Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium

PurposePlatelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim of the PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronary artery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients with coronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel.Materials and MethodsSearching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/or genotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics, and clinical outcomes to evaluate relationships among them.ResultsNine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient data from 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composed of 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRG-Genotype cohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochrome P450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (^*2 or ^*3) were 47.9% (intermediate metabolizers) and 14.2% (poor metabolizers), respectively.ConclusionThe PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotype that may be important to developing optimal antiplatelet regimens in East Asian patients.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT04734028","term_id":"NCT04734028"}}NCT04734028.     

小议仲景方中补气药之人参与黄芪

人参、黄芪二药自古以来就是用于养身、祛邪的要药,且在《神农本草经》上已有人参补脏气、黄芪固卫气之分的记载。仲景方则将这种区别发挥至极,以人参补养元气的不足以及脏气的虚耗,发挥其安神止悸的作用,并且广泛用于健脾益气、扶助正气的治疗;以黄芪治疗卫表不固导致的诸多症状,并且发挥其甘温之性,用于治疗风寒湿邪凝滞肌肤血脉。同时,仲景十分重视二药在调节水液运行代谢方面的区别,津液丧失、气阴两虚者用人参,以其生津;自汗皮水、风湿身重者用黄芪,以其利水。     

大熊猫核糖体蛋白L10亚基基因的cDNA克隆及序列分析

目的 了解大熊猫(ailuropoda melanoleuca) 核糖体蛋白L10亚基基因(RPL10)的结构特点及其与已报道的人和其他哺乳动物核糖体蛋白亚基RPL10基因的异同. 方法根据已报道的部分哺乳动物RPL10基因的相关信息设计引物,运用RT-PCR技术,从大熊猫的肌肉组织总RNA 中对核糖体蛋白亚基RPL10 基因的进行克隆、测序;采用Genescan 软件,对所克隆的基因序列进行氨基酸序列推定;采用ORF finder软件进行DNA 序列的开放阅读框查找;采用DNAMAN Version 6软件,对基因序列和氨基酸序列进行同源性比较;采用Ex2PASy Proteomics Server 软件,进行蛋白质功能位点和生化特性预测分析;采用http://www.imtech.res.in/raghava/apssp2/对蛋白质二级结构进行模拟分析.结果 大熊猫RPL10基因的表达序列长为685 bp,开放阅读框(ORF)为645 bp,编码214个氨基酸的蛋白质,该蛋白的相对分子质量为24.599 7×103,等电点为10.74,含有4个功能位点,分别为:2个蛋白激酶C磷酸化位点,2个N化位点,2个酰胺化位点,1个核糖体蛋白L10e信号位点.进一步分析发现,该基因的表达序列及其编码的氨基酸序列与已报道的人、牛、家犬、褐家鼠、小家鼠有很高的相似性,其表达序列同源性分别为92.4%、92.4%、97.21%、88.84%与89.61%;其编码的氨基酸序列除与牛的同源性为99.07%外,与其他哺乳动物同源性为100%.而且,其蛋白质的高级结构除牛外其他物种也具有一致性.结论 无论是从RPL10基因的序列、结构、功能位点,还是从其编码的氨基酸的序列和二级结构进行分析,都表明大熊猫的RPL10基因和已报道的哺乳动物的RPL10基因具有高度的遗传稳定性和功能一致性.     

The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety.

KEY MESSAGES

• The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.
• Collaborations have been established between researchers in North America and East African countries for these studies.
• Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.

     

持续腰大池引流在颅内动脉瘤术后的临床应用价值

目的:探讨持续腰大池引流在颅内动脉瘤术后的临床应用价值.方法:颅内动脉瘤术后,治疗组72例行持续腰大池引流,对照组49例每天腰椎穿刺,通过比较两组并发症及预后评定疗效.结果:经过持续腰大池引流后,有症状性脑血管痉挛的发生率从34.69%降低为18.31%,脑积水的发生率从26.53%降低为11.27%,脑梗塞的发生率从20.4%降低为7.04%,出院时恢复良好者占76.06%,而对照组为57.14%,以上均有统计学意义(P＜0.05),治疗组并发症的发生率为5.63%,死亡率为零,对照组并发症的发生率为零,两组之间并发症的发生无统计学意义.结论:持续腰大池引流能够减少蛛网膜下腔中的痉挛因素,减轻脑血管痉挛的发生,减少并发症,改善预后.     

