生物可降解镁合金血管支架:缺点及未来研究趋势

背景:可降解支架被认为是血管介入领域继球囊扩张血管成形、金属裸支架、药物洗脱支架后的第4次革新,镁合金支架是目前可降解支架的研发热点。目的:综述可降镁合金血管支架的研究现状,探讨其存在的缺点及研究应用趋势。方法:第一作者用计算机检索PubMed数据库、CNKI中国期刊全文数据库、万方全文数据库2001年1月至2014年11月收录的可降解镁合金血管支架相关研究内容,分析其研究现状及进展。结果与结论:镁合金作为可降解血管支架的体外研究集中在镁合金降解速度、生物相容性及镁合金对血管内皮细胞和平滑肌细胞的影响。目前的研究显示镁合金支架降解过快仍然是限制其大规模临床应用的主要原因,靶血管在置入支架后需要6-12个月的重建修复期,支架应在这段时间内提供机械支撑,现有的可降解镁合金支架尚难以达到这一要求。为提高镁合金支架的耐腐蚀性能及生物相容性,一方面可以考虑选择耐腐蚀性能更好的合金元素,另一方面通过支架涂层等表面改性技术来提高支架的抗腐蚀性能与生物相容性,也是未来镁合金支架研发的一大趋势。     

吻合器痔上黏膜环切术(PPH)治疗重度痔术后并发症分析(附384例报告)

目的探讨PPH术后并发症的原因及防治体会。方法回顾性分析2011-01—2013-12间实施PPH术治疗的384例重度痔患者术后并发症的情况。结果尿潴留81例(21.1%),肛门疼痛需用止痛剂165例(42.9%),术后原发性出血4例(1.1%),术后继发性出血7例(1.8%),肛门残留皮赘或仍有轻度痔核脱垂18例(4.7%),肛门狭窄2例(0.5%),直肠阴道瘘1例。随访10~30个月,有2例再次入院行痔切除术。结论 PPH术虽具有操作简便,创伤小、恢复快等优点,但仍需进一步规范手术操作及围手术期处理,减少并发症发生。     

Multiple Genes of the Renin-Angiotensin System Are Novel Targets of Wnt/β-Catenin Signaling

Activation of the renin-angiotensin system (RAS) plays an essential role in the pathogenesis of CKD and cardiovascular disease. However, current anti-RAS therapy only has limited efficacy, partly because of compensatory upregulation of renin expression. Therefore, a treatment strategy to simultaneously target multiple RAS genes is necessary to achieve greater efficacy. By bioinformatics analyses, we discovered that the promoter regions of all RAS genes contained putative T-cell factor (TCF)/lymphoid enhancer factor (LEF)-binding sites, and β-catenin induced the binding of LEF-1 to these sites in kidney tubular cells. Overexpression of either β-catenin or different Wnt ligands induced the expression of all RAS genes. Conversely, a small-molecule β-catenin inhibitor ICG-001 abolished RAS induction. In a mouse model of nephropathy induced by adriamycin, either transient therapy or late administration of ICG-001 abolished established proteinuria and kidney lesions. ICG-001 inhibited renal expression of multiple RAS genes in vivo and abolished the expression of other Wnt/β-catenin target genes. Moreover, ICG-001 therapy restored expression of nephrin, podocin, and Wilms’ tumor 1, attenuated interstitial myofibroblast activation, repressed matrix expression, and inhibited renal inflammation and fibrosis. Collectively, these studies identify all RAS genes as novel downstream targets of Wnt/β-catenin. Our results indicate that blockade of Wnt/β-catenin signaling can simultaneously repress multiple RAS genes, thereby leading to the reversal of established proteinuria and kidney injury.     

A Novel Segment Classification for Multifocal and Multicentric Breast Cancer to Facilitate Breast‐Conservation Treatment

Breast conservation treatment (BCT) is an appropriate alternative to mastectomy for the treatment of unifocal breast cancer. Multifocal and multicentric breast cancers (MFMCBC) challenge conventional indications for BCT and are often treated with mastectomy. Following progress in treatment strategies for unifocal tumors, there was a movement to evaluate the use of BCT for MFMCBC. Now a growing body of evidence from retrospective data has emerged, demonstrating acceptable local control and overall survival rates with BCT for MFMCBC. Prospective studies are needed to confirm these findings. One of the possible barriers to such trials is the absence of a standardized classification and nomenclature for MFMCBC at this point in time. A novel segment classification is presented in this article in an endeavor to overcome this deficiency and allow future work on this issue.     

IL-25 Elicits Innate Lymphoid Cells and Multipotent Progenitor Type 2 Cells That Reduce Renal Ischemic/Reperfusion Injury

IL-25 is an important immune regulator that can promote Th2 immune response-dependent immunity, inflammation, and tissue repair in asthma, intestinal infection, and autoimmune diseases. In this study, we examined the effects of IL-25 in renal ischemic/reperfusion injury (IRI). Treating IRI mice with IL-25 significantly improved renal function and reduced renal injury. Furthermore, IL-25 treatment increased the levels of IL-4, IL-5, and IL-13 in serum and kidney and promoted induction of alternatively activated (M2) macrophages in kidney. Notably, IL-25 treatment also increased the frequency of type 2 innate lymphoid cells (ILC2s) and multipotent progenitor type 2 (MPP^type2) cells in kidney. IL-25–responsive ILC2 and MPP^type2 cells produced greater amounts of Th2 cytokines that associated with the induction of M2 macrophages and suppression of classically activated (M1) macrophages in vitro. Finally, adoptive transfer of ILC2s or MPP^type2 cells not only reduced renal functional and histologic injury in IRI mice but also induced M2 macrophages in kidney. In conclusion, our data identify a mechanism whereby IL-25-elicited ILC2 and MPP^type2 cells regulate macrophage phenotype in kidney and prevent renal IRI.     

The Outcomes and Quality of Life of Patients with Achalasia after Peroral Endoscopic Myotomy in the Short-Term

Purpose: To assess the short-term efficacy and quality of life (QOL) of patients with achalasia after peroral endoscopic myotomy (POEM).Methods: Thirty-five achalasia patients underwent POEM from May 2013 to December 2013. The data on clinical evaluation and QOL before therapy, at 1 month and 6 months postoperation were collected and analyzed.Results: All the thirty-five patients underwent POEM successfully. By comparing the data of the preoperative with that of 1 month and 6 months after POEM respectively, we found that: mean Eckardt score decreased (6.83 vs 0.51, 6.83 vs 0.46, all P <0.05), esophagus diameter reduced (47.97 mm vs 32.00 mm, 47.97 mm vs 28.50 mm, all P <0.05), and esophageal manometry declined (29.5 mmHg vs 11.5 mmHg, 29.5 mmHg vs 10.3 mmHg, all P <0.05). Complications occurred in 14.3% (5/35) of the cases, and no recurrence was observed. At each time point, postoperative QOL scores were higher than those of preoperative (P <0.05).Conclusions: POEM is safe and effective for treating achalasia in the short-term, it can relieve clinic symptoms as well as improve patients’ QOL.