Placement of self-expandable metal stents （SEIVIS） is an effective mode of palliative treatment for patients with malignant gastrointestinal obstruction. Gastrointestinal mucosal bleeding complicates about 5% of pla...Placement of self-expandable metal stents （SEIVIS） is an effective mode of palliative treatment for patients with malignant gastrointestinal obstruction. Gastrointestinal mucosal bleeding complicates about 5% of placement of SEIVIS but is not well described. We report three cases of gastrointestinal bleeding post-SEIVIS placement and suggest that bleeding is caused by direct mucosal infringement by the sharp edges of the ends of the stents. 2005 The WJG Press and Elsevier Inc. All rights reserved展开更多
Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricu...Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricular dilatation, as well as heart failure with reduced or preserved left ventricular function.展开更多
AIM： To approach the elusive function of the SLA/LP molecule, we have characterized genomic organization and conservation of the major antigenic and functional properties of the SLA/LP molecule in various species. ME...AIM： To approach the elusive function of the SLA/LP molecule, we have characterized genomic organization and conservation of the major antigenic and functional properties of the SLA/LP molecule in various species. METHODS： By means of computational biology, we have characterized the complete SLA/LP gene, mRNA and deduced protein sequences in man, mouse, zebrafish, fly, and worm. RESULTS： The human SLA/LP gene sequence of approximately 39 kb, which maps to chromosome 4p15.2, is organized in 11 exons, of which 10 or 11 are translated, depending on the splice variant. Homologous molecules were identified in several biological model organisms. The various homologous protein sequences showed a high degree of similarity or homology, notably at those residues that are of functional importance. The only domain of the human protein sequence that lacks significant homology with homologous sequences is the major antigenic epitope recognized by autoantibodies from autoimmune hepatitis （AIH） patients. CONCLUSION： The SLA/LP molecule and its functionally relevant residues have been highly conserved throughout the evoluti n, suggesting an indispensable function of the molecule. The finding that the only non-conserved domain is the dominant antigenic epitope of the human SLA/LP sequence, suggests that SLA/LP autoimmunity is autoantigen-driven rather than being driven by molecular mimicry.展开更多
We aimed to investigate the impact of angiotensin-con-verting enzyme inhibitors(ACEIs) on hematocrit values in those with heart failure, and the relationship between incident anemia and mortality. Prevalent anemia is ...We aimed to investigate the impact of angiotensin-con-verting enzyme inhibitors(ACEIs) on hematocrit values in those with heart failure, and the relationship between incident anemia and mortality. Prevalent anemia is an independent risk factor for morbidity and mortality in those with heart failure. Studies in patients with polycythemia have demonstrated that ACEIs are effective in lowering hematocrit values. We used the Studies Of Left VentricularDysfunction(SOLVD) database to compare the odds of developing new anemia at one year in patients who were not anemic at entry and who were randomized to enalapril or placebo. Cox proportional hazards models were utilized to determine the impact of incident and prevalent anemia on subsequent mortality. Enalapril increased the odds of incident anemia(hematocrit ≤39%in men or ≤36%in women) at one year by 48%(odds ratio [OR] 1.48, 95%confidence interval [CI] 1.20 to 1.82) in unadjusted and 56%(OR 1.56, 95%CI 1.26 to 1.93) in adjusted models. With multivariate analysis, prevalent anemia at randomization was associated with a 44%(hazard ratio [HR] 1.44, 95%CI 1.31 to 1.66) increase in all cause mortality, whereas incident anemia after randomization was associated with a 108%increase(HR 2.08, 95%CI 1.82 to 2.38). After adjusting for incident and prevalent anemia, use of enalapril was associated with a survival benefit. Enalapril was associated with increased odds of developing anemia at one year. Those with periods of time with incident anemia had the poorest survival, followed by those with prevalent anemia, then those without anemia. Enalapril was protective of overall mortality after adjusting for incident anemia and in those with prevalent anemia.展开更多
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benef...Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and balanced.Additionally,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is needed.However,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.展开更多
