过继回输耐受性树突状细胞促进大鼠肝移植免疫耐受的应用研究

目的  探讨耐受性树突状细胞（tolDC）在肝移植免疫耐受诱导中的作用。方法  建立自发耐受[Brown Norway（BN）→Lewis,耐受组,n=6]和急性排斥反应（AR）（Lewis→BN）大鼠肝移植模型,AR模型大鼠中实验组进行tolDC回输（tolDC组,n=6）,对照组不进行干预（AR组,n=6）。观察各组大鼠术后生存时间,对各组大鼠移植肝组织进行病理学检查;采用流式细胞术检测各组大鼠外周血、移植肝、脾脏、淋巴结髓样树突状细胞（mDC）和浆细胞样树突状细胞（pDC）的表达情况;采用酶联免疫吸附试验检测各组大鼠血清白细胞介素（IL）-10和干扰素（IFN）-γ的表达情况。结果  AR组大鼠病理学表现主要为移植肝炎症细胞浸润和组织结构紊乱,生存时间7~14 d;tolDC组与耐受组大鼠移植肝组织基本正常,最长生存时间超过100 d。与AR组比较,耐受组和tolDC组大鼠外周血、移植肝、脾脏、淋巴结CD11⁺mDC水平均下降（均为P < 0.05）,且CD11⁺mDC表面CD86、主要组织相容性复合体（MHC）Ⅱ表达水平均降低（均为P < 0.05）。与AR组比较,耐受组和tolDC组大鼠外周血、移植肝、脾脏、淋巴结中pDC水平均升高（均为P < 0.05）,同时pDC表面的MHCⅡ表达水平均降低（均为P < 0.05）。与AR组比较,耐受组和tolDC组大鼠血清IL-10的表达水平均升高、IFN-γ的表达水平均降低（均为P < 0.05）。结论  作为tolDC亚群,mDC和pDC在大鼠肝移植术后移植物免疫耐受的发生过程中均具有正向调节作用。     

Femtosecond laser deep lamellar keratoplasty

We aimed to develop a novel and effective technique for creating a smooth deep lamellar dissection of the cornea using a femtosecond (FS) laser for deep anterior lamellar keratoplasty (DALK), we conducted a retrospective eye bank study. Thirteen fresh human corneas were mounted on an artificial anterior chamber, and deep lamellar cuts were made with a 500-kHz VisuMax FS laser at a level of 50–80 mm anterior to the Descemet’s membrane (DM). A posterior diameter of 8 mm with a side cut angle of 110° was used for the anterior penetrating side cut. The anterior lamellar tissue was bluntly dissected. The residual posterior stromal beds and side cuts were examined with microscopy and intraoperative optical coherence tomography (OCT) and post-cut endothelial cell evaluations. All corneas revealed a smooth residual posterior stromal bed without any visible irregularities or ridges by microscopy and OCT imaging. Six corneas were suitable for post-cut endothelial cell evaluation 2 days after laser cut, with no significant endothelial cell loss post-laser and blunt dissection of the posterior stroma. FS laser deep lamellar keratoplasty utilizing an ultrafast laser to produce a smooth deep stromal dissection followed by blunt dissection and removal of the anterior stromal tissue yields a consistent and smooth residual stromal bed. The creation of a smooth lamellar dissection in the deep posterior cornea may result in more consistent DALK without the need for air bubble or manual baring of DM that has the risk for DM perforation.     

Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect

Purpose:To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT).Methods:This cross-sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD-OCT machine.Results:There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 mm in the affected eyes) as compared to sick control (82.73 ± 11.33 mm in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 mm in the affected eyes) as compared to sick control (76.36 ± 8.06 mm in the affected eyes).Conclusion:Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group.     

亚溶量C5b-9与足细胞损伤及其信号传导的研究进展

膜性肾病的发病机制与亚溶量C5b-9(SC5b-9)诱导足细胞损伤有关.SC5b-9刺激足细胞产生的氧化剂、蛋白酶、前列腺素类、细胞外基质及各种细胞因子对足细胞有损伤作用.SC5b-9对足细胞的作用主要表现为引起足细胞凋亡、足细胞脱落以及对细胞周期的影响.MAPK通路在SC5b-9导致足细胞损伤中起到重要的作用.     

The relation between apical thrombus formation and systemic immune-inflammation index in patients with acute anterior myocardial infarction

Left ventricular (LV) apical thrombus formation is a well described and clinically important complication of acute myocardial infarction (MI) with a substantial risk of thromboembolism. Alterations in the inflammatory status may contribute to this complication. The aim of this study was to evaluate the predictive role of the systemic immune-inflammation index (SII) in identifying high risk patients who will develop an apical thrombus formation during the acute phase of anterior transmural infarction. Consecutive 1753 patients (mean age: 61.5 ± 9.6 years; male: 63.8 %) with first acute anterior MI who underwent primary percutaneous coronary intervention were assessed. Patients were divided into 2 groups according to the presence of apical thrombus. SII was calculated using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L). LV apical thrombus was detected on transthoracic echocardiogram in 99 patients (5.6%). Patients with an apical thrombus had lower LV ejection fraction, prolonged time from symptoms to treatment, higher rate of post-percutaneous coronary intervention thrombolysis in myocardial infarction flow ≤1 and significantly higher mean high-sensitivity C-reactive protein, and SII values and lower lymphocyte than those without an apical thrombus. Admission SII level was found to be a significant predictor for early LV apical thrombus formation complicating a first-ever anterior MI. This simple calculated tool may be used to identify high-risk patients for LV thrombus and individualization of targeted therapy.     

