2020年ATC肝移植研究前沿盘点

美国移植年会（ATC）是器官移植领域极具影响力的学术盛会。本文概述了2020年ATC肝移植领域的热点内容,包括供肝获取和质量评估、供肝保存和缺血-再灌注损伤（IRI）、肝细胞癌及其他肝脏恶性肿瘤肝移植、肝移植术后并发症、肝移植免疫学、围手术期管理和供者来源性感染、儿童肝移植、细胞治疗等多个方向的最新研究进展。     

蒙药对慢性侵袭纤维性甲状腺炎的疗效

我们在ELecsys2010型全自动电化学发光免疫分析仪的检测下,观察蒙药对慢性侵袭纤维性甲状腺炎的疗效时发现蒙药具有良好的调节ATG,治愈慢性侵袭纤维性甲状腺炎的作用。     

A method for generating high-yield enriched neuronal cultures from P19 embryonal carcinoma cells

P19 embryonal carcinoma (EC) cells are an invaluable tool for approximating the mechanisms that govern neuronal differentiation but with an enormous degree of simplification and have primarily been used to model the early stages of neurogenesis. However, they are often cultured under conditions that promote unrestricted non-neuronal growth that compromises neuronal viability. In this study we report an improved method to differentiate P19 EC cells that gives rise to high yields of functionally and morphologically mature neurons while significantly reducing the over-growth of non-neuronal cells in the cultures. In this protocol, P19 EC cells are induced in Minimum Essential Medium alpha supplemented with all-trans retinoic acid (RA) and 2.5% serum, and cultured as a monolayer. After RA-induction, cells are cultured on Matrigel coated-plates using defined media comprised of Neurobasal-A medium temporally supplemented with N2 and then B-27 for the remaining culture period. By treating the culture with Cytosine β-d-arabinofuranoside and 2′-Deoxycytidine for five days, the cultures are reliably promoted toward the neuronal differentiation vs non-neuronal differentiation, this accounting for a progressive neuronal enrichment of the cultures reaching 56% after 20 days of culture. P19-derived neural progenitor cells progressively expressed neuronal markers such as NeuN, Calretinin, Calbindin and Synapsin I in close resemblance to that occurring in vivo in the central nervous system (CNS). Furthermore, RA-induced P19 EC cells progressively acquired functional neuronal traits and after approximately 3 weeks in culture revealed mature neurophysiological properties, characteristics of CNS neurons. This protocol allows for a more specific assessment of the neuronal differentiation processes in vitro.     

Concomitant use of medication with antiplatelet effects in patients receiving either rivaroxaban or enoxaparin after total hip or knee arthroplasty

Introduction

The RECORD programme compared oral rivaroxaban with enoxaparin for prevention of venous thromboembolism after elective total hip or knee replacement. This analysis compared the safety of concomitant use of specified medications with rivaroxaban and enoxaparin by evaluating postoperative bleeding rates from the pooled RECORD1-4 data.

Materials and methods

The co-medications were non-steroidal anti-inflammatory drugs and platelet function inhibitors, including acetylsalicylic acid (no dose restriction). The endpoints evaluated were the composite of major and non-major clinically relevant bleeding and any bleeding occurring after first oral study drug intake. The time relative to surgery was stratified into three time periods: day 1-3, day 4-7 and after day 7. Relative bleeding rate ratios for co-medication use versus non-use were derived using stratified Mantel-Haenszel methods and compared between rivaroxaban and enoxaparin groups.

Results

Co-medication use with rivaroxaban or enoxaparin resulted in non-significant increases in bleeding events. Respective rate ratios were not significantly different between rivaroxaban and enoxaparin for all bleeding endpoints with concomitant use of non-steroidal anti-inflammatory drugs (any bleeding, 1.22 vs 1.22; major and non-major clinically relevant bleeding, 1.28 vs 0.90) and with concomitant use of platelet function inhibitors/acetylsalicylic acid (any bleeding, 1.32 vs 1.40; major and non-major clinically relevant bleeding, 1.11 vs 1.13).

