105Changes in Nitric Oxide Levels After Deep Dermal injury in the Female,Red Duroc Pig (FRDP)

Introduction : Hypertrophic scar is a devastating sequel to burns and other tangential skin injuries. It follows deep dermal injuries and does not occur after superficial injuries. Nitric oxide (NO) plays many important roles in wound healing from inflammation to scar remodeling. Studies have shown that expression of nitric oxide synthase and nitric oxide production are decreased in human hypertrophic scar. However little is known about NO involvement in the early stages of hypertrophic scarring, because of the lack of an animal model. It was recently reported that the female red Duroc pig (FRDP) makes thick scar, which is similar to human hypertrophic scar. We hypothesized that NO production in wounds on the female, red Duroc pig is similar to that of human hypertrophic scar and that NO involvement in deep wounds is different from that in superficial wounds. Methods : Superficial (0.015” to 0.030”) and deep (0.045” to 0.060”) wounds were created on the backs of four FRDPs. Biopsies were collected at weeks 1.5, 4, 8 and 21 post wounding including samples of uninjured skin. Nitric oxide levels were measured with the Griess reaction assay and normalized with tissue protein level. Results : Superficial wounds healed with an invisible scar whereas the deep wounds healed with scar resembling mild hypertrophic scar. The thickness of the scars from the deep wounds was significantly greater than uninjured skin and healed superficial wounds (p < 0.01). NO levels were increased at 1.5 weeks in deep wounds compared to superficial wounds and uninjured skin (p < 0.05). At 8 weeks, NO levels in deep wounds had returned to the level of uninjured tissue and superficial wounds. By 21 weeks, NO levels had decreased significantly when compared to superficial wounds (p < 0.01). There were no differences in NO levels between uninjured skin and superficial wounds at any time point (p > 0.05). Conclusions : NO production is similar in late, deep wounds on the female, red Duroc pig to that reported in the literature for human hypertrophic scar further validating this animal model. NO production is quite different after deep wounds as compared to superficial wounds in the FRDP. Early elevation in nitric oxide production might account for excessive inflammation in deep wounds that become thick scars in the FRDP. Nitric oxide regulators and effects at early stages of scar formation should be elucidated further and the FRDP appears to be a useful model.     

131I联合糖皮质激素治疗Graves眼病疗效的Meta分析

目的 对131I+糖皮质激素（GC）治疗Graves眼病（GO）进展的有效性和安全性进行系统评价。 方法 检索PubMed、Embase、Cochrane Library和中国知网、万方数据知识服务平台中关于131I+GC治疗GO的相关研究,检索时间从建库至2021年7月20日。根据纳入和排除标准筛选文献、提取数据。应用Stata 15.0软件进行Meta分析,比较131I+GC治疗与单纯131I治疗对不同时期 Graves 甲状腺功能亢进症（GH）合并GO患者的疗效,并分析静脉注射与口服GC 2种用药方式对GO治疗及其并发症发生情况的影响。采用χ2检验的P值和 I2对文献进行异质性评价,GO病情进展情况用相对危险度（RR）表示,采用Egger法和剪补法对纳入文献的发表偏倚和敏感性进行分析,采用Z检验分析2种用药方式的治疗效能。 结果 最终纳入22篇文献,其中15篇文献为随机对照试验类,7篇文献为队列研究类。131I+GC治疗较131I治疗对GH合并GO患者的疗效更佳,差异有统计学意义（Z=3.18,RR=0.37,95%CI:0.20~0.68,P=0.004）;标准剂量GC（0.3~0.5 mg/kg）较低剂量GC（0.2~0.3 mg/kg）能更好地预防GO的进展。不同的用药方式对预防GO进展的影响不大。 结论 131I+GC治疗对预防GH合并GO患者的病情进展是有效的,特别是活动期的GO患者;标准剂量GC较低剂量GC能更好地控制GO的进展,但同时产生更多的并发症;静脉注射与口服GC 2种用药方式对131I治疗后的GO患者疗效相当。     

Long-term outcomes of living kidney donors over the past 28 years in a single center in Taiwan

Background

The chronic shortage of kidneys for transplantation has increased the number of living donations, but demand remains high, which has created a long waiting list of end-stage kidney disease patients. Donors with decreased renal mass may suffer a higher risk of developing proteinuria, hypertension (HTN), and chronic renal disease (CKD) during long-term follow-up.

Methods

We retrospectively retrieved medical data of living kidney donors at our hospital over the past 28 years.

