角膜移植260例病因分析并与国外数据比较

目的:总结进行角膜移植手术患者的病因学资料,并与国外相应统计资料比较。方法:收集2001-12/2005-12在南昌大学医学院第一附属医院眼科接受角膜移植手术的260例患者(260眼)的临床资料做以统计,内容包括性别、年龄,与角膜移植相关的临床诊断、手术方法等,患者均知情同意。患者的病种统计以出院时第一诊断为基准。260例患者中行单纯板层角膜移植125例,单纯穿透性角膜移植63例,联合羊膜覆盖33例,联合角膜缘干细胞移植术20例,联合结膜瓣遮盖术19例。术后半年进行视力评估,视力<3.7为盲。结果:260例角膜移植患者全部进入结果分析,无脱落。①260例患者中男162例,女98例,年龄(24±19)岁。角膜移植的病因按病例数由多至少排列,首位为角膜炎后角膜白斑,计86例(占3.08%),尤以病毒性角膜炎为主;外伤后角膜疤痕病变居第2位,计78例(占30%),随后为角膜溃疡并穿孔、蚕食性角膜溃疡、圆锥角膜、角膜皮样瘤、角膜营养不良、角膜失代偿、角膜葡萄肿以及角膜原位癌。角膜炎后角膜白斑病毒性角膜炎后最为多见,而国外类似的统计表明大泡性角膜病变占据首位。②术后半年260例角膜移植患者的脱盲率达94%。结论:与发达国家角膜移植最常见病因为大泡性角膜病变不同,角膜炎后角膜白斑、外伤后角膜疤痕、角膜溃疡并穿孔依次是国内角膜移植最常见的原因。     

Worsening of chronic heart failure: definition,epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology

Episodes of worsening symptoms and signs characterize the clinical course of patients with chronic heart failure (HF). These events are associated with poorer quality of life, increased risks of hospitalization and death and are a major burden on healthcare resources. They usually require diuretic therapy, either administered intravenously or by escalation of oral doses or with combinations of different diuretic classes. Additional treatments may also have a major role, including initiation of guideline-recommended medical therapy (GRMT). Hospital admission is often necessary but treatment in the emergency service or in outpatient clinics or by primary care physicians has become increasingly used. Prevention of first and recurring episodes of worsening HF is an essential component of HF treatment and this may be achieved through early and rapid administration of GRMT. The aim of the present clinical consensus statement by the Heart Failure Association of the European Society of Cardiology is to provide an update on the definition, clinical characteristics, management and prevention of worsening HF in clinical practice.     

An integrative translational approach to study heart failure with preserved ejection fraction: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology

As heart failure with preserved ejection fraction (HFpEF) rises to epidemic proportions, major steps in patient management and therapeutic development are badly needed. With the current position paper we seek to update our view on HFpEF as a highly complex systemic syndrome, from risk factors and mechanisms to long‐term clinical manifestations. We will revise recent advances in animal model development, experimental set‐ups and basic and translational science approaches to HFpEF research, highlighting their drawbacks and advantages. Directions are provided for proper model selection as well as for integrative functional evaluation from the in vivo setting to in vitro cell function testing. Additionally, we address new research challenges that require integration of higher‐order inter‐organ and inter‐cell communication to achieve a full systems biology perspective of HFpEF.     

Allopeptimicins: unique antibacterial metabolites generated by hybrid PKS-NRPS,with original self-defense mechanism in Actinoallomurus

In the search for structurally novel metabolites with antibacterial activity, innovative approaches must be implemented to increase the probability of discovering novel chemistry from microbial sources. Here we report on the application of metabolomic tools to the genus Actinoallomurus, a poorly explored member of the Actinobacteria. From examining extracts derived from 88 isolates belonging to this genus, we identified a family of cyclodepsipeptides acylated with a C₂₀ polyketide chain, which we named allopeptimicins. These molecules possess unusual structural features, including several double bonds in the amino-polyketide chain and four non-proteinogenic amino acids in the octapeptide. Remarkably, allopeptimicins are produced as a complex of active and inactive congeners, the latter carrying a sulfate group on the polyketide amine. This modification is also a mechanism of self-protection in the producer strain. The structural uniqueness of allopeptimicins is reflected in a biosynthetic gene cluster showing a mosaic structure, with dedicated gene cassettes devoted to formation of specialized precursors and modular assembly lines related to those from different pathways.

Untargeted metabolomic analysis of Actinoallomurus spp. unveiled an unprecedented acylated cyclodepsipeptide with unusual features and potent antibacterial activity.