug development. In this narrative review, the available evidence concerning the orchestrating role of serotonin within the microbiota-gut-brain axis in the development of AD is summarized and discussed, and general considerations for future studies are highlighted.     

甲状腺乳头状癌伴发桥本甲状腺炎的临床研究

背景与目的：甲状腺乳头状癌（papillary thyroid carcinoma，PTC）和桥本甲状腺炎（Hashimoto’s thyroiditis，HT）的发病率均呈上升趋势，两者之间的关系已成为目前研究的热点。探讨PTC和HT之间的关系。方法：回顾性分析2014—2015年期间在中国科学院大学附属肿瘤医院头颈肿瘤外科行甲状腺癌手术治疗的首诊患者306例，术后病理学检查均明确诊断为PTC，其中术后病理学确诊伴发HT者42例，比较伴发HT与未伴发HT患者的临床病理学特征。结果：PTC患者女性发病年龄高于男性（46.2岁 vs 41.9岁）。相较于与未伴发HT的PTC患者，伴发HT的患者中女性比例更高（93% vs77%），中央区淋巴结数目较多［（5.0±3.4）枚 vs （2.5±2.7）枚］，术前促甲状腺激素（thyroid-stimulating hormone，TSH）水平较高［（3.28±1.91）μU/mL vs （2.12±1.29）μU/mL］，术前抗甲状腺过氧化物酶抗体（thyroid peroxidaseantibody，TPOAb）阳性率较高（55% vs 14%），术前甲状腺球蛋白抗体（thyroglobulin antibodies，TgAb）阳性率较高（69% vs 13%）。发生中央区淋巴结转移的患者中，中央区淋巴结转移数目与中央区淋巴结总数显著相关（Pearson相关系数=0.582）。多因素logistic回归分析发现，男性、低龄、被膜侵犯是PTC患者中央区淋巴结转移的独立危险因素。结论：伴发HT对PTC患者的预后无显著影响。伴发HT的PTC患者TSH水平显著偏高，提示HT可能是PTC发病风险因素之一。中央区淋巴结转移数目与中央区淋巴结总数相关，推测PTC淋巴结转移可能与淋巴结炎症反应相关。     

胃肠安丸对葡聚糖硫酸钠诱导溃疡性结肠炎小鼠的治疗作用及机制

目的探讨胃肠安丸对葡聚糖硫酸钠(DSS)诱导溃疡性结肠炎小鼠的治疗作用及机制。方法SPF级C57BL/6小鼠60只,除正常对照组小鼠外,其余小鼠均给予2.5%DSS水溶液,自由饮用7 d制备溃疡性结肠炎模型,模型评价后再随机分为模型组、美沙拉嗪组及胃肠安丸高剂量组、中剂量组、低剂量组。胃肠安丸低、中、高剂量组分别给予0.015、0.03、0.06 g/(kg·d)胃肠安丸混悬液0.5 mL灌胃,1次/d;美沙拉嗪组给予0.52 g/(kg·d)美沙拉嗪混悬液0.5 mL灌胃,1次/d;正常对照组和模型组给予等体积纯水灌胃,均连续干预10 d。对比各组小鼠疾病活动指数(DAI)评分、结肠长度,用HE染色观察小鼠结肠组织病理形态学变化,用流式细胞术检测脾组织中Treg、Th17、CD4^+、CD8^+细胞百分比,ELISA法检测血清细胞因子TNF-α、IL-6、IL-8、IL-10、CRP水平。结果药物干预过程中,各组小鼠体质量均逐日增加,腹泻、便血、体质量下降等症状逐日缓解,与模型组相比,美沙拉嗪组和胃肠安丸高剂量组能更快地缓解上述症状,2组DAI评分逐日下降(P<0.05)。药物干预结束后,与模型组比较,胃肠安丸高剂量组和美沙拉嗪组小鼠结肠较长(P<0.05),结肠组织充血、间质水肿及炎性细胞浸润较轻,CD4^+、CD8^+、Treg细胞百分比及血清IL-10水平较高(P<0.05),Th17细胞百分比及血清TNF-α、IL-6、IL-8、CRP水平较低(P<0.05)。结论胃肠安丸对DSS诱导的小鼠肠道黏膜损伤有一定的修复作用,其作用机制可能与恢复Treg/Th17免疫平衡以及调节相关细胞因子水平有关。     

