基于吴茱萸汤相关功效从平滑肌角度探讨其质量控制的可行性

目的：观察吴茱萸汤对平滑肌的活性及其特点,并探讨其作为全方质量控制方法的可行性。方法：利用体外实验从组织水平对血管、胃、小肠和子宫平滑肌收缩活性进行观察。结果：吴茱萸汤对血管平滑肌具有先收缩后舒张的双向作用,降低胃平滑肌的张力,对小肠及子宫平滑肌收缩具有明显的抑制作用。作为君药的吴莱萸与吴莱萸汤结果相近。其它组成药物则没有明显的作用。结论：吴茱萸汤的这种对不同平滑肌的收缩舒张的不同作用,可以作为对该方综合评定的指标。     

几种不同种源远志等位酶与可溶性蛋白鉴别研究

目的:利用等位酶与可溶性蛋白凝胶电泳技术探讨远志不同种源的鉴别与亲缘关系。方法:采用聚丙烯酰胺凝胶电泳(PAGE)技术分析不同种源远志苹果酸酶、过氧化物酶、酯酶与可溶性蛋白谱带,采用NASYS软件对电泳谱带进行聚类分析。结果:远志可溶性蛋白与等位酶聚丙烯酰胺凝胶电泳图谱能够鉴别不同种源的远志,9份不同种源远志可被聚为三种类型,遗传距离0.1054～1.2040,除卵叶远志外,其余8份远志遗传距离0.1054～0.6931,卵叶远志与远志间的遗传距离明显高于远志间的遗传距离,地理位置相近的远志遗传距离较小,亲缘关系较近。结论:利用等位酶与可溶性蛋白凝胶电泳技术可为不同种源远志的鉴定与划分提供参考。     

Diagnostic efficacy of serum ST2 in patients with ASC

BackgroundSoluble suppression of tumorigenicity 2 (ST2) is closely related to the development of cardiovascular disease, but the level of acute coronary syndrome (ACS) and the relationship between ST2 and ACS are unclear.Patients and MethodsPatients with the acute coronary syndrome were divided into the unstable angina pectoris (USAP) group (n = 65) and non‐ST‐segment elevation myocardial infarction (NSTEMI) group (n = 58), and the healthy population, without chest pain and with normal coronary CT, was included as a control group (n = 55). Laboratory index levels were collected from each participant. The baseline information was reviewed and analyzed. The binary logistic regression was used to explore the relation of ST2 levels with the occurrence of ACS and NSTEMI, and the diagnostic performance of ST2 for diagnosing ACS or NSTEMI was evaluated using a receiver‐operating characteristic (ROC) curve.ResultsThe level of ST2 was found significantly higher in NSTEMI than in USAP and was higher in USAP than in control (p < 0.01). ST2 levels were positively correlated with ALT, AST, and BNP in the control group, were negatively correlated with HGB and TG in the USAP group, and were positively correlated with WBC, GLU, BNP, and Gensini scores in the NSTEMI group. Multivariate analysis revealed that the occurrence of ACS was associated with ST2, BNP, GLU, TC, BUN, WBC, and PLT, and the occurrence of NSTEMI was associated with AST, WBC, LDL‐C, and ST2. Meanwhile, ST2 levels achieved good performance for ACS and NSTEMI diagnostician.ConclusionST2 could be used as an auxiliary diagnostic indicator for the occurrence of ACS and NSTEMI.     

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??OBJECTIVE To establish and compare the HPLC fingerprints of different medicinal parts of Morus alba. METHODS An HPLC analysis was performed on an Agilent Eclipse XDB C₁₈ (4.6 mm??250 mm, 5 ??m) chromatographic column, using gradient elution with acetonitrile and 0.1% aqueous formic acid at a flow rate of 1.0 mL??min^-1. The column temperature was kept at 30 ??, and the detection wavelength was set at 254 nm. The data was analyzed with Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine (Version 2004A). RESULTS The HPLC fingerprints and common models of different medicinal parts of M. alba were established. The numbers of common peaks obtained in the fingerprints of Mori Cortex, Mori Ramulus, Mori folium, and Mori Fructus were 10, 11, 12, and 8, respectively. Ten characteristic peaks were identified by comparison with the reference substances and accurate molecular weights determined by UPLC-Q-TOF/MS. Mori Cortex and Mori Ramulus both had mulberroside A, oxyresveratrol, kuwanon G, and morusin. Rutin and isoquercitrin were detected in both Mori folium and Mori Fructus. CONCLUSION The method is stable, reliable, and repeatable. The composition profiles of different medicinal parts are established, which provides a scientific basis for the quality control of M. alba.     