Objective We studied the pathologic features, cellular phenotypes, and matrix remodeling of clinical pulmonary-to-aortic valve transplants functioning up to 6 years. Methods Nine autografts and associated vascular wal...Objective We studied the pathologic features, cellular phenotypes, and matrix remodeling of clinical pulmonary-to-aortic valve transplants functioning up to 6 years. Methods Nine autografts and associated vascular walls early(2-10 weeks) and late(3-6 years) postoperatively were examined by using routine morphologic methods and immunohistochemistry. In 4 cases autograft and homograft cusps were obtained from the same patients. Results Autografts had near-normal trilaminar cuspal structure and collagen architecture and viable valvular interstitial and endothelial cells throughout the time course. In contrast, cusps of homografts used to replace the pulmonary valves in the same patients were devitalized. In early autograft explants, 19.3%±2.4%of cuspal interstitial cells were myofibroblasts expressing α-actin. In contrast, myofibroblasts comprised only 6.0%±1.1%of cells in late explants and 2.5%±0.4%and 4.6%±0.8%of cells in normal pulmonary and aortic valves, respectively (P< .05). In early autografts only 12.0%±4.6%of endothelial cells expressed the systemic arterial endothelial cellmarker EphrinB2,whereas later explants had 85.6%±5.4%of endothelial cells expressing EphrinB2(P< .05). In early autografts 43.0%±8.8%of interstitial cells expressed metalloproteinase 13, whereas late autografts had 11.4%±2.7%of interstitial cells expressing matrix metalloproteinase 13 (P< .05). Collagen content in autografts was comparable with that of normal valves and was higher than that seen in homograft valves (P< .005). However, autograft walls were damaged, with granulation tissue (early) and scarring, with focal loss of normal smooth muscle cells, elastin, and collagen (late). Conclusions The structure of pulmonary valves transplanted to the systemic circulation evolved toward that of normal aortic valves. Key processes in this remodeling included onset of a systemic endothelial cell phenotype and reversible plasticity of fibroblast-like valvular interstitial cells to myofibroblasts.展开更多
Objective: To determine the prevalence and causation of late onset cerebellar ataxia (LOCA) in south east Wales, United Kingdom. Methods: A population based study of LOCA was conducted in a defined geographical region...Objective: To determine the prevalence and causation of late onset cerebellar ataxia (LOCA) in south east Wales, United Kingdom. Methods: A population based study of LOCA was conducted in a defined geographical region with a total population of 742 400. Multiple sources of ascertainment were used to identify all cases prevalent on 1 January 2001. The inclusion criteria were: a predominantly progressive cerebellar ataxia with onset of symptoms at age ≥ 18 years; and disease duration of ≥ 1 year. Cases with known acquired ataxias, atoxic syndromes with associated prominent autonomic dysfunction and/or atypical parkinsonism suggestive of multiple system atrophy and disorders with ataxia as a minor feature were excluded. Results: We identified 76 index cases of LOCA, of whom 63 were sporadic, idiopathic LOCA (ILOCA) and 13 were familial LOCA, of whom six had either spinocerebellar ataxia type 6, Friedreich’ s ataxia or dominant episodic ataxia. The mean annual incidence rate for the period 1999- 2001 was 0.3/100 000 population/year. The crude prevalence rates were 8.4 per 100 000 (95% CI 7.2 to 11.6) for ILOCA and 1.8 per 100 000 (95% CI 0.8 to 2.7) for inherited LOCA. Of the 54/63 (85.7% ) patients with ILOCA who were assessed, mean (SD) age at onset of symptoms was 53.8 (14.1) years (range 19 to 78) with a male:female ratio of 2.1:1. The mean disease duration was 8.7 (6.3) years (range 1 to 31). The most frequent presenting complaint was disturbance in gait (90.7% ). Onethird had a relatively pure cerebellar syndrome (33.3% ) and two thirds (66.7% ) had additional extracerebellar neurological features. The majority (92% ) were ambulant but only 9.3% were independently self caring. Conclusion: This population based study provides insight into LOCA within a defined region and will inform decisions about the rational use of healthcare resources for patients with LOCA.展开更多
The explosion of new therapeutics in metastatic castrate-resistant prostatecancer （mCRPC） is unprecedented, but much more work needs to be done before we are satisfied. Six phase III trials with an overall survival ...The explosion of new therapeutics in metastatic castrate-resistant prostatecancer （mCRPC） is unprecedented, but much more work needs to be done before we are satisfied. Six phase III trials with an overall survival impact have now been reported （Table 1）.1-6 Four of these trials were exclusively or predominantly in the mCRPC post-docetaxel space （MDV3100, abiraterone, 223radium and cabazitaxel）. The 223radium trial also uniquely offered therapy to patients who were unsuitable for or refused docetaxel. The sipuleucel-T trial focused on mCRPC patients who were asymptomatic or minimally symptomatic; most of these patients were chemotherapy naive.展开更多
