Lack of correlation between HBsAg and HBV DNA levels in blood donors who test positive for HBsAg and anti-HBc: implications for future HBV screening policy

BACKGROUND: Studies showing a significant correlation between hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels have focused on the HBV seroconversion window period. STUDY DESIGN AND METHODS: HBsAg levels relative to HBV DNA results in 200 HBsAg-positive, anti-hepatitis B core antigen (HBc)-reactive blood donations were analyzed using quantitative polymerase chain reaction (PCR) (detection limit 400 copies/mL), two research PCR assays with increasing sensitivities (65 copies/mL and 1.3 copies/mL, respectively), and a quantitative HBsAg assay; HBsAg and HBV DNA levels were correlated with HBV serologic profiles; and the potential for replacing HBsAg screening with nucleic acid testing (NAT) was analyzed. RESULTS: Serologic profiles for over 90 percent of the donor samples were consistent with chronic HBV infection. Correlation between HBsAg and HBV DNA concentrations was weak (correlation coefficient = 0.33). Thirty-six percent (72/200) of donor samples had DNA levels under 400 copies per mL. Retesting of the 72 samples by more sensitive PCR assays showed that 60 out of 200 (30%) were positive by PCR with sensitivity of 65 copies per mL, whereas 6 out of 200 (3%) required PCR sensitivity of 1.3 copies per mL for positivity. Three percent (6/200) were negative by all three NAT assays. CONCLUSIONS: HBV DNA levels in HBsAg-positive, anti-HBc-reactive blood donations can be extremely low. About 6 percent of donations would be negative by current minipool HBV NAT methods. About 3 percent of donations would remain undetected by sensitive single-donor NAT. These results indicate caution in any consideration of dropping HBsAg screening.     

单侧输尿管梗阻大鼠肾脏组织基质金属蛋白酶3、基质金属蛋白酶2和金属蛋白酶组织抑制因子2的表达及益气活血法的影响

目的:肾间质纤维化是肾脏疾病进展到肾功能衰竭的共同通路。通过观察益气活血法中药制剂对肾间质纤维化大鼠肾组织基质金属蛋白酶3,基质金属蛋白酶2和金属蛋白酶组织抑制因子2表达的影响,探讨其抗肾间质纤维化的作用机制。方法:实验于2006-12/2007-06在首都医科大学解剖与组织胚胎学系实验室完成。①实验动物:Wistar雄性大鼠30只,采用随机数字法分为模型组、西药蒙诺组、中药小剂量组、中药中剂量组、中药大剂量组和假手术组。实验过程中对动物处置符合动物伦理学要求。②实验方法:其中前5组行单侧输尿管梗阻致肾小管间质纤维化模型手术,假手术组打开大鼠腹腔后,分离其左侧输尿管,不结扎即关闭腹腔。益气活血法中药制剂主要由生黄芪,当归,赤白芍,丹参,黄芩,车前草,牛膝等组成。西药组、中药小剂量组、中药中剂量组和中药大剂量组于手术前2d开始灌胃给药,1次/d,其药量分别为:西药组蒙诺10mg/(kg·d)、小剂量组0.018mL/(kg·d)、中剂量组0.036mL/(kg·d)、大剂量组0.072mL/(kg·d),连续给予2周。模型组及假手术组用相同体积的生理盐水灌胃。③实验评估:6组大鼠于术后14d麻醉后处死,观察梗阻肾脏病理改变,并用免疫组织化学方法检测肾组织对基质金属蛋白酶2、基质金属蛋白酶3和金属蛋白酶组织抑制因子2的表达,通过医学病理图像分析系统对基质金属蛋白酶2、基质金属蛋白酶3和金属蛋白酶组织抑制因子2的积分光密度进行统计学分析。结果:30只大鼠全部进入结果分析。肾组织切片免疫组织化学方法结果显示:基质金属蛋白酶2、基质金属蛋白酶3和金属蛋白酶组织抑制因子2主要表达部位在肾小管上皮,少量表达在肾间质和肾小球。基质金属蛋白酶2和基质金属蛋白酶3在模型组的表达较假手术组明显减弱,两组间积分光密度比较差异有显著性意义(P<0.05);中药大、中剂量组及西药蒙诺组的表达较模型组显著增强,积分光密度差异有显著性意义(P<0.05)。金属蛋白酶组织抑制因子2在模型组的表达较假手术组显著增强,两组间积分光密度比较差异有显著性意义(P<0.05);中药大、中剂量组及西药蒙诺组的表达较模型组有所减弱,两组间积分光密度比较差异有显著性意义(P<0.05);中药小剂量组无论基质金属蛋白酶2和基质金属蛋白酶3还是金属蛋白酶组织抑制因子2的表达与模型组相比均较为相似,两组间积分光密度比较差异无显著性意义(P>0.05)。结论:大鼠输尿管梗阻后呈现出的病理损害可能和肾组织基质金属蛋白酶3,基质金属蛋白酶2与金属蛋白酶组织抑制因子2的表达失衡有关,益气活血法可以上调基质金属蛋白酶2,基质金属蛋白酶3的表达,下调金属蛋白酶组织抑制因子2的表达,显示在抑制或延缓肾间质纤维化的进程中具有一定的作用。     

