Long-term presence of angiotensin II type 1 receptor autoantibody reduces aldosterone production by triggering Ca<Superscript>2+</Superscript> overload in H295R cells

Preeclamptic women are reported to have inadequate plasma volume expansion coupled with a suppressed secretion of aldosterone; however, the specific mechanism of preeclampsia remains unclear. We demonstrated that the presence of long-term angiotensin II type 1 receptor autoantibody (AT1-AA) reduces aldosterone production by triggering a Ca²⁺ overload in H295R cells. AT1-AA was discovered in preeclamptic women and reported to activate AT₁R, and consequently elevate intracellular Ca²⁺. We found that AT1-AA significantly prolonged the time of intracellular Ca²⁺ elevation. Besides promoting aldosterone production as a second messenger, Ca²⁺ overload shows a cytotoxic effect. Our data reveals that long-term presence of AT1-AA triggered a Ca²⁺ overload and consequent impairment of aldosterone production, which could be prevented by a PKC inhibitor, Gö 6983, or a calcium channel inhibitor, nifedipine. These findings have clinical significance because AT₁R blockers are not recommended for treatment of preeclampsia due to their potential harm to the fetus. Our findings also emphasize a potential clinical benefit of immunoadsorption or neutralization of AT1-AA in preeclamptic women.     

人血白蛋白在原发性肝癌肝切除术后的应用分析

目的 对东方肝胆外科医院原发性肝癌行肝切除术后使用人血白蛋白的情况进行合理性评价。 方法 回顾分析2012年6月至2013年6月期间150例原发性肝癌患者行肝切除术后应用人血白蛋白治疗的临床资料,比较患者术后应用人血白蛋白前后临床指标、生化指标,及人血白蛋白用药剂量相关因素分析,评价该院人血白蛋白的用药合理性。 结果 在统计的150份病历中,白蛋白总用量11 212.5 g(897瓶),总金额527 744元,占药品总费用的近20%,占住院总费用的近10%。患者在术后使用人血白蛋白后肝功能异常指标阳性率降低(P<0.05),人血白蛋白的使用剂量与患者用药前肝功能的Child-Pugh评分存在正相关(P<0.05)。 结论 该院原发性肝癌肝切除术后使用人血白蛋白较为合理,可达到预期的治疗效果。     

调查分析医院病案管理中存在的问题及相应的解决措施

目的调查并探讨医院的病案管理中所存在的问题,并对其解决的措施加以研究分析。方法选择我院的内科科室,调查科室的医务人员对于病案管理工作的重视情况及病案利用情况,选取2013年9月—2014年8月期间收治的51例患者,设为试验组,同时选取2012年9月—2013年8月期间收治的51例患者,设为对照组。该院自2013年9月开始实施病案管理措施,比较实施前后两组的病案质量的情况、患者的投诉率及患者的满意程度。结果试验组患者的病案质量的完善率(92.54%)、患者的满意程度(98.04%)均明显高于对照组患者的病案质量的完善率(61.76%)、患者的满意程度(72.55%),统计学均有意义(P<0.05);试验组患者的投诉率(1.96%)明显低于对照组患者的投诉率(27.45%),差异有统计学意义(P<0.05)。结论实施有效的病案管理措施后,可以较大程度的提高病案质量的完善率、满足患者的期望值,使患者较为满意,应在临床上加以推广使用。     

Polymorphisms in arachidonic acid metabolism-related genes and the risk and prognosis of colorectal cancer

Cyclooxygenase-2 (COX-2), 12-lipoxygenase (12-LOX) and phospholipaseA2 (PLA2) played important roles in the modulation of apoptosis, angiogenesis, carcinogenesis and invasion of colorectal cancer (CRC). The polymorphisms in COX-2, 12-LOX and PLA2 may affect their roles. Therefore, we investigated if COX-2 ?1195G > A, 12-LOX 261Arg > Gln and PLA2 c.349 + 191A > G polymorphisms were associated with risk and prognosis of CRC as well as possible interactions with the environmental factors on the risk of CRC in Northeast of China. A case–control study with 451 cases and 631 controls were carried out, a cohort with 386 patients were followed up. Genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Compared with the 261Arg/Arg genotype, 12-LOX 261Arg/Gln genotype and 261Arg/Gln + Gln/Gln genotypes reduced the risk of rectal cancer by 33 % (adjusted OR = 0.67, 95 % CI 0.47–0.97, p = 0.03) and 32 % (adjusted OR = 0.68, 95 % CI 0.49–0.96, p = 0.03), respectively. The adjusted HR for the association between 12-LOX 261Gln/Gln genotype and overall survival in patients with CRC was 1.68 (95 % CI 1.06–2.68, p = 0.03). There was also evidence of an interaction between the PLA2 c.349 + 191 A > G genotypes and the overnight food consumption (adjusted OR_i = 1.92, 95 % CI 1.14–3.25, P _interaction = 0.01). These observations indicate that 12-LOX 261Arg > Gln polymorphism may affect risk of rectal cancer, and it may be a potential predictive marker for prognosis of CRC.     