Results

There were 45 male and 60 female donors with a mean donation age of 46.34 ± 12.47 years (range = 20-70y). The mean follow-up duration was 4.67 ± 4.78 years. The serum creatinine (Cr) at donation was 0.93 ± 0.22 mg/dL, while the latest Cr was 1.26 ± 0.45 mg/dL (P < .001). The mean age at follow-up was 50.95 ± 14.57 years. At last follow-up, eight subjects (7.6%) displayed HTN requiring treatment, 10 (9.5%), proteinuria and 55.4%, an estimated glomerular filtration rate (eGFR) of less than 60 mL/min, including one with diabetic nephropathy at 10 years after donation who required long-term hemodialysis. Although gender did not correlate with occurrence of HTN, proteinuria, and CKD, the occurrence of CKD was associated with age at donation (P < .001, odds ratio [OR] = 1.076), and age at follow-up (P < .001, OR = 1.071). HTN donors were older (P = .036, OR = 1.057) with longer follow-up durations (P = .007, OR = 1.166) and had higher Cr values at donation (P = .044, OR = 94.4). Donors with proteinuria were not related to gender, follow-up duration, initial Cr, warm ischemic time, or duration of admission. eGFR was indeed worse after donation (P = .002).

Conclusions

Our results indicated a significant proportion of living donors may develop CKD upon long-term follow-up. The factors affecting donor risk of CKD were baseline renal function, older age, and duration after kidney donation.     

病房爱心学校对白血病患儿住院心理适应性的研究

目的 探讨病房爱心学校对白血病患儿住院适应性的影响.方法 病房开办爱心学校,制定教学计划,组织丰富多彩的活动;责任护士全程负责,建立患儿基本资料档案,安排每天课程及人员分配;采取家属留陪制度;营造温馨的病房环境.采用特质应对方式问卷和儿童社交焦虑量表对50例白血病患儿进行测评.结果 疗程结束时患儿积极应对评分显著高于入院后,消极应对评分及社交焦虑评分显著降低(均P＜0.01).结论 开办爱心病房学校,实施人文关怀措施,能提高白血病患儿住院心理适应性.     

水冲核小切口老年性白内障摘除术临床观察98例

目的 探讨水冲核技术在老年性白内障摘除术中的临床治疗效果. 方法 回顾性分析2008年6月～2011年6月间我院收治的98例(98眼)老年性白内障患者,根据其手术方式分为两组,观察组58例,采取水冲核非超声乳化手术;对照组40例,采用传统手法小切口非超声乳化手术,分析其治疗过程及预后. 结果 98例(98眼)术后视力均有不同程度提高,术后3个月内的最佳裸眼视力0.5以上者,观察组47例(81.0％),对照组27例(67.5％),P＜0.05,差异有统计学意义.最佳裸眼视力1.0以上者,观察组12例(20.7％),对照组3例(7.5％),P＜0.05,差异有统计学意义.术后散光观察组平均为(1.04±0.10)D,对照组平均为(1.21±0.11)D,术后观察组和对照组的角膜平均散光度数的比较,P＜0.05,差异有统计学意义.观察组的角膜平均散光度数手术前后差异无显著性;对照组的角膜平均散光度数手术前后差异有统计学意义. 结论 水冲核白内障手术对角膜内皮的损伤较小、恢复较快,优于常规法,值得在临床中推广.     

Induction of Alloimmune Tolerance in Heart Transplantation Through Gene Silencing of TLR Adaptors

Toll‐like receptors (TLRs) activate biochemical pathways that evoke activation of innate immunity, which leads to dendritic cell (DC) maturation and initiation of adaptive immune responses that provoke allograft rejection. We aimed to prolong allograft survival by selectively inhibiting expression of the common adaptors of TLR signaling, namely MyD88 and TRIF, using siRNA. In vitro we demonstrated that blocking expression of MyD88 and TRIF led to reduced DC maturation. In vivo treatment of recipients with MyD88 and TRIF siRNA significantly prolonged allograft survival in the BALB/c > C57BL6 cardiac transplant model. Moreover, the combination of MyD88 and TRIF siRNA along with a low dose of rapamycin further extended the allograft survival (88.8 ± 7.1 days). Tissue histopathology demonstrated an overall reduction in lymphocyte interstitium infiltration, vascular obstruction and hemorrhage in mice treated with MyD88 and TRIF siRNA vector plus rapamycin. Furthermore, treatment was associated with an increase in the numbers of CD4⁺CD25⁺FoxP3⁺ regulatory T cells and Th2 deviation. To our knowledge, this study is the first demonstration of prolonging the survival of allogeneic heart grafts through gene silencing of TLR signaling adaptors, highlighting the therapeutic potential of siRNA in clinical transplantation.     