表皮细胞培养及其临床应用

目的:对表皮细胞的培养方法、临床应用进展方面的研究成果进行综述,展望其发展趋势。资料来源:应用计算机检索PubMed数据库1970-01/2006-08相关表皮细胞的文献,检索词“keratinocytes,culture,skin grafting”,同时检索中国期刊网2000-01/2006-08期间的相关文献,检索词为“表皮细胞,培养,皮肤移植”。资料选择:对资料进行初审,选取相关文献查找全文。纳入标准:①表皮细胞的培养。②表皮细胞的移植。排除标准:综述文献、重复研究类文章。资料提炼:共收集到30篇符合标准的文献,英文文献26篇,中文文献4篇,其中与培养相关的文献19篇,与移植相关的文献11篇。资料综合:自1975年以来,表皮细胞从最初的有血清、有滋养层培养,到无血清、无滋养层培养,再到后来的自动化培养。其培养方法有了较大的发展。这些发展促进了其临床应用,从细胞悬液移植到自、异体细胞膜片移植,再到表皮细胞-生物材料复合物移植。培养和移植方法的发展使人们在治疗大面积皮肤缺损方面看到了希望。结论:目前在表皮细胞培养及其临床应用上还有不少问题需要解决,但随着表皮细胞培养方法和技术的进一步完善,特别是与纳米科学、材料科学等学科的交叉,定能在不远的将来获得理想的永久性皮肤替代物。     

Antithrombin III in fresh frozen plasma, cryoprecipitate, and cryoprecipitate-depleted plasma

Antithrombin III (AT III) is a plasma protein that inhibits several activated procoagulants. Hereditary disease or acquired conditions such as severe hepatic dysfunction, nephrotic syndrome and intravascular coagulation may be associated with reduced levels of AT III. Its replacement may be essential in controlling thrombosis. In order to determine the most effective form of replacement, we compared AT III biological activity and antigen levels in conventionally prepared fresh frozen plasma, cryoprecipitate and cryoprecipitate depleted plasma (CDP). Both the activity and antigen levels were comparable in all three products (approximately 100%) and AT III was not concentrated in cryoprecipitate. These results indicate that conventionally prepared CDP, fresh frozen plasma and cryoprecipitate contain equal quantities volume for volume of AT III. On this basis, all products are equally effective as therapy for AT III deficiency, but CDP and fresh frozen plasma are recommended as convenient sources of this factor.     

原发性血小板减少性紫癜模型小鼠血浆内皮素水平与加味小柴胡颗粒及其组方的干预

目的:建立原发性血小板减少性紫癜动物模型,观察加味小柴胡颗粒及其组方对造模小鼠血浆内皮素含量的调节。方法:实验于2006-07/12在南京中医药大学第一临床医学院实验中心完成。①实验动物与药品:选取SPF级BALB/C小鼠54只,随机数字表法分为5组:正常组10只、模型组12只、加味小柴胡颗粒组11只、小柴胡颗粒组11只、丹参三七颗粒组10只。小柴胡颗粒主要成份为柴胡、黄芩、法半夏、党参、炙甘草、生姜、大枣,每克颗粒含生药5.45g;丹参三七颗粒每克含生药2g;加味小柴胡颗粒:在小柴胡颗粒主要成份上添加丹参、三七,每克颗粒含生药4.18g;均由天江制药厂提供。②实验方法:除正常组外,各组均建立原发性血小板减少性紫癜动物模型。造模后7d灌胃给药,加味小柴胡颗粒组给予加味小柴胡颗粒16.7g生药/kg体质量,小柴胡颗粒组给予小柴胡颗粒13.8g生药/kg体质量,丹参三七颗粒组给予丹参三七颗粒4.4g生药/kg体质量,正常组及模型组均给予等容积蒸馏水。每天给药1次,共给药14d。③实验评估:各组小鼠眼球取血,分离血浆,取上清液用放射免疫法测定血浆内皮素含量。结果:54只BALB/C小鼠均进入结果分析。与正常组比较,模型组血浆内皮素含量明显升高(P<0.05)。与模型组比较,加味小柴胡颗粒组、丹参三七颗粒组明显下降(P<0.05),而小柴胡颗粒组无明显变化(P>0.05)。结论:原发性血小板减少性紫癜血管内皮功能异常,表现为血浆内皮素明显升高,加味小柴胡颗粒及丹参三七颗粒均对其有下调作用,而小柴胡颗粒无影响。     