Effects of Cassava Juice (Manihot esculenta Crantz) on Renal and Hepatic Function and Motor Impairments in Male Rats

Cassava (Manihot esculenta Crantz) is a plant that contains neurotoxins such as linamarin and lotaustraline. Its long-term consumption is associated with neuronal damage and contributes to the development of motor impairment in humans and rats. We investigated the effects of the consumption of cassava juice on renal and hepatic function and motor impairments in male rats. The rats received the vehicle, non-toxic and toxic doses of cassava juice, or linamarin as a pharmacological control, over 35 consecutive days. The effects were evaluated in an open field test, rotarod, and swim test. The toxic cassava dose and linamarin resulted in motor impairments in the rotarod and swim test from day 7 of treatment. The toxic cassava dose and linamarin increased the parameters that indicate renal and hepatic damage, with the exception of total protein and albumin levels. Behavioral variables that show motor incoordination (i.e., latency to fall in the rotarod) were negatively correlated with biochemical parameters of renal and kidney damage, whereas spin behavior was positively correlated. Our data indicate that chronic oral consumption of cassava juice caused renal and hepatic damage that was correlated with motor coordination impairment in rats, similarly to their principal neurotoxic compound, linamarin.     

肾炎方联合缬沙坦分散片对慢性肾小球肾炎患者的疗效与肾功能的影响

目的:探究肾炎方联合缬沙坦分散片治疗慢性肾小球肾炎患者的疗效及对肾功能的影响。方法:选取2016年2月至2019年2月重庆医科大学附属一医院合川医院肾脏内科收治的慢性肾小球肾炎患者122例作为研究对象,随机分为对照组和观察组,每组61例。对照组患者采用下缬沙坦分散片治疗,观察组在对照组基础上采用自拟肾炎方与缬沙坦分散片联合治疗,分析比较2组患者的肾功能指标的动态变化、炎性因子的表达水平、临床疗效及治疗后不良反应。结果:治疗后观察组TC、TG、BUN、Scr及24 hUPE5项指标的动态变化均低于对照组,差异有统计学意义(P<0.05),且观察组ALB动态变化高于对照组,差异有统计学意义(P<0.05);治疗后观察组IL-6、IL-10、CRP及TNF-α水平明显低于对照组,差异有统计学意义(P<0.05),观察组治疗有效率(98.4%)优于对照组(86.9%),差异有统计学意义(P<0.05);观察组不良反应发生率(6.6%)低于对照组(31.1%),差异有统计学意义(P<0.05)。结论:采用自拟肾炎方与缬沙坦分散片联合的治疗方案可增强疗效,提升肾功能,降低促炎性因子的表达水平及不良反应,值得在临床中推广普及。     

"管氏培元九宫"针法治疗功能性阳痿疗效观察

目的观察"管氏培元九宫"针法治疗功能性阳痿的临床疗效。方法将60例功能性阳痿患者按随机数字表法随机分为治疗组和对照组,每组30例。治疗组采用"管氏培元九宫"穴,按"洛书九宫数"施行针刺治疗;对照组口服复方玄驹胶囊。观察两组治疗前后国际勃起功能指数-5(IIEF-5)评分,并比较临床疗效。结果治疗组总有效率为80.0%,对照组为70.0%,两组比较差异具有统计学意义(P<0.05)。治疗组治疗后IIEF-5评分高于治疗前和对照组(P<0.05)。结论"管氏培元九宫"针法对功能性阳痿具有较好临床疗效。