关于社区卫生服务中的几个伦理问题

社区卫生服务是我国卫生服务体系的重要组成部分,社区卫生服务在发展过程中受到了多方因素的影响,这其中就包括伦理问题。为了社区卫生服务的长期稳定发展,必须重视社区卫生服务中人性化服务、隐私、弱势群体等伦理问题。     

高血压性脑出血再发危险因素的临床研究

目的 :探讨高血压性脑出血再发危险因素。方法 :对收治的 6 1例高血压性脑出血再发患者进行回顾性分析。结果 :高血压性脑出血的再发率为 7.2 9% ,再次出血的临床表现较首次重 ,出血量较首次大 ,合并症较首次多 ,病死率明显升高 ;再次出血组与一次出血组的血压中平均收缩压无显著差异 (P>0 .0 5 ) ,但舒张压大于 90、95 mm Hg、收缩压大于 2 0 0 mm Hg及舒张压大于 95 mm Hg同时收缩压大于 2 0 0 mm Hg病例中 ,均与一次出血组存在极显著差异 (P<0 .0 1)。结论 :抓好血压的管理 ,是预防高血压性脑出血再发的关键。     

磷酯酶C抗实验性血栓形成和促纤溶作用

研究磷酯酶C(phospholipaseC ,PLC)对实验性血栓形成和纤溶功能的影响。方法 :运用下腔静脉结扎法制造大鼠血栓形成模型 ,研究PLC对实验性血栓形成的影响并与尿激酶 (UK)比较 ;运用纤维蛋白平板法、双缩脲法、加钙法研究PLC对人和家兔体内、外纤溶功能的影响。结果 :PLC 173U kg与对照组相比可明显降低血栓的重量和长度 (P <0 .0 5 ) ,但对血栓形成率作用不明显 ,其作用比UK 2 2 2U kg稍弱 ;PLC能溶解标准、加热纤维蛋白平板 ,表现出较强的促纤溶活性 ;PLC在体外能显著降低人、家兔血浆纤维蛋白原 (Fg)和血浆优球蛋白溶解时间 (ELT)(P <0 .0 5 ) ;PLC在体内能显著降低家兔Fg和ELT(P <0 .0 5 )。结论 :PLC具有抗实验性血栓形成和促纤溶活性的功能。     

辅助生殖技术中影响出生婴儿性别比的相关因素分析

目的探讨辅助生殖技术（ART）中影响出生婴儿性别比的相关因素。方法收集2008年1月~2014年3月于我院接受ART
治疗并成功分娩的4348个周期的患者的临床资料,包括男女双方年龄、不孕原因、授精方式、移植胚胎期别、移植胚胎类型、分
娩类型（单胎、双胎分娩）、既往ART流产次数、ART分娩次数和分娩的5607名新生儿的性别,分析不同因素对于分娩新生儿性
别的影响。结果共有3019名男婴和2588名女婴出生,性别比为116∶100;单胎分娩的3087名新生儿出生性别比为117∶100;双
胎分娩的2520名新生儿性别比为116:100;经ART治疗一胎分娩5542名新生儿出生性别比为117∶100;二胎分娩新生儿65名,
出生性别比为117∶100。在单胎妊娠活产婴儿中,若女方或男方高龄,出生男婴比例较对照组（年龄<35 岁）显著增高(分别为
58.4% vs 52.8%,P=0.012;56.4% vs 52.3%;P=0.026）,同时观察到ICSI组出生男婴比例较IVF组明显较低（45.7% vs 55.6%,P<
0.001）,其它因素则对出生婴儿性别比无显著影响;在双胎妊娠活产新生儿组中,上述不同因素对出生新生儿性别比均无显著
性差异。ART治疗后生育一胎新生儿中,女方高龄组出生男婴比例显著高于对照组（57.4% vs 53.0%, P=0.009）,并可知ICSI组
中出生男婴比例显著低于IVF组（48.6% vs 55.4%, P=0.001）;而ART治疗后生育二胎新生儿中,不同因素各组间出生婴儿性别
比均无显著性差异。单因素Logistic 回归分析提示,女方年龄（OR：0.836,95% CI 0.731~0.955,P<0.05）、授精方式（OR∶
1.151,95% CI 1.027~1.289,P<0.05）对出生婴儿性别比产生的影响有统计学意义,其它因素对出生婴儿性别比则无显著影响。
进一步行多因素Logistic回归分析提示,无独立的预测因素。结论经ART治疗后高龄女性生育男性婴儿比例更高,在单胎活
产婴儿中男方高龄与出生男婴比例增加相关,而ICSI授精方式较IVF女性婴儿比例更高。
     

抗人胃腺癌单克隆抗体的制备及其在临床应用中的探讨

本文应用杂交瘤技术制备出4株抗胃腺癌细胞株SGC-7901单克隆抗体,4株单克隆抗体的相应抗原与CEA、HLA、ABO抗原无关。免疫酶组织化学染色法证明,相应抗原位于细胞膜及细胞浆,因癌腺腔内也可见到阳性染色,说明相应抗原是分泌性抗原。临床应用结果表明,4株单克隆抗体与胃癌组织有较强的特异性,值得进一步推广应用。