绝经后女性阻塞性睡眠呼吸暂停低通气综合征患者代谢相关因素与心功能损伤的相关性分析

睡眠呼吸暂停低通气综合征为临床常见疾病之一,严重影响人类健康,临床中以阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)最常见[1]。流行病学调查显示,美国40岁以上人群OSHAS患者占2%~4%,我国OSAHS患病率约为4%[2-3]。     

新疆乌鲁木齐维吾尔族≥18岁居民糖尿病患病率及其影响因素调查

目的 了解新疆乌鲁木齐市维吾尔族居民糖尿病前期及糖尿病患病情况,并分析其危险因素,为糖尿病防治提供基础依据。方法 2017年5月在乌鲁木齐市进行横断面调查,抽取两个区的四个社区进行。采用1990年WHO诊断标准,统计糖尿病前期及糖尿病患病情况,对相关危险因素进行分析。结果 共选择2013名乌鲁木齐市维吾尔族居民为调查对象,糖尿病患病率9.8%,糖尿病前期患病率9.6%,未诊断糖尿病患者占53.8%。IFG、IGT、IFG+IGT、新诊断DM、既往DM患病率分别为2.5%、6.1%、1.0%、5.3%、4.5%。糖尿病前期及糖尿病青年、中年、老年患病率分别为8.5%、31.7%、55.2%。糖尿病前期及糖尿病在BMI<24、超重、肥胖中患病率分别是6.2%、18.8%、36.8%,中心性肥胖中糖尿病前期及糖尿病的患病率为28.1%。腰围、收缩压、心率、甘油三酯（TG）、低密度脂蛋白（LDL-C）、血肌酐、糖尿病家族史、食水果多、喜食油炸食品、体力活动小是糖尿病前期及糖尿病的独立危险因素。结论 乌鲁木齐乃至新疆地区维吾尔族居民糖尿病形式严峻,应关注中青年健康,加强糖尿病科普宣传,提倡合理饮食、增加运动量、控制体重,延缓和控制糖尿病的到来。     

Combination therapy with afatinib and bevacizumab in an EGFR-mutated non-small cell lung cancer patient with acquired ERBB2 amplification: A case report

Introduction:Acquired resistance to reversible EGFR tyrosine kinase inhibitors remains a significant obstacle, and acquired ERBB2 amplification is the most common “bypass” mechanism. For patients with sensitizing EGFR mutation who experience resistance via ERBB2 amplification, no targeted drug has been demonstrated to be effective.Patient concerns:A 56-year-old female nonsmoker suffered from left leg paralysis and low back pain. Imaging examination revealed a mass in the anterior segment of the right upper lobe lung and possible multiple metastases in the right hilar, mediastinal lymph nodes, bone metastases, and soft tissue invasion.Diagnosis:Transbronchial lung biopsy revealed a moderately differentiated adenocarcinoma (cT4N2M1c, stage IV). An EGFR exon 19 deletion was identified using amplification refractory mutation system.Interventions:After the patient was treated with gefitinib initiation (250 mg/d) for 15 months, the tumor progressed with ERBB2 amplification revealed by next-generation sequencing test. Then, the patient was started on afatinib (40 mg/d) plus bevacizumab (7.5 mg/kg every 3 weeks).Outcomes:The combination therapy of afatinib and bevacizumab in this patient was effective with some slight side effects. Computed tomography scans showed the tumor shrinkage and the pleural effusion disappeared in the right lung. The overall survival was 23.5 months.Conclusion:To date, there is no targeted therapy approved and demonstrated to be effective for non-small cell lung cancer patients with EGFR sensitizing mutations, and ERBB2 amplification. The effectiveness of combination therapy with afatinib and bevacizumab may provide a new therapeutic option for these patients.     

Relapsing subarachnoid hemorrhage as a clinical manifestation in microscopic polyangiitis: a case report and literature review

Clinical Rheumatology - Microscopic polyangiitis (MPA) is a systemic small-vessel vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA) and predominantly causes kidney and...