Homozygous familial hypercholesterolemia in China: Genetic and clinical characteristics from a real-world,multi-center,cohort study

BackgroundThere is a lack of large-scale data on the clinical and genotype characteristics of homozygous familial hypercholesterolemia (HoFH) patients in Asia.ObjectiveTo define the characteristics of phenotypic and genetic HoFH probands from mainland China.MethodsWe collected data from patients with suspected HoFH from ten clinical hospitals across mainland China from 2003 to 2019. Clinical data and DNA testing were obtained in all patients. The Kaplan-Meier method was used to generate survival curves, and the groups were compared with the log-rank test.ResultsA total of 108 unrelated probands with suspected HoFH (mean age 14.9 years) were included. The three most common variants were W483X (c.1448 G>A), A627T (c.1879 G>A), H583Y (c.1747 C>T). The majority (64.8%) were compound heterozygotes (n = 70), 23 (21.3%) were true HoFH patients. True HoFH showed higher LDL-C levels compared to compound HoFH (16.8±3.6 mmol/L vs. 15.0±3.1 mmol/L, P = 0.022). During follow-up, only 21.2% patients exhibited an LDL-C reduction of more than 50%. Kaplan-Meier analysis showed that the true HoFH probands had significantly worse survival rates compared to other genotype probands (13-year survival; 20.3% vs. 76.7%, respectively; P = 0.016). In addition, true HoFH shows that 2.8-fold (P = 0.022) increase any death and 3.0-fold (P = 0.023) increase cardiovascular death risk in relative to other FH.ConclusionsThis report shows that HoFH has devastating consequences, and that patients are often only diagnosed after they have been exposed to severely elevated LDL-C for years. Systematic screening and early intensive treatment are an absolute requirement for these young individuals with HoFH.     

Freezing of gait subtypes have different cognitive correlates in Parkinson's disease

BackgroundFreezing of gait (FOG) is a major concern for Parkinson's disease (PD) patients because it is a leading cause of falls and is associated with poor quality of life. The pathophysiology is unknown but it is hypothesized that it relates to cognitive abnormalities; particularly executive and visuospatial dysfunction. However, prior results have been discrepant. Pharmacologic subtypes of FOG include those that are responsive and unresponsive to levodopa.ObjectiveTo determine whether executive and visuospatial dysfunction are associated specifically with the levodopa unresponsive subtype of FOG.Methods135 PD subjects completed a single assessment included FOG questionnaire, UPDRS motor scale, comprehensive cognitive battery and measure of hallucinations. Analyses compared unresponsive (n = 16), responsive (n = 20) and no FOG (n = 99) subtypes.ResultsThe unresponsive subtype had a significantly older age of onset of PD than the responsive group (p = .03) and had worse motor scores (p = .003) than the no FOG group. Longer disease duration was associated with the responsive group compared to the no FOG group (p = .002). The unresponsive FOG group had significantly poorer visuospatial ability (p = .001) and executive functioning (p = .02) than both the no and responsive FOG subgroups. These latter groups were not significantly different. The responsive FOG group was associated with the presence of hallucinations.ConclusionAside from pharmacological differences, unresponsive FOG is associated with executive and visuospatial dysfunction implicating frontostriatal pathways while responsive FOG is associated with hallucinations suggesting involvement of posterior cortical regions. Further study and treatment of FOG should include appropriate subtype classification.     

Hepatic ischemia-reperfusion increases circulating bone marrow-derived progenitor cells and tumor growth in a mouse model of colorectal liver metastases

BackgroundHepatic pedicle clamping is often required to reduce blood loss and transfusion during liver resection. However, the question remains whether use of hepatic pedicle clamping promotes tumor growth. Endothelial progenitor cells (EPCs) are mobilized from bone marrow in response to tissue ischemia, which allows neovascularization of ischemic tissue. It has been suggested that EPCs are involved in tumor progression. We hypothesized that hepatic ischemia reperfusion (I/R)-induced mobilization of EPCs could enhance growth of microscopic tumor, therefore promoting liver metastasis in a mouse model of colorectal cancer.Materials and methodsWe used mouse models of hepatic I/R and hind limb ischemia. For comparison, we studied mice that underwent limb ischemia as positive controls of EPC mobilization. At day 0, we divided 40 mice into four groups: hepatic I/R, hind limb ischemia, combined hepatic I/R and hind limb ischemia, and control (sham midline incision laparotomy). At day 2, we induced liver metastasis in all mice by injecting CT-26 cells into the spleen. Time-dependent circulating EPCs were determined by flow cytometry. We evaluated liver metastasis and microvascular density on day 21.ResultsThe number of circulating progenitor cells increased rapidly in the ischemic groups compared with the control group. Hepatic I/R significantly increased tumor outgrowth compared with the control group. Increased tumor growth was associated with enhanced CD31-positive microvascular density in liver tissue.ConclusionsHepatic I/R leads to mobilization of bone marrow–derived EPCs and enhanced intra-hepatic angiogenesis, which is associated with increased tumor burden in an animal model of colorectal liver metastasis.     