Researchers reporting in the Nature journal Scientific Reports haveused next generation sequencing and quantitative reverse transcriptase PCR （RT-PCR） technology to profile plasma microRNA （miRNA） expression in co...Researchers reporting in the Nature journal Scientific Reports haveused next generation sequencing and quantitative reverse transcriptase PCR （RT-PCR） technology to profile plasma microRNA （miRNA） expression in cohorts of men with and without late-onset hypogonadism （LOH）. The study proposes a panel of three miRNAs as novel biomarkers to aid in the diagnosis of LOH.展开更多
GATA-3 was first cloned as a T cell specific transcription factor in 1991 and its importance in the transcriptional control of T helper type 2 cell （Th2） differentiation was established in the mid to late 90＇s. A r...GATA-3 was first cloned as a T cell specific transcription factor in 1991 and its importance in the transcriptional control of T helper type 2 cell （Th2） differentiation was established in the mid to late 90＇s. A role for GATA-3 during thymic development has long implied by its continuous and regulated expression through out T lineage development, but the absolute requirement for GATA-3 during early T lymphoid commitment/survival previously precluded definitive answers to this question. Several technical breakthroughs have fueled fruitful investigation in recent years and uncovered unexpected and critical roles for GATA-3 in CD4 thymocyte survival, invariant natural killer T cell generation and function, and also in beta selection. Not only does GATA-3 participate in nearly every stage of T cell development from common lymphoid progenitor to Th2, conditional knockout studies have indicated that the influence of GATA-3 also extends beyond the immune system. Cellular ＆ Molecular Immunology. 2007; 4（1）： 15-29.展开更多
Sexual lifestyles are closely related to overall human health and well-being.Few studies have focused on sexual lifestyles among older adults living with HIV(OALHIV),especially in low-and middle-income countries.This ...Sexual lifestyles are closely related to overall human health and well-being.Few studies have focused on sexual lifestyles among older adults living with HIV(OALHIV),especially in low-and middle-income countries.This study is a part of the sexual well-being among older adults in China(SWELL)study,which is a multicenter cross-sectional study focused on sexual health among older adults aged 50 years and older.Participants were 680 OALHIV(≥50 years old)from the SWELL study conducted from June 2020 to December 2022.Data were collected through one-on-one interviews.We used logistic regression to assess the correlates of sexual activity and sexual satis-faction.Among all participants,37.1%were sexually active.Being older,male,in a steady relationship and employed were associated with being sexually active.The prevalence of sexual satisfaction was 69.8%among sexually active OALHIV.Being homosexual and reporting a better general health status were associated with sexual satisfaction.The OALHIV who have depressive symptoms were less likely to report sexual satisfaction.To support holistic healthy aging among OALHIV,it is important for healthcare providers to be educated about the importance of enquiring about sexual activity,satisfaction and problems and addressing concerns while conveying sex-positive attitudes during clinical reviews,as these are still critical aspects of their health and well-being.展开更多
来自新西兰的两位奥克兰大学医学系Andrew Grey 和 Mark Bolland认为：尽管缺乏对健康有益的证据，钙剂和维生素D补充剂仍然被推荐用来预防和治疗骨质疏松症。他们调查了现状难以改变的原因，呼吁有关推荐机构、学术界、专家团队终止与...来自新西兰的两位奥克兰大学医学系Andrew Grey 和 Mark Bolland认为：尽管缺乏对健康有益的证据，钙剂和维生素D补充剂仍然被推荐用来预防和治疗骨质疏松症。他们调查了现状难以改变的原因，呼吁有关推荐机构、学术界、专家团队终止与企业之间的联系。展开更多
文摘Placement of self-expandable metal stents （SEIVIS） is an effective mode of palliative treatment for patients with malignant gastrointestinal obstruction. Gastrointestinal mucosal bleeding complicates about 5% of placement of SEIVIS but is not well described. We report three cases of gastrointestinal bleeding post-SEIVIS placement and suggest that bleeding is caused by direct mucosal infringement by the sharp edges of the ends of the stents. 2005 The WJG Press and Elsevier Inc. All rights reserved
文摘Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricular dilatation, as well as heart failure with reduced or preserved left ventricular function.
