Novel T-cell inhibiting peptides delay the onset of Type 1 diabetes in non-obese diabetic mice

The aim of this study was to investigate the effectiveness of immunomodulatory peptides in preventing the spontaneous onset of Type 1 diabetes in NOD mice. Two such peptides, CP and C1, were injected intraperitoneally in NOD mice three times a week starting at two different time points, nine weeks and 11 weeks of age, and blood sugar levels monitored for the development of diabetes. CP was shown to be effective in delaying the onset of diabetes compared to control (P = 0.006). The timing of peptide administration was crucial since delay in treatment did not prevent the onset of diabetes (nine weeks versus 11 weeks of age). C1 was effective in delaying the onset of Type 1 diabetes with borderline significance when given at week 11 (P = 0.05). These findings confirm the efficacy of these peptides in the prevention and possible treatment for Type 1 diabetes and thereby create new opportunities for genetic manipulation.     

Epitope-based approaches to a universal influenza vaccine

The development of vaccines has been one of the most important contributions of immunology to public health to date. Although several infectious diseases have all but vanished thanks to effective vaccines, the most common infectious disease, influenza, still represents a major threat to public health. This is more concerning than ever before in light of potentially virulent avian pandemic strains which have emerged in the last decade and infected human hosts, causing high morbidity and mortality. Despite considerable efforts to improve production of influenza vaccines and vaccinate large portions of the population annually, the currently available influenza vaccines are strain-specific and not effective enough. Considering the vulnerability of infants and elderly to seasonal influenza-related complications and the ever present public health threat of a deadly influenza pandemic, there is urgent need for a new kind of influenza vaccine. Ideally, such a vaccine should provide enhanced long term, multi-strain protection without compromising safety and in this way, dramatically improve global protection against seasonal and pandemic influenza viruses. This review highlights one approach to developing a universal influenza vaccine, which is based on highly conserved viral sequences, ‘epitopes’, that specifically activate humoral and/or cellular immune responses. This approach to vaccinology was pioneered by Prof Arnon, who initiated development of an epitope-based universal vaccine called Multimeric-001 (M-001), which has already been validated in clinical trials to induce broad immunity against A and B-Type, seasonal and pandemic strains.     

前列地尔注射液对室间隔缺损介入治疗后血浆氨基末端脑利钠肽前体水平及心功能的影响

目的 观察先天性心脏病室间隔缺损（VSD）患儿介入封堵术后联合应用前列地尔注射液对术后血浆氨基末端脑利钠肽前体（NT-proBNP）水平及心功能的影响。方法 选择本院2011年1月至2013年1月住院行介入封堵治疗的VSD患儿120例,男51例,女69例,年龄5～8,平均6.1±2.3岁。随机分为前列地尔组60例,对照组60例,前列地尔组在封堵术后即刻注射前列地尔注射液连续7天,分别在术前、术后第3天、术后6个月采用双向侧流免疫法测定其血浆NT-proBNP水平,所有患儿在术前、术后第7天和术后6个月分别进行超声心动图检查,测定左心室舒张期末内径（LVEDD）、左心室收缩期末内径（LVESD）、左心室收缩期末容量（LVESV）、左心室舒张期末容量（LVEDV）、左心室射血分数（LVEF）,并比较两组临床特征、血浆NT-proBNP水平及心功能参数的变化。结果 两组患儿LVEDD、LVESD、LVEDV、LVESV在介入术后第7天及术后6个月均明显小于术前（P<0.05）,且封堵术后6个月前列地尔组LVEDD、LVESD、LVEDV、LVESV较对照组减小更明显（P<0.05）。两组患儿术前血浆NT-proBNP水平无统计学差异（P>0.05）;两组患儿血浆NT-proBNP水平术前与术后第3天、术后第3天与术后6个月比较差异均有统计学意义（P<0.01）,且前列地尔组封堵术后3天、术后6个月较对照组下降更明显（P<0.01）。结论 VSD患儿介入封堵术联合前列地尔治疗可进一步降低血浆NT-proBNP水平并改善患儿心功能。     

重组人脑利钠肽和硝酸甘油治疗难治性心力衰竭的疗效及安全性分析

【摘要】 目的 观察重组人脑利钠钛和硝酸甘油治疗难治性心力衰竭的疗效和安全性。方法 选取2018年1月～〖JP〗2019年3月就诊于本院的难治性心力衰竭患者164例,入选患者随机分为对照组和观察组,其中对照组84例应用硝酸甘油治疗,观察组80例应用重组人脑利钠钛治疗。比较两组患者治疗前后N端前脑钠肽（NT proBNP）、左室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、总有效率及两组患者呼吸困难、周身水肿、肺部啰音的改善情况。安全性评估采用用药过程中及用药后定期测定血压、心率,并对治疗过程中所有不良反应进行记录。结果 治疗后两组NT proBNP、LVEF、LVEDD、LVESD较治疗前均有改善,且观察组治疗前后LVEDD、LVESD改善较对照组更明显（P＜0.05）;观察组总有效率优于对照组（P＜0.05）;观察组呼吸困难、周身水肿、肺部啰音程度的改善均优于对照组（P＜0.05）;两组NT proBNP、LVEF改善比较差异无统计学意义（P＞0.05）。两组药物相关的不良反应比较差异无统计学意义（P＞0.05）。结论 重组人脑利钠钛较硝酸甘油更能显著改善难治性心力衰竭患者的心功能和全身症状,其安全性与硝酸甘油类似。     