Angio-Seal Used as a Bailout for Incomplete Hemostasis After Dual Perclose ProGlide Deployment in Transcatheter Aortic Valve Implantation

BackgroundThe failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice.MethodsThis research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared.ResultsNo significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044).ConclusionFinding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure.     

Analysis of atherosclerotic plaque distribution in the carotid artery

BackgroundThe present study was designed to investigate the hypothesis that the outer wall at the carotid bifurcation is the most common area of atherosclerotic plaque deposition due to the low shear stress.HypothesisWe hypothesized that the most common site of arteriosclerosis in carotid arteries is different in the early and late stages.MethodsThis is an observational study of patients with <50% stenosis of the common and internal carotid arteries (ICAs) identified by Duplex ultrasound in our health promotion center. Plaque location was categorized as a quarter of the cross‐section in the distal common carotid artery (CCA) and proximal ICA. Carotid plaque score (CPS) was calculated by the addition of one point for each detected section. The sum of CPSs was calculated for each section.ResultsAmong 3996 Duplex scans of carotid arteries in 999 patients between June 2020 and October 2020, a total of 569 patients (73.6% male; mean age, 68.4± 9.1 years; 652 CCAs and 567 ICAs) were included. Total CPS was high in the anterior and posterior sections. The distribution in the ICA was: 308 (31.0%) anterior, 90 (9.0%) medial, 373 (37.5%) posterior, and 224 (22.5%) lateral section. The distribution in the CCA was 385 (32.6%) anterior, 103 (8.7%) medial, 528 (44.7%) posterior, and 165 (14.0%) lateral section. The axial distribution of posterior and lateral sections was significantly different according to the directional flow (p < .001).ConclusionsAnterior and posterior sections of the CCA and ICA were atherosclerotic plaque‐prone sites. This result is different from the tendency of atherogenesis to affect the lateral section having low shear stress at the carotid bifurcation.     

Successful Rescue of Life-threatening Hemoptysis Caused by Pulmonary Tuberculosis Bridging with Extracorporeal Membrane Oxygenation

Massive hemoptysis is a fatal complication associated with pulmonary tuberculosis (TB). It can lead to severe respiratory failure. Extracorporeal membrane oxygenation (ECMO) is a life-saving technology that is rarely indicated for bleeding disorders. We herein report a 26-year-old man who presented with severe respiratory failure caused by massive hemoptysis with pulmonary TB. Transcatheter artery embolization was successfully performed with venovenous ECMO support. The hemostatic procedure allowed concomitant anticoagulant use, and neither bleeding nor thrombotic complications occurred throughout the clinical course. Administering the appropriate hemostatic procedure with subsequent management, including anticoagulant therapy, supported ECMO application in a case of bleeding.     

Two Distinct Cases of Adult-onset Kawasaki Disease

Kawasaki disease (KD) is a systemic vasculitis syndrome that mostly affects children under 4 years old. Among the reported KD cases, only 1% were over 10 years old. We herein report 2 cases of adult-onset KD (AKD) in 19- and 17-year-old boys diagnosed with a persistent fever and cervical lymphadenitis. Both patients showed cardiac complications, such as coronary artery dilation and myocarditis. Repeated intravenous immunoglobulin therapy was effective in the 19-year-old, while plasma exchange therapy was needed for the 17-year-old, with no sequelae noted at discharge. KD should be considered as a differential diagnosis for persistent fever in adults.     

Environment Symmetry Drives a Multidirectional Code in Rat Retrosplenial Cortex

We investigated how environment symmetry shapes the neural processing of direction by recording directionally tuned retrosplenial neurons in male Lister hooded rats exploring multicompartment environments that had different levels of global rotational symmetry. Our hypothesis built on prior observations of twofold symmetry in the directional tuning curves of rats in a globally twofold-symmetric environment. To test whether environment symmetry was the relevant factor shaping the directional responses, here we deployed the same apparatus (two connected rectangular boxes) plus one with fourfold symmetry (a 2 × 2 array of connected square boxes) and one with onefold symmetry (a circular open-field arena). Consistent with our hypothesis we found many neurons with tuning curve symmetries that mirrored these environment symmetries, having twofold, fourfold, or onefold symmetric tuning, respectively. Some cells expressed this pattern only globally (across the whole environment), maintaining singular tuning curves in each subcompartment. However, others also expressed it locally within each subcompartment. Because multidirectionality has not been reported in naive rats in single environmental compartments, this suggests an experience-dependent effect of global environment symmetry on local firing symmetry. An intermingled population of directional neurons were classic head direction cells with globally referenced directional tuning. These cells were electrophysiologically distinct, with narrower tuning curves and a burstier firing pattern. Thus, retrosplenial directional neurons can simultaneously encode overall head direction and local head direction (relative to compartment layout). Furthermore, they can learn about global environment symmetry and express this locally. This may be important for the encoding of environment structure beyond immediate perceptual reach.SIGNIFICANCE STATEMENT We investigated how environment symmetry shapes the neural code for space by recording directionally tuned neurons from the retrosplenial cortex of rats exploring single- or multicompartment environments having onefold, twofold, or fourfold rotational symmetry. We found that many cells expressed a symmetry in their head direction tuning curves that matched the corresponding global environment symmetry, indicating plasticity of their directional tuning. They were also electrophysiologically distinct from canonical head directional cells. Notably, following exploration of the global space, many multidirectionally tuned neurons encoded global environment symmetry, even in local subcompartments. Our results suggest that multidirectional head direction codes contribute to the cognitive mapping of the complex structure of multicompartmented spaces.