酒精性肝炎自噬关键基因的筛选及生物信息学分析

目的 筛选酒精性肝炎（AH）的自噬关键基因,探讨AH潜在的生物标志物和治疗靶点。 方法  采用基因表达综合数据库（GEO）中的2个AH基因芯片和从MSigDB、GeneCards数据库中获得的自噬相关数据集,通过加权基因共表达网络分析（WGCNA）获取关键基因。对筛选的关键基因进行基因本体（GO）、京都基因和基因组百科全书（KEGG）功能富集分析,蛋白质相互作用（PPI）分析,免疫浸润分析,构建信使RNA（mRNA）-微小RNA（miRNA）网络,进行酒精性肝病不同分期的自噬相关关键基因的表达差异分析,并进一步通过实时荧光定量逆转录聚合酶链反应（RT-qPCR）在AH患者和小鼠肝脏组织中验证。 结果  本研究筛选得到了11个与AH自噬相关的基因（EEF1A2、CFTR、SOX4、TREM2、CTHRC1、HSPB8、TUBB3、PRKAA2、RNASE1、MTCL1、HGF）,均为上调基因。在AH患者和小鼠肝脏组织中,SOX4、TREM2、HSPB8、PRKAA2在AH组中的相对表达量均高于对照组。 结论  SOX4、TREM2、HSPB8、PRKAA2可能是AH潜在的生物标志物和治疗靶点。     

曲古抑菌素A预处理对小鼠脑缺血再灌注损伤皮质炎症反应和凋亡的影响*

目的 探讨曲古抑菌素A预处理在小鼠脑缺血再灌注损伤中对大脑皮质炎症反应和凋亡的影响。方法 Balb/c小鼠随机分为3组：假手术组（S组）、缺血再灌注组（IR组）、曲古抑菌素A预处理组（预处理组）,每组10只。采用颈部切口大脑中动脉线栓（MCAO）法缺血1?h,再灌注24?h复制脑缺血再灌注模型,预处理组在复制脑缺血再灌注模型前连续3?d腹腔注射曲古抑菌素A 5?mg/kg。取脑皮质组织,光学显微镜下观察病理学结果,ELISA检测TNF-α、IL-1β,免疫组织化学法检测Bcl-2、Bax、Caspase-3,TUNEL检测细胞凋亡。结果 3组TNF-α、IL-1β、Bax、Bcl-2及Caspase-3比较,差异有统计学意义（P?<0.05）。与S组比较,IR组病理学损伤严重,TNF-α、IL-1β、Bax、Caspase-3阳性表达水平升高,Bcl-2降低（P?<0.05）;与IR组比较,预处理组病理学损伤减轻,TNF-α、IL-1β、Bax、Caspase-3阳性表达水平降低,Bcl-2升高（P?<0.05）。结论 曲古抑菌素A预处理能抑制炎症因子、凋亡因子的表达及减少细胞凋亡,从而减轻脑缺血再灌注损伤。     

原发性甲状腺淋巴瘤17例临床分析

目的：探讨原发性甲状腺淋巴瘤（primary thyroid lymphoma,PTL）的临床特点、诊断、治疗及预后。方法：回顾性分析2013年1月至2019年9月北京协和医院收治的17例PTL患者临床资料。结果：9例患者出现甲减,16例患者合并桥本甲状腺炎（Hashimoto’s thyroiditis,HT）,7例患者通过甲状腺穿刺活检确诊,10例患者通过甲状腺部分切除术确诊。弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）11例,黏膜相关淋巴瘤（mucosa associated lymphoid tissue lymphoma,MALT）,DLBCL、MALT转化和滤泡型淋巴瘤（follicular lymphoma,FL）各2例。DLBCL组患者平均年龄（61.7±13.0）岁,DLBCL、MALT转化组患者平均年龄（59.0±2.8）岁,MALT组患者平均年龄（61.5±3.5）岁,均明显大于FL组患者的（31.0±14.1岁）。DLBCL组患者血LDH为（380.3±197.9）U/L,高于MALT组和FL组。FL组国际预后指数（international prognostic index,IPI）为 0分,低于其他3组。DLBCL组患者Ki-67为（70.0±16.1）%,高于MALT组的（16.25±8.80）%。结论：原发性甲状腺淋巴瘤与HT关系密切,诊断依靠病理,DLBCL为最常见病理类型,治疗方案根据病理类型及临床分期决定。