重组人脑利钠肽对急性冠脉综合征伴心力衰竭患者的影响

目的 分析重组人脑利钠肽(rhBNP)对急性冠脉综合征(ACS)伴心力衰竭患者的影响。方法 选取2017年1月～2018年12月在本院接受治疗的ACS合并心力衰竭患者232例,随机数字表法分成对照组58例使用常规疗法和硝酸甘油治疗,治疗组174例使用常规疗法和rhBNP治疗;观察患者治疗前后神经内分泌激素和氨基末端脑钠尿肽(NT-proBNP)含量、心功能指标、6 min步行距离及治疗后发生心脏不良事件情况。结果 治疗后6 h治疗组患者血清醛固酮、肾上腺素、血管紧张素Ⅱ、肾素、去甲肾上腺素及NT-proBNP含量较治疗前、对照组降低(P0.05);治疗后1个月治疗组患者LVEF较治疗前、对照组升高,LVESV、LVEDV较治疗前、对照组降低(P0.05);治疗后1个月治疗组患者6 min步行距离较治疗前、对照组升高,治疗后6个月治疗组心脏不良事件发生率低于对照组(P0.05)。结论 rhBNP可显著改善ACS合并心力衰竭患者心功能指标,降低血清神经内分泌激素、NTproBNP含量和心脏不良事件发生率。     

Enteroendocrine secretion after roux‐en‐Y gastric bypass: is it important?

Observational studies suggest that bariatric surgery is the most effective intervention for achieving a significant and durable weight loss. In patients with type 2 diabetes, such surgery is often associated with remission of their diabetes. The mechanism(s) by which surgeries such as Roux‐en‐Y Gastric Bypass (RYGB) leads to favorable effects on glucose metabolism remain unknown. RYGB is associated with altered secretion of enteroendocrine hormones, leading to the belief that these hormones contribute to the improvement in insulin secretion and action as well as satiation after this procedure. However, it is important to consider the not insignificant effects of caloric restriction and the mechanical changes to the upper gut in determining the outcomes of such surgery.     

Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction

OBJECTIVES:

Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements.

METHODS:

A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated.

RESULTS:

Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90±3.75 vs. 1.35±0.72 nmol/L, p<0.001). Although the left atrial diameter was comparable in patients and controls, the left atrial volume index was increased in patients with acute myocardial infarction (26.5±7.1 vs. 21.3±4.9 mL/m², p<0.01). Multivariate regression analysis showed a strong independent correlation between the left atrial volume index and the plasma atrial natriuretic peptide level (β = 0.23, p = 0.03).

CONCLUSIONS:

The left atrial volume index and plasma atrial natriuretic peptide level were correlated in patients with acute myocardial infarction.     

Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

Background

Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE.

Materials and Methods

A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated.

Results

A total of 1258 patients were included in the systematic review. The rate of recurrent venous thromboembolism (VTE) in patients with PE managed as outpatients was 1.47% (95% CI: 0.47 to 3.0%; I²: 65.4%) during the 3 month follow-up period. The rate of fatal PE was 0.47% (95% CI: 0.16 to 1.0%; I²: 0%). The rates of major bleeding and fatal intracranial hemorrhage were 0.81% (95% CI: 0.37 to 1.42%; I²: 0%) and 0.29% (95% CI: 0.06 to 0.68%; I²: 0%), respectively. The overall 3 month mortality rate was 1.58% (95% CI: 0.71 to 2.80%; I²: 45%). The event rates were similar if employing risk stratification models versus using clinical gestalt to select appropriate patients for outpatient management.

Conclusions

Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, low-risk patients with acute PE can safely be treated as outpatients if home circumstances are adequate.     

灯盏生脉胶囊联合重组人脑利钠肽治疗慢性心力衰竭的临床研究

目的探讨灯盏生脉胶囊联合注射用重组人脑利钠肽治疗慢性心力衰竭的临床疗效。方法选取2016年2月—2018年2月恩施自治州中心医院治疗的84例慢性心力衰竭患者为研究对象,采用随机数字表将患者分为对照组(42例)和治疗组(42例)。对照组给予注射用重组人脑利钠肽,首次静脉冲击1.5μg/kg,随后按照0.01μg/(kg·min)静脉泵入。治疗组在对照组治疗的基础上口服灯盏生脉胶囊,2粒/次,3次/d。两组患者均连续治疗2周。观察两组临床疗效,比较治疗前后两组患者的心功能指标和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为80.95%、97.62%,两组比较差异具有统计学意义(P0.05)。治疗后,两组左室射血分数(LVEF)显著升高,左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室收缩末期容积(LVESV)均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组心功能指标显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清可溶性糖化终末产物受体(s RAGE)、高迁移率族蛋白1(HMGB1)、N-末端B型脑钠肽前体(NT-pro BNP)、转化生子因子-β1(TGF-β1)、β-内啡肽(β-EP)水平均降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组血清学指标水平显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论灯盏生脉胶囊联合注射用重组人脑利钠肽治疗慢性心力衰竭具有较好的临床疗效,可有效改善患者心功能,降低血清学指标水平,具有一定的临床推广应用价值。