Research progress in targeted therapy and immunotherapy for gastric cancer

Gastric cancer (GC) is one of the most common malignant tumors worldwide. Its incidence ranks the 5th among all malignant tumors globally, and it is the 3rd leading cause of death among patients with cancer. Surgical treatment is the first choice in clinical practice. However, targeted therapy, immunotherapy, and other treatment methods have also become research hotspots at home and abroad with the development of individualized precision therapy in recent years, besides traditional radiotherapy and chemotherapy. At present, targeted therapy and immunotherapy are methods used for treating GC, and they have important clinical application value and prospects. This study aimed to review the research progress of targeted therapy and immunotherapy for GC, focusing on its mechanism of action and related important clinical trials, hoping to provide references for the clinical treatment of GC.     

Chinese expert consensus on interventional diagnosis and management of acquired digestive-respiratory tract fistulas (second edition)

Acquired digestive-respiratory tract fistulas occur with abnormal communication between the respiratory tract and digestive tract caused by a variety of benign or malignant diseases, leading to the alimentary canal contents in the respiratory tract. Although various departments have been actively exploring advanced fistula closure techniques, including surgical methods and multimodal therapy, some of which have gotten good clinical effects, there are few large-scale evidence-based medical data to guide clinical diagnosis and treatment. The guidelines update the etiology, classification, pathogenesis, diagnosis, and management of acquired digestive-respiratory tract fistulas. It has been proved that the implantation of the respiratory and digestive stent is the most important and best treatment for acquired digestive-respiratory tract fistulas. The guidelines conduct an in-depth review of the current evidence and introduce in detail the selection of stents, implantation methods, postoperative management and efficacy evaluation.     

Difficulties in the Diagnosis of Fibrinogen Aα-Chain Amyloidosis—Literature Review and Case Report of a Patient After Kidney Transplantation

BackgroundAmyloidosis is a very heterogeneous disease. Correct diagnosis is extremely important because of the various treatment options for different types of amyloidosis. This study presents a case report and literature review of the misdiagnosis of fibrinogen Aα-chain amyloidosis (AFib amyloidosis).Case presentationWe report a 65-year-old man diagnosed with proteinuria in 2009. The kidney biopsy revealed the presence of Congo red-stained amyloid deposits. During differential diagnosis, amyloid deposits were discovered in adipose tissue and gingiva. Bone marrow trephine biopsy showed a predominance of lambda chains presenting plasmocytes. Based on performed medical examination, light chain amyloidosis was identified. Therefore, the patient received high-dose melphalan and underwent successful autologous peripheral blood stem cell transplantation. However, proteinuria, worsening of the kidneys’ function, and incorrect levels of free light chains were still observed. In 2019, due to continuous treatment failure, a previously acquired kidney biopsy was examined by mass spectrometry, and numerous fibrinogen deposits were identified. Recommended DNA analysis revealed that the patient had AFib amyloidosis. Therefore, chemotherapy treatment was abandoned, and successful kidney transplantation was performed.ConclusionToday, it is essential for medical practitioners to remember the possibility of rare and hereditary types of amyloidosis. There are multiple cases where a diagnosis was wrong or delayed because of the atypical course of the disease, the coexistence of another disease, and the rarity of AFib amyloidosis, and all of these reasons may result in the wrong treatment that will delay the right therapy. However, with the new, more precise diagnostics methods, such situations will become rare.     

