Attenuation of Donor‐Reactive T Cells Allows Effective Control of Allograft Rejection Using Regulatory T Cell Therapy

Regulatory T cells (Tregs) are essential for the establishment and maintenance of immune tolerance, suggesting a potential therapeutic role for Tregs in transplantation. However, Treg administration alone is insufficient in inducing long‐term allograft survival in normal hosts, likely due to the high frequency of alloreactive T cells. We hypothesized that a targeted reduction of alloreactive T effector cells would allow a therapeutic window for Treg efficacy. Here we show that preconditioning recipient mice with donor‐specific transfusion followed by cyclophosphamide treatment deleted 70–80% donor‐reactive T cells, but failed to prolong islet allograft survival. However, infusion of either 5 × 10⁶ Tregs with direct donor reactivity or 25 × 10⁶ polyclonal Tregs led to indefinite survival of BALB/c islets in more than 70% of preconditioned C57BL/6 recipients. Notably, protection of C3H islets in autoimmune nonobese diabetic mice required islet autoantigen‐specific Tregs together with polyclonal Tregs. Treg therapy led to significant reduction of CD8⁺ T cells and concomitant increase in endogenous Tregs among graft‐infiltrating cells early after transplantation. Together, these results demonstrate that reduction of the donor‐reactive T cells will be an important component of Treg‐based therapies in transplantation.     

Effect of kolaviron,a biflavonoid complex from Garcinia kola seeds,on the antioxidant,hormonal and spermatogenic indices of diabetic male rats

The antihyperglycaemic effect of kolaviron (KV), a biflavonoid from Garcinia kola has been established in previous studies. In this study, we investigated the effect of KV (200 mg kg^?1) on the antioxidant, hormonal and spermatogenic indices of alloxan‐diabetic male rats, and metformin hydrochloride (MET) (30 mg kg^?1) served as standard drug. The results showed that KV and MET significantly (P < 0.05) decreased the fasting blood glucose of the diabetic rats. Also, untreated and MET‐treated diabetic groups had significantly (P < 0.05) lower body‐weight gain and relative weights of testes. In addition, epididymal sperm abnormalities were increased, whereas sperm count, motility, testicular protein and sialic acid were decreased in untreated diabetic group. Also, antioxidant parameters, reduced glutathione, catalase, superoxide dismutase, glutathione‐S‐transferase and glutathione peroxidase were significantly (P < 0.05) reduced in the testes with a concomitant increase in lipid peroxidation in untreated diabetic group. Furthermore, untreated diabetic group had significantly (P < 0.05) lower levels of testosterone, luteinising and follicle‐stimulating hormones relative to controls. Treatment with KV restored the relative weights of testes, activities of antioxidant enzymes, sperm and hormonal indices of the diabetic animals. This study demonstrated the role of KV to promote fertility in diabetic male rats by enhancing the hormonal and antioxidant status of the rats.     

Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass

BackgroundBariatric surgery has been shown to improve many obesity related co-morbidities, including gestational diabetes mellitus (GDM). Recently, new diagnostic criteria for GDM following the International Association of Diabetes and Pregnancy Study Group recommendations were implemented. The objective of this study was to compare the use of 2 different GDM criteria in diagnostic and pregnancy outcome after Roux-en-Y gastric bypass (RYGB).MethodsPregnant women who had previously undergone RYGB (n = 30) were screened for GDM with Carpenter and Coustan (C&C) criteria (n = 18) or the new diagnostic criteria (n = 12).ResultsNone of the patients screened using C&C criteria where diagnosed with GDM, while 50% of the patients screened with the new criteria had GDM. Among women that underwent oral glucose tolerance tests (OGTT) (n = 19) as required for the new diagnostic criteria, 57.9% developed reactive hypoglycemia. All women diagnosed with GDM had excellent metabolic control during pregnancy and comparing the outcome of these pregnancies and those of women without GDM, there were no significant differences regarding the age at time of surgery or at pregnancy, body mass index before surgery and pregnancy, parity, previous history of GDM, time from surgery to conception, weight lost until pregnancy, weight gain during pregnancy, gestational age at delivery, and birth weight adjusted for gestational age.ConclusionNew GDM diagnostic criteria in post-RYGB pregnant women increased the prevalence of GDM diagnostic without changing pregnancy outcomes. In addition, OGTTs were associated with a high rate of reactive hypoglycemia. These data suggest that alternative GDM diagnostic criteria are needed for these postbariatric patients.     

Neuromonitoring

The monitoring of critically ill brain injured patients has become increasingly complex. Several techniques are now available for global and regional brain monitoring that provide assessment of cerebral perfusion, oxygenation and metabolic status, and early warning of impending brain hypoxia/ischaemia. Developments in multimodality monitoring have enabled a move away from rigid physiological target setting to an individually tailored, patient-specific approach to the management of acute brain injury. Multimodal monitoring generates large and complex datasets, and systems that analyse and present information in a user-friendly format at the bedside are essential to maximize its clinical relevance. This review describes current neuromonitoring techniques used during the intensive care management of acute brain injury.     

