Should pulse pressure and day/night variations in blood pressure be seen as independent risk factors requiring correction or simply as markers to be taken into account when evaluating overall vascular risk?

Patients with a blunted fall in nocturnal BP (known as non-dippers) have a high risk of micro- and macrovascular complications, particularly if they have hypertension, but also in normotensive patients with diabetes. A blunted fall in nocturnal BP reflects the high level of CV risk in these patients. ABPM data indicating an altered circadian BP rhythm reverse circadian BP profile should alert the physician to the potential risk of complications and should lead to efforts to treat hypertension effectively, especially at night, and to check for sleep apnoea syndrome, particularly in cases of resistant hypertension, or autonomic neuropathy (postural hypotension), a well known risk factor for cardiovascular (CV) events. Patients should be carefully screened for nephropathy. However, the definitions of "non-dipper" vary widely. Suitable treatments are poorly defined, but angiotensin-converting enzyme inhibitors (ACEi), diuretics, salt restriction and the maintenance of continuous positive airway pressure (CPAP) can be used as non-specific treatments. The efficacy of taking blood pressure-lowering drugs at bedtime rather than in the morning is still debated but deserves attention. In the diabetic population, brachial pulse pressure (PP) is an independent predictor of cardiovascular mortality, but not of all-cause mortality. It is also associated with complications of both type 2 and type 1 diabetes, this effect being stronger for nocturnal than for diurnal PP, and is strongly predictive of coronary heart disease in patients with type 2 diabetes. The stronger association between PP and age in diabetic than in non-diabetic populations suggests that diabetes accelerates vascular ageing. In patients with incipient nephropathy or overt renal failure, PP increases CV risk. However, misinterpretation could be related to confusion between brachial PP and central PP. The therapeutic implications of PP measurement remain poorly documented in diabetes.     

Elevated total serum immunoglobulin E (>1000 IU/mL): implications?

Atopic eczema, allergic broncho‐pulmonary aspergillosis, helminthic infections and rare primary immunodeficiencies are known to elevate total serum immunoglobulin E (IgE) above 1000 IU/mL. However, of 352 patients with IgE >1000 IU/mL seen in our hospital over a 5‐year period, less than 50% had these conditions. Markedly elevated IgE levels in the rest of the patients were associated with asthma, allergic rhinitis and food allergy, instances where the test is of limited diagnostic utility.     

E/A和E/Em比值对舒张性心力衰竭的诊断价值

舒张性心力衰竭（diastolic heart failure,DHF）是一组具有心功能衰竭症状和体征而左室射血分数正常,以舒张功能异常为特征的临床综合征.舒张功能异常所致的充血性心力衰竭十分常见.流行病学研究显示,DHF发病率占心力衰竭病例的38%～54%,其病死率与收缩性心力衰竭相似,但预后优于收缩性心力衰竭.     

HPV E6/E7蛋白在肺癌中的研究进展

肺癌是一种多因素参与的恶性肿瘤性疾病.目前在肺癌中检测到HPV E6/E7蛋白存在的报道不断出现,其在肺癌的作用也不断引起研究者的关注.本文就HPV E6/E7蛋白的生物特性与发病机制,以及在肺癌中所起的作用作一综述.     

Cultured Human Bone Marrow–Derived CD31 Cells Are Effective for Cardiac and Vascular Repair Through Enhanced Angiogenic,Adhesion, and Anti-Inflammatory Effects

Background

Cell therapy for cardiovascular disease has been limited by low engraftment of administered cells and modest therapeutic effects. Bone marrow (BM) -derived CD31⁺ cells are a promising cell source owing to their high angiovasculogenic and paracrine activities.

Objectives

This study sought to identify culture conditions that could augment the cell adhesion, angiogenic, and anti-inflammatory activities of BM-derived CD31⁺ cells, and to determine whether these cultured CD31⁺ cells are effective for cardiac and vascular repair.

