Noninvasive central pulse pressure is an independent determinant of renal function

The purpose of this study was to investigate the prognostic properties of different BP measurements for renal function decrement and early chronic kidney disease (CKD) in community‐dwelling populations with normal renal function at baseline. A total of 1426 participants were included and followed for a median of 4.8 years (interquartile range, 4.5‐5.2), and central hemodynamic profile and estimated glomerular filtration rate (eGFR) were evaluated. One main outcome was the rapid eGFR decline defined as a decline in eGFR of greater than 3 mL/min per 1.73 m² per year; the other was the new incidence of CKD. At the end of follow‐up, mean eGFR decreased from 93.39 ± 13.46 mL/min per 1.73 m² to 85.72 ± 14.81 mL/min per 1.73 m², and the incidence of rapid eGFR decline and CKD were 20.7% and 5.6%, respectively. In multivariate linear regression analysis, central pulse pressure (PP), age, fasting blood glucose, and concentration of homocysteine were independent determinants of the change in renal function. Not only in the prediction of rapid eGFR decline but also in the incident of CKD, baseline central PP was the only BP component that consistently independently associated with both outcomes after adjustment for various confounders. When compared with subjects in the lowest quartile of central PP, those in the highest quartile demonstrated a significantly increased risk of CKD (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.08‐2.96; P = .006). The study showed that central PP emerged as an independent predictor of the decline in renal function.     

Peak blood pressure‐guided monitoring may serve as an effective approach for blood pressure control in the out‐of‐office setting

We aimed to explore whether diurnal blood pressure (BP) peak characteristics have a significant influence on the association between left ventricular damage with the two BP components (morning BP vs. afternoon peak BP) in untreated hypertensives. This cross‐sectional study included 1084 hypertensives who underwent echocardiography and 24‐h ambulatory BP monitoring. Participants were stratified according to the relationship between morning systolic BP (MSBP; average SBP within 2 h of waking up) and afternoon peak systolic BP (ASBP; average SBP between 16:00 and 18:00). Afternoon and morning hypertension was defined as ≥ 135/85 mm Hg. The morning and afternoon peak BPs occurred at around 7:00 and 17:00, respectively. In general hypertensives, morning BP and afternoon peak BP are significantly different in absolute values (for binary SBP, McNemar''s χ² = 6.42; p = .014). ASBP was more pronounced than MSBP in 602 patients (55.5%), in whom 24‐h SBP showed higher consistency with ASBP than with MSBP (Kappa value: 0.767 vs 0.646, both p < .01). In subjects with ASBP ≥ MSBP, ASBP was associated with left ventricular hypertrophy independent of MSBP (logistic regression analysis odds ratio: 1.046, p < .01), and left ventricular mass index was more strongly correlated with ASBP than with MSBP (multiple regression coefficient β: 0.453, p < .01), in which the relationships held true independently of 24‐h SBP. The opposite results were obtained in subjects with MSBP > ASBP. Peak BP‐guided monitoring may serve as an effective approach to out‐of‐office hypertension monitoring and control, providing the best consistency with 24‐h average SBP and highest discrimination performance for target organ damage, independently of 24‐h SBP.     

Relationship between high‐normal albuminuria and arterial stiffness in Chinese population

