Functional supertype of HLA-A2 in the presentation of Flu matrix p58-66 to induce CD8+ T-cell response in a Northern Chinese population

The functional supertype of HLA-A2 was investigated in the presentation of the A*0201-restricted Flu matrix p58-66 peptide to activate recall CD8+ T-cell response. In healthy Northern Chinese, the HLA-A2 supertype was mainly composed of the six alleles, A*0201 (26.4%), A*0206 (12.7%), A*0203 (8.2%), A*0207 (7.3%), A*0210 (1.8%) and A*0205 (0.9%), as analyzed by PCR using sequence specific primer (PCR-SSP) and sequence based typing (SBT). The IFN-gamma release Elispot assay was employed to assess effector CD8+ T cells. In A*0201-bearing individuals, the CD8+ T-cell response was potent when stimulated with autologous CD8- PBMCs. The frequency of the effector CD8+ T cells was 96.6% with the magnitude of effector CD8+ T cells of 225 SFC/5 x 104 CD8+ T cells and the RI of 25.7. In non-A*0201 individuals, the effector CD8+ T cells were minimally detectable while the peptide was presented by the autologous CD8- PBMCs. However, the induction of the response of CD8+ T cells obtained from non-A*0201 individuals was remarkably improved when the peptide was presented by autologous dendritic cells instead of CD8- PBMCs. The HLA-A2 alleles possessing cross-reactivity in the peptide presentation were mainly of A*0206 and non-A*0201 heterozygotes of A*0206 and A*0210. Moreover, A*0206 as the HLA-A2 functional supertype was further confirmed by tetramer assay. In two A*0206+ donors with CD8+ T-cell response to the peptide, the CD8+ T-cell frequency assessed by specific binding of peptide HLA-A*0201 tetramer was 4.62% and 1.66%, respectively. Thus, our results have substantiated the immunological relevance of the HLA-A2 supertype, which may benefit the design of peptide vaccines with the potential to be applicable in broader populations.     

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults—The Yishun Study

ObjectivesTo describe the normative values of sarcopenia among community-dwelling adults (≥21 years of age); compare the prevalence of sarcopenia using Asian Working Group for Sarcopenia criteria, 2014 (AWGS2014), Asian Working Group for Sarcopenia criteria, 2019 (AWGS2019), and European Working Group on Sarcopenia in Older People criteria, 2018 (EWGSOP2) guidelines; and identify factors associated with sarcopenia.DesignParticipants were recruited through random sampling. Sarcopenia assessments were performed using a dual-energy x-ray absorptiometry scan (muscle mass), handgrip test (muscle strength), and usual walking test (physical performance). Questionnaires were administered to evaluate lifestyle and cognition.Setting and ParticipantsIn total, 542 community-dwelling Singaporeans were recruited (21?90 years old, 57.9% women).MethodsWe assessed anthropometry, body composition, and questionnaire-based physical and cognitive factors, and estimated sarcopenia prevalence according to the AWGS2014, AWGS2019, and EWGSOP2 recommendations, and examined associations using logistic regression.ResultsAccording to AWGS2019, the Singapore population-adjusted sarcopenia prevalence was 13.6% (men 13.0%; women 14.2%) overall, and 32.2% (men 33.7%, women 30.9%) in those aged 60 years and above. The cut-offs derived from young adult reference group for low appendicular lean mass index were 5.28 kg/m2 for men and 3.69 kg/m2 for women (lower than AWGS recommended cut-off); for gait speed it was 0.82 m/s, (AWGS2019 recommended cut-off 1.0 m/s, AWGS2014 cut-off was 0.8 m/s); and for handgrip strength it was 27.9 kg/m2 for men and 16.7 kg/m2 for women (close to AWGS2019 recommendation). Age, sex, marital status, alcoholism, physical activity, body mass index, waist circumference, and global cognition were associated with sarcopenia (P < .05).Conclusions and ImplicationsThis is the first study to provide reference values of muscle mass, strength, and gait speed across the adult lifespan of Singaporeans. Using AWGS2019 criteria, sarcopenia is prominent in older age (32.2% in ≥60 years old), but it is already nontrivial (6.9%) among young and middle-age persons. Multidomain lifestyle modifications addressing muscle strength, cognition, and nutrition over the adult lifespan are important to delay the development of sarcopenia.     

病人知情同意权的几个辩证法问题

以知情同意为核心的病人自主权是医疗服务和现代医患关系新的支撑点。在人体实验、放弃治疗等领域,充分尊重病人的知情同意权具有极大的现实意义。然而,医生的解释说明、医疗干预和亲属代理同意则构成了对知情同意的限制。因此,必须辩证理解和知情同意的内涵,以最大限度地保障病人利益。     

国产与进口吲哚美辛缓释胶囊生物等效性评价

比较国产与进口吲哚美辛缓释胶囊在人体内的生物利用度和生物等效性.18名健康男性志愿者双周期随机交叉口服吲哚美辛缓释胶囊75 mg,用反相高效液相色谱法测定达稳态后的血药浓度.受试制剂与参比制剂的达峰时间(Tpeak)分别为(3.78±1. 00)h和(3.50±1.29)h;达峰浓度(Cmax)分别为(7.51±2.74)ug/ml和(8.05±2.58)ug/ml;药时曲线面积(AUC)分别为(66.41±30.12)和(63.90±26.50)ug@ml-1@h-1.多次给药达稳态条件下,国产的吲哚美辛缓释胶囊与进口制剂的相对生物利用度为(103.20±21.90)%.双单侧检验表明,国产与进口吲哚美辛缓释胶囊具有生物等效性.     