Methods

CD31⁺ cells were isolated from human BM by magnetic-activated cell sorting and cultured for 10 days under hematopoietic stem cell, mesenchymal stem cell, or endothelial cell culture conditions. These cells were characterized by adhesion, angiogenesis, and inflammatory assays. The best of the cultured cells were implanted into myocardial infarction (MI) and hindlimb ischemia (HLI) models to determine therapeutic effects and underlying mechanisms.

Results

The CD31⁺ cells cultured in endothelial cell medium (EC-CD31⁺ cells) showed the highest adhesion and angiogenic activities and lowest inflammatory properties in vitro compared with uncultured or other cultured CD31⁺ cells. When implanted into mouse MI or HLI models, EC-CD31⁺ cells improved cardiac function and repaired limb ischemia to a greater extent than uncultured CD31⁺ cells. Histologically, injected EC-CD31⁺ cells exhibited higher retention, neovascularization, and cardiomyocyte proliferation. Importantly, cell retention and endothelial transdifferentiation was sustained up to 1 year.

Conclusions

Short-term cultured EC-CD31⁺ cells have higher cell engraftment, vessel-formation, cardiomyocyte proliferation, and anti-inflammatory potential, are highly effective for both cardiac and peripheral vascular repair, and enhance survival of mice with heart failure. These cultured CD31⁺ cells may be a promising source for treating ischemic cardiovascular diseases.     

E/E’指数与射血分数正常的心力衰竭

射血分数正常的心力衰竭(HFNEF)常见,超声心动图一直是主要的非侵入性诊断方法,但由于缺乏理想参数,使用上受到限制。近年来研究表明组织多普勒E/E’指数与左室充盈压及脑钠肽有良好相关性,用来正确诊断HFNEF,甚至在心房颤动病人,E/E’也是心血管疾病预后的强预测因子。     

2015-2016年深圳市登革Ⅲ、Ⅳ型分离病毒株E/NS1基因序列特征

目的 了解2015-2016年深圳市分离的登革Ⅲ、Ⅳ型病毒E/NS1基因序列特征及登革Ⅲ、Ⅳ型病毒流行规律,探究其可能的传播来源。方法 收集2015-2016年深圳市登革热患者病例资料及急性期血清,用C6/36细胞培养分离登革病毒,用FQ-PCR对其进行血清分型,分离成功的病毒株用反转录-聚合酶链反应(PCR)方法扩增E基因和NS1基因,进行序列分析,绘制系统进化树,氨基酸比对分析4个不同血清型NS1蛋白。结果 从5份Ⅲ型的登革病毒标本中成功分离4份病毒株,3份Ⅳ型登革病毒标本中成功分离2份登革病毒;BLAST分析保守E基因结果表明,与DENV-3分离株同源性最高(99%)的毒株主要是印度尼西亚2010和2015年分离株、菲律宾2015年分离株。与DENV-4分离株同源性最高(99%)的毒株主要是菲律宾2013年分离株、印度尼西亚2010分离株、意大利2009年分离株。NS1基因序列分析显示所选4株不同血清型的病毒株氨基酸相似性为77.69%,4个不同血清型的登革热NS1抗原存在5-7个氨基酸保守区域。结论 2015-2016年深圳市输入的登革Ⅲ、Ⅳ型病毒可能来自印度尼西亚和菲律宾,应加强出入境人员的监测工作,避免输入引起本地感染的风险。     

Relationship of Myocardial Fibrosis to Left Ventricular and Mitochondrial Function in Nonischemic Dilated Cardiomyopathy—A Comparison of Focal and Interstitial Fibrosis