Neonatal prebiotic (BGOS) supplementation increases the levels of synaptophysin,GluN2A‐subunits and BDNF proteins in the adult rat hippocampus

Compelling data suggest that perturbations in microbial colonization of the gut in early‐life, influences neurodevelopment and adult brain function. If this is the case, then ensuring the growth of beneficial bacteria at an early age will lead to optimal brain development and maturation. We have tested whether feeding neonatal rats daily (from post‐natal days 3‐21) with a galacto‐oligosaccharide prebiotic (Bimuno®, BGOS) or a control solution, alters the levels of hippocampal N‐Methyl‐D‐Aspartate receptor (NMDAR) subunits (GluN1, GluN2A, GluN2B), synaptic proteins (synaptophysin, MAP2, and GAP43) and brain‐derived‐neurotrophic factor (BDNF), at post‐natal days 22 and 56. The administration of BGOS significantly elevated GluN2A subunits, synaptophysin and BDNF in the hippocampus of 22 day old rats. The effect was also observed on day 56 (26 days after the feeding ceased). The levels of all other proteins (GluN1, GluN2B, MAP2, GAP43) remained unaltered. Increased GluN2A, synaptophysin, BDNF, but not MAP2, may suggest that neonatal BGOS feeding alters neurotransmission rather than synaptic architecture. Although the functional consequences of our findings require further investigation, the current study confirms that the manipulation of gut bacteria in early‐life, has central effects that persist until at least young adulthood. Synapse 70:121–124, 2016. © 2016 Wiley Periodicals, Inc.     

基于尿动力学客观指标的神经原性膀胱概率预测模型构建

目的:建立概率预测的Logistic回归模型,分析影响神经原性膀胱尿动力学的主要危险因素和保护因素,并评价模型的灵敏度、特异度和准确性。方法:收集2004-03/2006-03在中山大学附属第一医院尿流动力学室行尿动力学检查的患者80例,对其尿动力学图的客观指标进行回顾性分析。①80例中尿流动力学图正常者29例为对照组,尿流动力学图显示神经原性膀胱者51例为病例组。②将两组资料采用统一的变量指标(包括性别、年龄以及尿流动力学仪器自动采集计算的34个数据)输入SPSS12.0版本数据库,进行主成分分析,将贡献率高的主成分进行单因素分析,取其中有统计学意义的主成分作多因素Logistic回归分析,建立Logistic回归方程,计算各因素的OR值,并计算模型的灵敏度、特异度和准确度。结果:①尿动力学34个客观指标进行主成分分析后得出8个主成分(C1～8),取贡献率高的5个主成分进行单因素分析,结果有2个主成分可以进入多因素Logistic回归分析。获得Logistic回归概率预测模型,此概率预测模型灵敏度为82.4%,特异度75.9%,准确度为80.0%。②主成分C1的OR值=4.606,C1中的首次尿意膀胱压力和逼尿肌压力、正常尿意膀胱压力和逼尿肌压力、强烈尿意膀胱压力和逼尿肌压力、尿急尿意膀胱压力和逼尿肌压力、充盈期最大逼尿肌压力的系数分别是0.823,0.834,0.781,0.913,0.924,0.932,0.883,0.916,0.857,高于C1中其他变量的系数,故可把主成分C1看作是一个“压力型”指标。③C3的OR值=0.183,C3中系数较高的变量是最大流率、平均流率、压力流率中最大流率和平均流率,分别是0.694,0.777,0.768,0.771,因此把C3看作为“流率”变量指标。结论:①成功构建了人神经原性膀胱尿流动力学图的概率预测模型,其中“压力”因子主成分是危险因素,“流率”因子主成分是保护因素。②概率预测模型的灵敏度、特异度和准确性显示其有较好的代表性。     

Can the reading for serologic reactivity following 37 degrees C incubation be omitted?