中国北方汉族、维吾尔族、哈萨克族DYS19基因座的遗传多态性

目的;研究DYS19基因座在中国北方汉族、维吾尔族、哈萨克族群体中的遗传多态性及其法医学应用。方法：应用聚合酶链反应后变性聚丙烯酰胺凝胶电泳分离扩增产物结合银染显带的方法,对101例北方汉族、56例维吾尔族、30例哈萨克族无关男性个体的DYS19基因座进行检测。结果：DYS19基因座在3个群体中共检出5种等位基因,基因频率分布范围分别为0．069－0．594,0．071－0．500,0．100－0．667;个人识别机率分别为0．600,0．675,0．491。χ^2检验表明等位基因分布具有明显的人群差异。家系调查符合单体父系遗传方式。结论：DYS19基因座个人识别机率高,属较高鉴别能力的遗传标记系统,且具有明显的人群分布差异,在法医学及人类遗传学研究中具有重要的应用价值。     

人胚胎肾上腺皮质褪黑素受体亚型蛋白的分布

目的：研究褪黑素（Mel)受体亚型在人胚胎肾上腺皮质的分布。方法：应用免疫组化染色检测Ｍel受体亚型的人胚胎肾上腺皮质的分布。结果：在人胚胎肾上腺皮质的球状速、束状带和网状带均存在Ｍel受体mt1(Mella)和ＭＴ２（Ｍellb)亚型蛋白的表达,且主要分布于细胞质。结论：人胚胎肾上腺皮质存在Ｍel受体mt1和ＭＴ２亚型。     

基于Kano模型的养老机构老年人护理服务需求属性分析

目的 分析养老机构老年人护理服务需求属性,为制订针对性干预措施提供参考.方法 基于Kano模型设计养老机构老年人护理服务需求调查问卷,对天津市7所养老机构共687名老年人进行调查.结果 养老机构老年人护理服务需求34个条目中,魅力属性需求10条(29.4％),均位于保留区Ⅳ;期望属性需求10条(29.4％),其中7条位于优势区Ⅰ;必备属性需求11条(32.4％),其中7条位于待改进区Ⅱ;无差异属性需求3条(8.8％),均位于次要改进区Ⅲ.生理健康与医疗需要维度中,魅力属性2条,期望属性4条,必备属性5条,无差异属性1条;安全需要维度中,期望属性1条,必备属性4条,无差异属性2条;尊重需要维度中,魅力属性1条,期望属性3条,必备属性2条;爱与归属需要维度中,魅力属性4条,期望属性2条;自我实现需要维度的3条均为魅力属性.结论 养老机构老年人必备、期望属性护理服务需求主要集中在生理健康与医疗、安全及尊重需要,魅力属性需求主要集中在爱与归属、自我实现需要.养老机构应在维持和完善必备、期望属性需求的基础上,发展和创新魅力属性需求,客观分析和优化改造无差异属性需求.     

Protection From the Second Warm Ischemic Injury in Kidney Transplantation Using an Ex Vivo Porcine Model and Thermally Insulating Jackets

BackgroundKidney transplantation is the optimum treatment for kidney failure in carefully selected patients. Technical surgical complications and second warm ischemic time (SWIT) increase the risk of delayed graft function (DGF) and subsequent short- and long-term graft outcomes including the need for post-transplant dialysis and graft failure. Intraoperative organ thermal regulation could reduce SWIT, minimizing surgical complications due to time pressure, and limiting graft ischemia-reperfusion injury.MethodsA novel ischemic-injury thermal protection jacket (iiPJ) was designed and fabricated in silicone composite and polyurethane (PU) elastomer prototypes. Both were compared with no thermal insulation as controls. Time to reach ischemic threshold (15°C) and thermal energy transfer were compared. A water bath model was used to examine the thermal protective properties of porcine kidneys, as a feasibility study prior to in vivo translation.ResultsIn both iterations of the iiPJ, the time taken to reach the warm ischemia threshold was 35.2 ± 1.4 minutes (silicone) and 38.4 ± 3.1 minutes (PU), compared with 17.2 ± 1.5 minutes for controls (n = 5, P < .001 for both comparisons). Thermal energy transfer was also found to be significantly less for both iiPJ variants compared with controls. There was no significant difference between the thermal performance of the 2 iiPJ variants.ConclusionProtection from SWIT by using a protective insulation jacket is feasible. With clinical translation, this novel strategy could facilitate more optimal surgical performance and reduce transplanted organ ischemia-reperfusion injury, in particular the SWIT, potentially affecting delayed graft function and long-term outcomes.     

腹腔镜右半结肠癌切除术后消化道重建的研究现状及前景

腹腔镜右半结肠癌切除术后腹腔内吻合正逐渐成为结直肠手术领域中的热点。研究者发现:腹腔内吻合与腹腔外吻合比较,前者在促进病人术后恢复,降低术后并发症发生率等方面有潜在优势。且腹腔内吻合较腹腔外吻合病人术后胃肠功能恢复更快、术后疼痛评分更低。但对于腹腔内吻合的并发症发生率,尤其是重要指标吻合口漏的比较,尚缺乏足够证据。而手术技术不统一、吻合口漏定义不明确是目前研究的主要困难。多项高质量的前瞻性随机对照试验目前正在进行中,对于腹腔镜右半结肠癌切除术的客观评价仍需要更高级别的循证医学证据验证。笔者综合分析国内外研究进展,系统阐述腹腔镜右半结肠癌切除术后消化道重建的研究现状及前景,旨在为我国结直肠外科临床研究探索新方向。