BackgroundMitochondrial damage is associated with histologic myocardial fibrosis. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) can be used to identify focal fibrosis. We examined whether myocardial fibrosis on CMR and collagen volume fraction (CVF) from biopsies correlated with left ventricular (LV) and mitochondrial function in patients with nonischemic dilated cardiomyopathy (DCM).Methods and ResultsFifty-nine DCM patients underwent CMR, cardiac catheterization, and endomyocardial biopsy. Minimum first derivative of LV pressure (LVdP/dt_min) was measured as an index of LV relaxation. Mitochondrial RNA expression was also analyzed. For quantitative analysis of myocardial fibrosis, percentage LGE (%LGE) and CVF were calculated. Patients were divided into 2 groups on the basis of the presence (LGE group; n = 27) or absence (non-LGE group; n = 32) of LGE. Mean CVF and absolute value of LVdP/dt_min were significantly higher and lower, respectively, in the LGE group than in the non-LGE group. Multivariate analysis revealed that %LGE was an independent determinant of LVdP/dt_min. The abundance of mitochondrial enzyme mRNA was significantly lower in the LGE group.ConclusionsNoninvasive CMR imaging is more useful in predicting diastolic dysfunction than invasive histologic assessments. In addition, it might indicate mitochondrial dysfunction in DCM.     

No reflow : quels facteurs prédictifs ?

Introduction

During the past 20 years, significant progress has been made in the recanalization of ACS with ST elevation. It is now accepted that the reopening of the large coronary vessels in the acute phase of infarction by thrombolysis or angioplasty is necessary but not sufficient, because in 20–50% of cases, the coronary recanalization is an illusion of reperfusion. This phenomenon is called “no reflow”.

Objective

The main objective of our study was to identify predictors of poor perfusion or “no reflow” in the acute phase of myocardial infarction.

Methods

Observational prospective study, in the department of cardiology and internal medicine, university hospital of Blida, over a period of 28 months from 1st September 2010 to 31st January 2013. We identified all patients hospitalized for myocardial infarction in acute phase, who underwent primary angioplasty or thrombolysis with angiographic control during a good TIMI flow. The endpoint was regression of ST segment (regression < 50% ST-segment defined no reflow).

Results

Three hundred and seventy-nine patients were included. The mean age was 56.3 ± 2.1, 87.8% of patients were male. In total, 35.9% hypertensive, 27.1% diabetic type 2, 50.1% and 10.8% dyslipidemia, smoking. One hundred and forty-seven (38.8%) developed a no reflow. Mortality was 3.9%, strongly correlated with no reflow (P = 0.001). Predictors of no reflow after multivariate analysis were: age (OR 98, 0.961–0.996 95%, P = 0.02), heart rate (1.01, 95% CI 0.998–1.02, P = 0.035), the type 2 diabetes (odds ratio 1.87, CI 1.2–3.0, P = 0.08), reaching the core (OR 7, 95% CI 1.2–18.4, P = 0.027), direct stenting (OR 0.48, 95% CI 0.31–0.78, P = 0.003). An interesting subgroup of patients was identified namely the subgroup strategy deferred primary angioplasty with stenting best reperfusion (OR 3.7, 95% CI 1.5–8.8, P = 0.04), a lower rate of reocclusion of culprit artery and a lower rate of stenting with 23/51 (45.1%) versus 136/136 (100%) of immediate stenting group with a P < 0.001.

Conclusion

No reflow is a common phenomenon, strongly correlated with mortality predictors are age, heart rate, diabetes, achieving the core and direct stenting. The distal embolization in primary angioplasty is an important phenomenon, a delayed stenting strategy appears to limit this phenomenon.     

宫颈癌组织中HPV16型E6/E7序列突变分析

目的：分析泉州地区宫颈癌患者HPV16型E6/E7序列突变情况,探讨其与宫颈癌发生的相关性。方法：取35例HPV16阳性的宫颈癌组织标本,采用PCR法扩增E6、E7全长基因。PCR产物直接测序,并与野生型序列进行比对。分析E6、E7基因的变异情况。结果：E6、E7基因的突变率分别为91.4%和89.2%。E6基因中有10个位点为错义突变, 2个位点为无义突变。氨基酸突变频率最高的是D25E（77.1%）。E7基因中共发现5个突变位点,有2个位点为错义突变,3个位点为无义突变,突变频率最高是N29S和无义突变T846C（均为75.0%）。结论：HPV16 E6、E7基因中最常见突变位点D25E、N29S和T846C可能与宫颈癌的发生密切相关,可为研究针对中国人群的HPV疫苗提供一定的线索。     

Hepatitis E,what’s the real issue?