High‐normal albuminuria is related to the morbidity and mortality of cardiovascular disease. Arterial stiffness has been regarded as a predictor of cardiovascular disease. However, the relationship between high‐normal albuminuria and arterial stiffness is uncertain in Chinese population. A total of 1343 Chinese participants (aged 58.9 ± 12.1 years, 63.53% male) were included in this study. High‐normal albuminuria was defined as urinary albumin‐to‐creatinine ratio (UACR) above the median within normal albuminuria. Based on the level of UACR, all participants were divided into low‐normal albuminuria group (UACR < 6.36 mg/g, n = 580), high‐normal albuminuria group (6.36 mg/g ≤ UACR < 30 mg/g, n = 581), microalbuminuria (30 mg/g ≤ UACR < 300 mg/g, n = 162), and macroalbuminuria (UACR ≥ 300 mg/g, n = 20). Arterial stiffness was assessed by measuring carotid‐femoral pulse wave velocity (cfPWV). With the increment of UACR, the level of cfPWV was increased gradually (P < .001). Stepwise multiple regression analysis showed that systolic blood pressure, age, serum creatinine, heart rate, logarithmic (LG)‐transformed UACR, and fasting plasma glucose were independently associated with cfPWV in all subjects (P < .001). LG‐UACR was found to be related to cfPWV in high‐normal albuminuria and macroalbuminuria subjects. After further stratification in the high‐normal albuminuria subjects, their relation remained in male, elderly over 65 years old, or normotensives. In summary, UACR is associated with arterial stiffness in subjects with proteinuria excretion in high normal level. High‐normal albuminuria might be an early indicator of arterial stiffness, especially in male, elderly, or normotensives in Chinese population. Furthermore, age and blood pressure are still observed to be the most important risk factor of arterial stiffness.     

人二倍体细胞2BS株和KMB17株在疫苗研发中的应用

人二倍体细胞是WHO认可的更安全的疫苗生产用细胞基质,已成为全世界疫苗生产首选的细胞基质。我国自主研制的二倍体细胞KMB17株和2BS株来源于人胚肺细胞,因其无致癌性、无外源因子污染,且细胞性状比较稳定,越来越多地在人用疫苗研发与生产中使用。由于KMB17细胞和2BS细胞对多种病毒具有敏感性,因此也作为细胞基质被应用于许多病毒性疫苗的研究开发。目前,用这两种人二倍体细胞生产的疫苗,包括甲型肝炎疫苗、脊髓灰质炎疫苗和肠道病毒71型灭活疫苗等,已在我国大量上市。     

二甲双胍联合利拉鲁肽对棕榈酸诱导的内皮细胞氧化损伤具有协同保护作用

目的 探讨二甲双胍和利拉鲁肽在改善棕榈酸诱导的人脐静脉内皮细胞氧化损伤方面是否具有协同保护效应.方法 分离培养人脐静脉内皮细胞,应用不同浓度棕榈酸处理诱导细胞氧化损伤,观察不同浓度二甲双胍和（或）利拉鲁肽对细胞氧化损伤的影响.流式细胞仪检测细胞内的活性氧簇（ROS）水平,硝酸还原酶法检测上清一氧化氮（NO）的水平,组间比较采用单因素方差分析和Q检验.结果 与对照组相比,0.25和0.50 mmoL/L棕榈酸细胞内ROS水平显著升高[（125±17）％、（189±8）％比100％,P＜0.05],上清NO水平降低[（89.9±6.2）％、（79.8±4.8）％比100.0％,P＜0.05];二甲双胍（0.5 ～ 1.0 mmol/L）和利拉鲁肽（10 ～ 100 nmol/L）单独应用后,可使0.50 mmol/L棕榈酸所致的ROS产生增加和NO产生减低作用下降;低剂量的二甲双胍（0.1 mmol/L）或利拉鲁肽（3 nmoL/L）单独应用对0.5 mmol/L棕榈酸的作用均无明显的影响,但两者联合则可减低上述作用：两者联合组与棕榈酸组相比,ROS水平降低[（158±31）％比（250±27）％,P＜0.05],NO水平增加[（91.7±30.6）％比（82.3±5.0）％,P＜0.05].结论 二甲双胍和利拉鲁肽在改善棕榈酸诱导的内皮细胞氧化损伤方面具有协同效应.     