基金Supported by the Deutsche Forschungsgemeinschaft(SFB 548)
文摘AIM： To approach the elusive function of the SLA/LP molecule, we have characterized genomic organization and conservation of the major antigenic and functional properties of the SLA/LP molecule in various species. METHODS： By means of computational biology, we have characterized the complete SLA/LP gene, mRNA and deduced protein sequences in man, mouse, zebrafish, fly, and worm. RESULTS： The human SLA/LP gene sequence of approximately 39 kb, which maps to chromosome 4p15.2, is organized in 11 exons, of which 10 or 11 are translated, depending on the splice variant. Homologous molecules were identified in several biological model organisms. The various homologous protein sequences showed a high degree of similarity or homology, notably at those residues that are of functional importance. The only domain of the human protein sequence that lacks significant homology with homologous sequences is the major antigenic epitope recognized by autoantibodies from autoimmune hepatitis （AIH） patients. CONCLUSION： The SLA/LP molecule and its functionally relevant residues have been highly conserved throughout the evoluti n, suggesting an indispensable function of the molecule. The finding that the only non-conserved domain is the dominant antigenic epitope of the human SLA/LP sequence, suggests that SLA/LP autoimmunity is autoantigen-driven rather than being driven by molecular mimicry.
文摘We aimed to investigate the impact of angiotensin-con-verting enzyme inhibitors(ACEIs) on hematocrit values in those with heart failure, and the relationship between incident anemia and mortality. Prevalent anemia is an independent risk factor for morbidity and mortality in those with heart failure. Studies in patients with polycythemia have demonstrated that ACEIs are effective in lowering hematocrit values. We used the Studies Of Left VentricularDysfunction(SOLVD) database to compare the odds of developing new anemia at one year in patients who were not anemic at entry and who were randomized to enalapril or placebo. Cox proportional hazards models were utilized to determine the impact of incident and prevalent anemia on subsequent mortality. Enalapril increased the odds of incident anemia(hematocrit ≤39%in men or ≤36%in women) at one year by 48%(odds ratio [OR] 1.48, 95%confidence interval [CI] 1.20 to 1.82) in unadjusted and 56%(OR 1.56, 95%CI 1.26 to 1.93) in adjusted models. With multivariate analysis, prevalent anemia at randomization was associated with a 44%(hazard ratio [HR] 1.44, 95%CI 1.31 to 1.66) increase in all cause mortality, whereas incident anemia after randomization was associated with a 108%increase(HR 2.08, 95%CI 1.82 to 2.38). After adjusting for incident and prevalent anemia, use of enalapril was associated with a survival benefit. Enalapril was associated with increased odds of developing anemia at one year. Those with periods of time with incident anemia had the poorest survival, followed by those with prevalent anemia, then those without anemia. Enalapril was protective of overall mortality after adjusting for incident anemia and in those with prevalent anemia.
文摘Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and balanced.Additionally,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is needed.However,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.