Hepatitis E Virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis in the world with an estimated 20 million cases every year and 70 000 deaths. Hepatitis E is a waterborne infection in the developing countries. In these countries, HEV genotypes 1 and 2 cause large outbreaks and affect young subjects, resulting in significant mortality in pregnant women and patients with cirrhosis. In the developed countries, HEV genotypes 3 and 4 are responsible for autochthonous, sporadic hepatitis and transmission is zoonotic. Parenteral transmission by the transfusion of blood products has been identified as a potential new mode of transmission. The prevalence of positive HEV viraemia in blood donors in Europe ranges from 1/600 to 1/2500 in highly endemic European countries. HEV can cause neurological disorders and chronic infections in immunocompromised patients. The progression of acute hepatitis E is usually asymptomatic and resolves spontaneously. Diagnostic tools include anti‐HEV IgM antibodies in serum and/or viral RNA detection in the blood or the stools by PCR. Ribavirin is used to treat chronic infection. A vaccine has been developed in China.     

E问E答

网友“betterday”问：我今年43岁,餐后2小时血糖19．0mmol／L,是否要打胰岛素？     

E问E答

网友“天亮了”问：跟糖尿病患者一起生活会被传染吗？     

E问E答

海军总医院内分泌科主治医师 尚健 答：血糖波动较大,往往是晚餐前血糖急剧升高。解决办法：①首先查找是否为饮食导致的高血糖;②1型糖尿病患者往往胰岛功能很差,外源补充胰岛素很难纠正血糖的漂移。建议血糖波动较大的患者可行72小时连续动态血糖监测,可以详细了解血糖波动情况,更好地指导治疗以及饮食,尤其对于夜间有无低血糖情况一目了然。     

Val/Leu<Superscript>247</Superscript> and Trp/Ser<Superscript>316</Superscript> polymorphisms in β<Subscript>2</Subscript> glycoprotein I and their association with thrombosis in unselected Chilean patients

It is known that polymorphisms of β ₂-glycoprotein I (β ₂GPI) in exon 7 affect interaction between the phospholipid binding site and the antibodies, and that other polymorphisms in exon 8 increase the generation of antibodies. In this study, we analyzed genetic polymorphisms of β ₂GPI in unselected Chilean patients to determine the prevalence of β ₂GPI polymorphisms in the phospholipid domain in patients with venous and arterial thrombosis and the clinical correlation with thromboembolic complications. This study comprised 149 patients with venous and arterial thrombosis (62 with venous thrombosis and 87 with arterial thrombosis) and 160 healthy controls with no previous history of thrombosis. Polymorphisms of exons 7 and 8 of β ₂GPI, which encode for its fifth domain, were determined by PCR-RFLP. The presence of aPL or anti-β ₂GPI in the patients was detected by ELISA. Anti-β ₂GPI were present in 8/149 patients (5.4%); of these, five had aCL antibodies of low titer. The allele containing Val/Leu²⁴⁷ and Trp/Ser³¹⁶ was significantly more frequent in patients with thrombosis than in the control group (OR=3.1, CI 1.6–6.0, p=0.0003; OR=2.9, CI 1.1–8.6, p=0.027, respectively). These polymorphisms did not correlate with aPL or anti-β ₂GPI but significant differences were observed with venous thrombosis (p=<0.0001) and arterial thrombosis (p=0.026). In conclusion, the β ₂GPI polymorphisms Val/Leu²⁴⁷ and Trp/Ser³¹⁶ are not related to the presence of anti-β ₂GPI antibodies in unselected Chilean patients with venous and arterial thrombosis, but they are significantly associated with venous and arterial thrombosis.