布地奈德福莫特罗联合噻托溴铵对重度慢性阻塞性肺疾病稳定期患者的疗效分析

目的 探讨布地奈德福莫特罗（信必可都保）联合噻托溴铵（思力华）对重度慢性阻塞性肺疾病（COPD）稳定期患者的临床治疗效果.方法 选取重度COPD患者90例,随机分为试验组（45例）和对照组（45例）,两组均在常规治疗（常规吸氧、抗炎、解痉、平喘）的基础上,试验组使用布地奈德福莫特罗联合噻托溴铵吸入,对照组则以布地奈德福莫斯特罗单药治疗,治疗周期6个月;对两组患者的疗效进行对比分析.结果 经过6个月的治疗,两组患者的6 min步行距离、呼吸困难的症状均有改善,但试验组的效果更加明显（P＜0.05）;试验组患者的血气、肺功能指标均明显升高（P＜0.05）.结论 相比于使用布地奈德福莫特罗单药治疗,患者在血气分析、肺功能以及呼吸困难的改善上,噻托溴铵与布地奈德福莫特罗联合治疗重度COPD稳定期患者的疗效更好,具有在临床治疗中推广应用的价值.     

A comprehensive investigation of RHD polymorphisms in the Chinese Han population in Xi’an

Background

This study is a comprehensive analysis of RHD in D-negative phenotypes in saline, in Xi’an, Shanxi province, central China.

Material and methods

DCcEe in saline was measured for each blood sample from every donor between January 2008 and June 2012 in the Xi’an Blood Centre, China. D-negative results were confirmed by an indirect antiglobulin test and further investigated by adsorption-elution as required. The initial step of molecular analysis was RHD zygosity testing. Then RHD was detected by a sequence-specific polymerase chain reaction system for RHD(1227G>A), weak D type 15, and RHD(711delC) alleles for the samples carrying at least one RHD. For the remaining non-identified samples, ten RHD exons were amplified using a previously widely used RHD coding region sequencing method. Some RHD/RHCE conversion alleles were identified while those remaining were submitted to direct sequencing.

Results

Overall, 2,493 D-negative samples in saline were detected in a total of 890,403 donors (D-negative rate, 0.28%). Among the D-negative individuals, RHD deletion (d/d) was assessed in 1685 donors (67.59%). Non-functional RHD alleles were detected in 184 donors (7.38%), the most common being the RHD-CE(2–9)-RHD and RHD(711delC) alleles. Two new alleles were observed and family investigations were performed; RHD(1227G>A) DEL was detected in 516 individuals (20.70%), and weak D or partial D variants were identified in 108 donors (4.33%). The most common alleles were weak D type 15, D^VI type 3 and D^V type 2. Four new weak D alleles were noted, and two cases of RHD(1227G>A)/weak D type 15 heterozygosity were confirmed.

Conclusions

Currently, it seems to be difficult to observe any new RHD alleles in the Han Chinese population. D prediction in this population is easier because popular alleles are dominant, accounting for about 99.80% of alleles in D-negative people. Weak D types and partial D variants are rare and occur in approximately 0.01% of the population.     

CREPT在肾癌组织中的表达及其与预后的关系

目的 探讨肾癌组织中肿瘤细胞周期相关蛋白（cell-cycle-related and expression-elevated protein in tumor,CREPT）的表达与临床病理特征和生存率的关系。方法 纳入90例于2014至2016年间在北京大学人民医院接受了根治性肾切除术并经组织学证实的肾癌患者,运用免疫组织化学方法检测这些患者的癌组织和癌旁组织中CREPT的表达,并结合临床病理资料分析CREPT表达水平与患者TNM分期和Fuhrman分级的关系。通过Kaplan-Meier生存分析及多因素COX回归分析CREPT表达与预后的关系。结果 46.7%（42/90）的患者癌组织中CREPT表达为高水平,而在癌旁组织中所有患者CREPT表达均为低水平,组间比较差异有统计学意义（P<0.05）。CREPT的表达水平与TNM分期（P=0.001）和Fuhrman分级（P<0.001）有关联,但与性别（P=0.149）、年龄（P=0.605）、肿瘤大小（P=0.673）和组织学类型（P=0.756）无关。截至2018年12月,有85例患者完成随访。Kaplan-Meier分析显示,CREPT高表达患者总生存时间和无瘤生存时间均低于CREPT低表达患者,差异有统计学意义（P<0.05）。多因素COX回归分析显示,患者总生存时间及无瘤生存时间与CREPT的表达水平有关（P<0.05）。结论 CREPT在肾癌组织中呈高表达,表达水平与临床分期、分级以及患者预后密切相关。