Balancing Waitlist Dropout in Pancreas Transplantation

BackgroundThe time a patient spends on the waiting list for a Simultaneous Pancreas-Kidney (SPK) transplant depends on several donor and recipient-specific factors. The average wait-list time for SPK in the United States has been about 1 to 3 years, significantly shorter than the average wait time for kidney-only transplantation. A single-center retrospective analysis of SPK waitlisted candidates was performed to determine the implication of wait-list time on dropout from the wait-list due to death or poor health.MethodsWe analyzed all deceased donor Simultaneous Pancreas-Kidney wait-listed candidates between Jan 1994 and June 2021. Waitlisted candidates who got transplanted (TG) were compared to those who dropped out from the wait list due to death or poor health (DPHG).ResultsIn the study period, 297 candidates were waitlisted for SPK transplants. Eight candidates were removed, as transplantation was not needed due to improvement in health while on the waiting list. Fourteen wait-listed candidates transferred to another center were also excluded from the study group. Two hundred and thirty wait-listed candidates were transplanted (TG). Forty-five patients were delisted due to death or poor health (DPHG). The mean body mass index of candidates in TG and DPHG were 25.1 and 24.9, respectively. The mean age at dropout in DPHG was 40.7, similar to the mean age at transplant in TG (39.4). The mean age of diabetes onset was slightly lower in TG (17.4) compared to 20.02 in DPHG. The mean days spent by the candidates on the waitlist in DPHG were significantly higher than those in TG (821 days vs 252 days). Eight of the 45 patients (17.7%) in DPHG had 1 or more organ transplants before listing compared to 1 of 230 patients (0.43%) in TG. Despite low wait times for SPK transplants, increased wait times can account for a dropout from the waitlist due to death or poor health. Centers should exercise caution in wait listing SPK candidates with prior organ transplants.     

Case Report: Bilateral Lung Transplantation for Rapidly Progressive Undifferentiated Interstitial Lung Disease—A Cautionary Tale

Interstitial lung disease is fast becoming one of the most common indications for lung transplantation (LTx); however, LTx for Goodpasture's syndrome with pulmonary involvement has not been previously described in the literature. In this report, we outline the case of a young male with undifferentiated rapidly progressive interstitial lung disease who ultimately received a bilateral sequential LTx after deterioration requiring extracorporeal membrane oxygenation. The original disease soon recurred in the graft, and unfortunately, the patient did not survive. The diagnosis of Goodpasture's syndrome was made postmortem and was not clearly evident on examination of the native explanted tissue, nor was there an elevated titer of antiglomerular basement membrane antibodies during his initial work-up. We hypothesize that the donor and recipient's HLA profile made him more susceptible to aggressive disease. In hindsight, active Goodpasture's disease would have been a contraindication to proceed to transplantation. This case is a cautionary reminder of the high stakes of performing LTx without a certain diagnosis.     

Conversion to Belatacept in kidney transplant recipients with chronic antibody-mediated rejection (CAMR)

BackgroundThe costimulatory inhibitor Belatacept (Bela) has been shown to be an effective alternative in several clinical situations, including chronic antibody-mediated rejection, calcineurin toxicity, and de novo alloantibody formation. To further explore the usefulness of Belatacept under various clinical scenarios, we performed a retrospective analysis of a prospective database of all recipients who had a BPAR diagnosis of CAMR and were converted to a Belatacept maintenance immunosuppression regimen after kidney transplantation.Material and methodWe conducted a retrospective analysis of a prospectively collected database of all kidney transplants adult patients at SUNY Upstate Medical Hospital from 1 January 2013 to 31 December 2021. Our inclusion criteria were the patients who have been diagnosed with CAMR according to their renal biopsy based on the 2013 Banff criteria. The primary objective was to compare the kidney viability and function using GFR between the two interest groups and finally compare the outcomes.ResultsA total of 48 patients met our inclusion criteria based on the kidney biopsy result, which showed chronic antibody-mediated graft rejection (CAMR). Nineteen patients (39.6%) were converted to the Belatacept, and we continued the previous immunosuppression regimen in 29 patients (60.4%). The mean time from the transplant date to the diagnosis of CAMR was 1385 days in the Belatacept group and 914 days for the non-Belatacept group (P = 0.15). The mean GFR comparison at each time point between the groups did not show a significant difference, and Belatacept did not show superiority compared to the standard immunosuppression regimen in terms of kidney function preservation. 1 (5.2%) patient from the Belatacept group and 1 (3.4%) patient from the non-Belatacept group had a biopsy-proven acute rejection (BPAR) after CAMR confirmation, and it was comparable (P = 0.76). De novo synthesis of the DSA rate was 12.5% in the Belatacept group and 15% In the non-Belatacept group, which was comparable. (P = 0.90). The patient survival rate was 100% in both groups.ConclusionsWe conclude that compared to the standard Tacrolimus/MMF/Prednisone regimen, Belatacept did not significantly benefit in preserving the GFR in long-term follow-ups and stabilizing the DSA production, which is one of the main factors resulting in chronic graft failure.