Conclusions

This explorative analysis indicates that there is no significant increase in bleeding risk for rivaroxaban compared with enoxaparin when co-administered with non-steroidal anti-inflammatory drugs or acetylsalicylic acid, although, because of low usage, the experience with platelet function inhibitors (except acetylsalicylic acid) was limited.     

Androgen deprivation therapy and cardiovascular risk: No meaningful difference between GnRH antagonist and agonists—a nationwide population-based cohort study based on 2010–2013 French Health Insurance data

BackgroundObservational studies suggested that androgen deprivation therapy (ADT) is associated with an increased cardiovascular (CV) risk. They all compared ADT-treated cancer patients to non-treated patients or non-cancer subjects. Our aim was to evaluate whether CV risk differs by type of ADT.MethodsThrough nationwide population-based claims reimbursement database linked to hospital discharge database, we identified adult men with prostate cancer who initiated ADT (gonadotrophin releasing hormone [GnRH] agonist or antagonist, antiandrogen [AA], combined androgen blockade [CAB]) or had orchiectomy (OT) between 1st July, 2010, and the 31st December, 2011, and followed them up to 31st December, 2013. The main analysis followed an ‘on-treatment’ approach that censored all patients at the time of first therapeutic modification; it used Cox regression analysis to estimate hazard ratios (HRs) for hospitalisations for ischaemic events (myocardial infarction or ischaemic stroke, whichever came first), adjusted on age, baseline co-morbidities and taking into account death as a competing risk.ResultsAmong the 35,118 new ADT users, 71% received GnRH agonist (reference group), 12% CAB, 13% AA, 3.6% GnRH antagonist and 0.6% had OT. CAB was associated with an increased risk (adjusted HR [95% confidence interval {CI}], 1.6 [1.3–2.0]) and AA with a decreased risk (adjusted HR [95% CI], 0.6 [0.4–0.9]) of ischaemic events when compared to GnRH agonist. No significant association was found with GnRH antagonist (adjusted HR [95% CI], 1.2 (0.7–2.1)).ConclusionCV risk appeared different across ADT modalities. The probability of a clinically meaningful difference when comparing GnRH antagonists to agonists appears rather low. In a context where better overall and cancer specific survival without worsening quality of life is a challenge for clinicians, a potential heterogeneity in CV morbidity becomes crucial when choosing an ADT.     

The inhalation acute toxic class method: test procedures and biometric evaluations

A method of inhalation acute toxic (ATC) classification is presented with the use of significantly fewer animals in comparison with the classical LC₅₀ test. The principle of the inhalation ATC method is based on the oral ATC method, which has been adopted in 1996 as an official test guideline of the OECD and the European Union. The inhalation ATC method, like the oral ATC method, is a stepwise procedure; three animals of each sex are used simultaneously for each tested concentration, and not, as in the oral ATC method, three animals of each sex separately for each dose. The method was developed for three starting concentrations and two reference systems (based on ppm and mg/l). Depending on the LC₅₀, slope, classification system and starting concentration, on average 50 to 80% fewer animals will be used in comparison to at least 30 animals with the classical LC₅₀ test. The method was biometrically evaluated with the use of the probit model for dose-response relationships. At present, there are 12 different international classification systems based on LC₅₀ values: 6 systems referring to mg/litre and 6 systems based on ppm values, and exposure time varying from 1 to 4 h. The test procedures and the calculations of the classification probabilities demonstrate that the inhalation ATC method is a reliable alternative to the classical LC₅₀ test with the use of significantly fewer animals. Classification probabilities are presented for all classification systems currently in use, and expected numbers of experimental and of moribund/dead animals are demonstrated for one system of each reference system and for all three starting concentrations. The conclusion is justified that there is no need to validate the inhalation ATC method with the use of experimental animals. Received: 25 February 1997 / Accepted: 9 April 1997