Comparison of the efficacy and safety of the adalimumab biosimilar TQ-Z2301 and adalimumab for the treatment of Chinese patients with active ankylosing spondylitis: a multi-center,randomized, double-blind,phase III clinical trial

Clinical Rheumatology - To assess the clinical equivalence of TQ-Z2301, a biosimilar of adalimumab, to the reference adalimumab in the treatment of Chinese patients with active ankylosing...     

结肠镜术前肠道准备三种方案清洁效果的对比研究

目的 比较临床上常用的3种肠道准备方案的肠道清洁效果,寻求最快速有效的肠道准备方案。方法 对2017年5月至6月在江苏省人民医院消化科病房拟行肠镜检查的患者77例行不同方案的肠道准备,并按不同方案分为3组。第1组22例口服聚乙二醇电解质散2 L+乳果糖口服液6包单次服用;第2组31例口服聚乙二醇电解质散2 L+乳果糖口服液6包分次服用;第3组24例口服聚乙二醇电解质散3 L。观察患者服药后肠道准备的效果和不良反应情况。结果 肉眼观察肠道清洁有效的例数,第2组明显多于其他两组（P＜0.05）;肠镜下渥太华量表评分显示,第1组和第2组对比差异无统计学意义（P＞0.05）,第2组和第3组对比,差异有统计学意义（P＜0.05）,说明渥太华评分标准判断下,第2组优于第3组;服药不良反应率比较,第2组明显优于其他两组（P＜0.05）。结论 采用聚乙二醇电解质散2 L+乳果糖口服液6包分次服用方案进行肠道准备,具有较好的肠道清洁效果,不良反应少,患者更易接受。     

趋化因子诱饵受体D6在心肌梗死后心肌重塑中的作用及机制研究

目的:研究急性心肌梗死(AMI)后患者体内趋化因子诱饵受体D6的水平变化过程以及D6在心肌梗死后影响心肌重塑的可能机制。方法:将35例AMI患者根据心肌梗死后72 h血清趋化因子CCL2的检测水平分为h CCL2high组(n=18)和h CCL2low组(n=17),流式细胞术分析外周血中CD14++CD16-炎症单核细胞比例,Q-PCR测定外周血单核细胞趋化因子诱饵受体D6 mRNA的表达,3周后超声心动图测定心脏功能。将30只AMI雄性BLAB/C小白鼠根据血清CCL2的检测水平分为m CCL2high组(n=17)和m CCL2low组(n=13),流式细胞术分析小鼠外周血中CD11b+单核细胞比例;梗死心肌冰冻切片后免疫荧光染色D6阳性细胞,Q-PCR测定心肌梗死后3 d时间梗死区D6 mRNA的表达。3周后通过小动物超声检测小鼠心脏功能。结果:h CCL2high组患者外周血中CD14++CD16-炎症单核细胞比例显著高于h CCL2low组(P<0.001),其单核细胞D6受体的表达明显低于h CCL2low组(P<0.001),但单核细胞D6的表达与患者LVEF%未见明显相关性(P=0.16)。急性心肌梗死小鼠m CCL2high组外周血中CD11b+单核细胞细胞比例显著高于m CCL2low组(P<0.001),梗死心肌组织D6 mRNA表达显著低于m CCL2low组(P<0.001),小鼠梗死心肌免疫荧光可见D6表达于CD11b阳性单核细胞和CD31阳性内皮细胞。3周后小鼠心脏超声示LVEF%与梗死区D6的表达呈正相关(P=0.01)。结论:急性心肌梗死后梗死区组织可表达趋化因子诱饵受体D6,梗死区D6的高表达可抑制心肌梗死后的炎症浸润。梗死区趋化因子诱饵受体D6通过特异性结合CCL2减少心肌梗死后心肌局部的炎症浸润进而减轻心肌梗死后的心肌重塑。     

人PD-L1基因转染细胞株的构建及其对活化的Jurkat细胞增殖和凋亡的影响

目的:构建稳定表达人PD-L1分子的基因转染细胞株,观察其对活化的Jurkat细胞增殖和凋亡的影响。方法:将编码人PD-L1分子的全长c DNA重组入反转录病毒表达载体p EGZ-Term-R,将重组载体p EGZ-Term-R/PD-L1和辅助病毒载体用脂质体法共转染293T细胞,包装具有感染能力的完整病毒;收集含有完整重组反转录病毒的293T细胞培养上清,感染L929细胞,筛选并获得G418抗性的基因转染细胞。采用流式细胞术检测表达PDL1的基因转染细胞,命名为L929/PD-L1。采用PHA活化T细胞系来源的细胞株Jurkat,并将其与丝裂霉素预处理的L929/PD-L1细胞共培养,用细胞计数法观察L929/PD-L1细胞株对活化的Jurkat细胞增殖能力的影响,并检测其凋亡情况。结果:成功获得了稳定表达人PD-L1基因的转染细胞株L929/PD-L1。PHA可诱导Jurkat细胞活化并表达PD-1分子;L929/PD-L1与PHA刺激后的Jurkat细胞共培养,可抑制Jurkat细胞增殖,促进其凋亡。结论:成功构建了稳定表达人PD-L1的细胞株,PD-L1分子抑制活化的Jurkat细胞增殖,促进其凋亡。