宁波市部分社区糖尿病肾病的中医辨证分型横断面调查

目的：探讨社区2型糖尿病患者的糖尿病肾病发病率及中医证型分布特点.方法：对2010年5月～2010年7月宁波市部分社区1604例2型糖尿病患者进行尿微量白蛋白（MA）及尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）的检验分析和辨证分型.结果：通过尿MA与尿NAG联合检验,1 604例2型糖尿病患者的糖尿病肾病患病率为28.4％,中医证型分布以气阴两虚型稍偏多.结论：尿MA与尿NAG联合检验可提高糖尿病肾病的筛查率.宁波地区部分社区2型糖尿病患者的糖尿病肾病患病率与国内报道相当,在糖尿病肾病的不同阶段,其中医病机及证型分布有一定相关性.     

Fogarty导管取栓术联合多种微创技术治疗急性下肢动脉缺血的疗效

目的 探讨Fogarty导管取栓术联合多种微创技术在治疗急性下肢动脉缺血中的临床应用价值。 方法 回顾性分析2007年2月至2011年1月期间笔者所在医院收治的88例（88条肢体）急性下肢动脉缺血患者的临床资料,比较行Fogarty导管取栓术（取栓组）和行Fogarty导管取栓术联合多种微创技术（联合组）患者手术前后踝-肱指数（ABI）、足趾血氧饱和度（SO2）及足部皮温的改变情况,并比较2组患者术后的死亡率、截肢率及各并发症发生率。结果 取栓组和联合组患者术后的ABI、足趾SO2及足部皮温与同组术前比较均升高（P＜0.05）;2组患者术前ABI、足趾SO2及足部皮温比较差异均无统计学意义（P＞0.05）;术后联合组患者的ABI、足趾SO2、足部皮温及其改变值较取栓组均升高 （P＜0.05）。术后取栓组患者的死亡率、截肢率、肌病肾病代谢性综合征（MNMS） 发生率、骨筋膜室综合征发生率及一过性肾功能不全发生率分别为13.04% （6/46）、17.39% （8/46）、26.09% （12/46）、26.09% （12/46）及13.04% （6/46）,联合组分别为4.76% （2/42）、7.14% （3/42）、14.29% （6/42）、9.52% （4/42）及9.52% （4/42）,取栓组各指标均较高（P＜0.05）。结论 Fogarty导管取栓术联合多种微创技术具有手术微创性、治疗有效性等特点,可作为急性下肢动脉缺血的外科治疗方法之一。     

WJD 5~(th) Anniversary Special Issues(2): Type 2 diabetes Genetic polymorphisms of cytokine genes in type 2 diabetes mellitus

Diabetes mellitus is a combined metabolic disorder which includes hyperglycemia,dyslipidemia,stroke and several other complications.Various groups all over the world are relentlessly working out the possible role of a vast number of genes associated with type 2 diabetes(T2DM).Inflammation is an important outcome of any kind of imbalance in the body and is therefore an indicator of several diseases,including T2DM.Various ethnic populations around the world show different levels of variations in single nucleotide polymorphisms(SNPs).The present review was undertaken to explore the association of cytokine gene polymorphisms with T2DM in populations of different ethnicities.This will lead to the understanding of the role of cytokine genes in T2DM risk and development.Association studies of genotypes of SNPs present in cytokine genes will help to identify risk haplotype(s)for disease susceptibility by developing prognostic markers and alter treatment strategies for T2DM and related complications.This will enable individuals at risk to take prior precautionary measures and avoid or delay the onset of the disease.Future challenges will be to understand the genotypic interactions between SNPs in one cytokine gene or several genes at different loci and study their association with T2DM.     

实施自我管理教育项目对住院2型糖尿病患者的影响

目的探讨实施自我管理教育项目对2型糖尿病患者健康信念、自我管理行为及糖化血红蛋白的影响。方法将100例住院2型糖尿病患者随机分为对照组与观察组各50例。对照组给予常规健康教育,观察组在此基础上由科室医生、教育护士、营养师、心理咨询师等8名成员组成自我管理教育项目组,对患者进行自我管理教育。两组均随访3个月,分别在干预前、干预后第3个月评估患者的健康信念、自我管理行为和糖化血红蛋白水平。结果观察组干预后健康信念得分显著高于对照组（P〈0．01）;自我管理行为显著优于对照组（P〈0．05）;糖化血红蛋白降低程度较对照组更为显著（P〈0．01）。结论对住院2型糖尿病患者实施自我管理教育项目,能提高其健康信念水平、改善自我管理行为、降低糖化血红蛋白。