The need to detect antibodies that agglutinate and/or hemolyze red cells (RBCs) directly at 37 degrees C, but do not react in subsequently performed indirect antiglobulin tests (IATs), is of concern relative to the streamlining and automation of antibody detection methods. To determine incidence and significance of such reactions, data from 87,480 tests, which used low-ionic-strength saline, 10-minute incubation at 37 degrees C, and anti-IgG, were analyzed for unexpected antibodies. There were 3590 positive tests, of which 475 showed reactions at 37 degrees C but not in subsequently performed IATs (37 + IAT-). Of these, 196 reactions were due to autoantibodies or other factors usually considered insignificant with respect to the survival of transfused incompatible RBCs, 176 were due to alloantibodies of questionable clinical significance (M, Lea, P1, etc.), and 103 were associated with alloantibodies of potential clinical significance (63 E, 27 K, 5 Jka, 4 D, 3 cE, and 1 C). This latter reaction was seen in 72 patients, with two 37 + IAT-antibodies occurring in each of 3 patients. Of the 75 potentially significant 37 + IAT-antibodies, 57 were seen in patients recently exposed to homologous RBCs, 13 in patients with a history of transfusion and/or pregnancy, and 5 in patients with no known exposure to homologous RBCs. IAT reactivity was observed in subsequent samples with 27 of these antibodies. The predictive value of a 37 + IAT-test was 21.7 percent for a potentially significant antibody. The incidence was 0.12 percent of all tests for unexpected antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)     

转化生长因子β细胞内信号转导负调控蛋白Smad6，7在肾间质纤维化大鼠肾脏表达与益气活血法的影响

目的:观察肾间质纤维化大鼠肾组织中转化生长因子β细胞内信号转导负调控蛋白Smad6,7表达变化与益气活血法中药制剂的影响。方法:实验于2006-12/2007-06在首都医科大学解剖与组织胚胎学系实验室完成。①实验动物:Wistar雄性大鼠30只,采用随机数字法随机分为模型组、中药大剂量组、中药中剂量组、中药小剂量组、西药蒙诺组、假手术组,每组5只。益气活血法中药提取液(生黄芪15g,当归10g,赤白芍10g,丹参30g,黄芩10g,车前草15g,牛膝15g等)经水提醇沉得4.4kg/L生药提取液。实验过程中对动物处置符合动物伦理学要求。②实验方法:其中前5组行单侧输尿管梗阻致肾小管间质纤维化模型手术。假手术组打开大鼠腹腔后分离左侧输尿管,并不结扎即关闭腹腔。中药大剂量组、中药中剂量组、中药小剂量组、西药蒙诺组,于手术前2d给予灌胃给药0.072mL/(kg·d),0.036mL/(kg·d),0.018mL/(kg·d),10mg/(kg·d),1次/d,连续2周。模型组及假手术组用相同体积的生理盐水灌胃。③实验评估:6组大鼠于术后14d麻醉后处死,观察梗阻肾组织病理改变,用免疫组化方法检测肾组织Smad6,7蛋白表达,通过医学病理图像分析系统对Smad6,7蛋白的积分光密度进行统计学分析。结果:30只大鼠全部进入结果分析。苏木精-伊红染色显示模型组肾小管上皮细胞萎缩,大部分肾小管管腔扩张,间质纤维组织增生,大量炎性细胞浸润,肾小球数目明显减少。中药大剂量组、中剂量组、西药蒙诺组较模型组肾间质炎性细胞浸润、纤维组织增生、肾小管扩张情况明显减轻。Smad6,7蛋白主要在肾皮质肾小管上皮细胞内表达,在模型组它们的表达较假手术组明显减弱且分布面积减少,两组间积分光密度差异具有统计学意义(P<0.05);中药中剂量组、大剂量组、西药蒙诺组Smad6,7蛋白的表达较模型组明显增强、面积增加,积分光密度差异具有统计学意义(P<0.05)。结论:益气活血法可以通过诱导肾组织Smad6,7蛋白表达而抑制肾间质纤维化。     

Percutaneous umbilical blood sampling and umbilical vein transfusions. Rapid serologic differentiation of fetal blood from maternal blood

Percutaneous umbilical blood samples (PUBS), obtained under ultrasound guidance, are used for prenatal diagnosis and management of hemolytic disease of the newborn (HDN) and other fetal disorders. Rapid testing at the time of sampling is vital to distinguish fetal from maternal blood. Blood typing was performed by slide technique in the treatment room during 38 procedures on 25 patients. Anti-I was used to test 50 presumed PUBS; venous I-positive maternal blood was tested in parallel. Because anti-I cannot detect fetal blood after umbilical vein transfusion (UVT) of I-positive donor blood, ABO and Rh blood typing reagents were used to test 29 samples when maternal and fetal or donor blood groups differed. Monoclonal reagents were used for optimal detection of weak AB antigens in fetal blood. Avid, chemically modified anti-D was used for Rh typing. Blood typing showed 27 (34%) of 79 samples to be maternal blood. Fetal blood was obtained in 8 of 10 cases investigated for fetal disorder and in 16 cases of potential HDN (anti-D, 5; -CD, 5; -cE, 2; -K, 2; -c; -E). The absence of HDN (antigen-negative fetus) was determined in 4 cases. UVT afforded live birth of 9 of 10 infants with HDN and was not indicated in two cases.