文摘Objective We studied the pathologic features, cellular phenotypes, and matrix remodeling of clinical pulmonary-to-aortic valve transplants functioning up to 6 years. Methods Nine autografts and associated vascular walls early(2-10 weeks) and late(3-6 years) postoperatively were examined by using routine morphologic methods and immunohistochemistry. In 4 cases autograft and homograft cusps were obtained from the same patients. Results Autografts had near-normal trilaminar cuspal structure and collagen architecture and viable valvular interstitial and endothelial cells throughout the time course. In contrast, cusps of homografts used to replace the pulmonary valves in the same patients were devitalized. In early autograft explants, 19.3%±2.4%of cuspal interstitial cells were myofibroblasts expressing α-actin. In contrast, myofibroblasts comprised only 6.0%±1.1%of cells in late explants and 2.5%±0.4%and 4.6%±0.8%of cells in normal pulmonary and aortic valves, respectively (P< .05). In early autografts only 12.0%±4.6%of endothelial cells expressed the systemic arterial endothelial cellmarker EphrinB2,whereas later explants had 85.6%±5.4%of endothelial cells expressing EphrinB2(P< .05). In early autografts 43.0%±8.8%of interstitial cells expressed metalloproteinase 13, whereas late autografts had 11.4%±2.7%of interstitial cells expressing matrix metalloproteinase 13 (P< .05). Collagen content in autografts was comparable with that of normal valves and was higher than that seen in homograft valves (P< .005). However, autograft walls were damaged, with granulation tissue (early) and scarring, with focal loss of normal smooth muscle cells, elastin, and collagen (late). Conclusions The structure of pulmonary valves transplanted to the systemic circulation evolved toward that of normal aortic valves. Key processes in this remodeling included onset of a systemic endothelial cell phenotype and reversible plasticity of fibroblast-like valvular interstitial cells to myofibroblasts.
文摘Objective: To determine the prevalence and causation of late onset cerebellar ataxia (LOCA) in south east Wales, United Kingdom. Methods: A population based study of LOCA was conducted in a defined geographical region with a total population of 742 400. Multiple sources of ascertainment were used to identify all cases prevalent on 1 January 2001. The inclusion criteria were: a predominantly progressive cerebellar ataxia with onset of symptoms at age ≥ 18 years; and disease duration of ≥ 1 year. Cases with known acquired ataxias, atoxic syndromes with associated prominent autonomic dysfunction and/or atypical parkinsonism suggestive of multiple system atrophy and disorders with ataxia as a minor feature were excluded. Results: We identified 76 index cases of LOCA, of whom 63 were sporadic, idiopathic LOCA (ILOCA) and 13 were familial LOCA, of whom six had either spinocerebellar ataxia type 6, Friedreich’ s ataxia or dominant episodic ataxia. The mean annual incidence rate for the period 1999- 2001 was 0.3/100 000 population/year. The crude prevalence rates were 8.4 per 100 000 (95% CI 7.2 to 11.6) for ILOCA and 1.8 per 100 000 (95% CI 0.8 to 2.7) for inherited LOCA. Of the 54/63 (85.7% ) patients with ILOCA who were assessed, mean (SD) age at onset of symptoms was 53.8 (14.1) years (range 19 to 78) with a male:female ratio of 2.1:1. The mean disease duration was 8.7 (6.3) years (range 1 to 31). The most frequent presenting complaint was disturbance in gait (90.7% ). Onethird had a relatively pure cerebellar syndrome (33.3% ) and two thirds (66.7% ) had additional extracerebellar neurological features. The majority (92% ) were ambulant but only 9.3% were independently self caring. Conclusion: This population based study provides insight into LOCA within a defined region and will inform decisions about the rational use of healthcare resources for patients with LOCA.
文摘The explosion of new therapeutics in metastatic castrate-resistant prostatecancer （mCRPC） is unprecedented, but much more work needs to be done before we are satisfied. Six phase III trials with an overall survival impact have now been reported （Table 1）.1-6 Four of these trials were exclusively or predominantly in the mCRPC post-docetaxel space （MDV3100, abiraterone, 223radium and cabazitaxel）. The 223radium trial also uniquely offered therapy to patients who were unsuitable for or refused docetaxel. The sipuleucel-T trial focused on mCRPC patients who were asymptomatic or minimally symptomatic; most of these patients were chemotherapy naive.
文摘Researchers reporting in the Nature journal Scientific Reports haveused next generation sequencing and quantitative reverse transcriptase PCR （RT-PCR） technology to profile plasma microRNA （miRNA） expression in cohorts of men with and without late-onset hypogonadism （LOH）. The study proposes a panel of three miRNAs as novel biomarkers to aid in the diagnosis of LOH.
文摘GATA-3 was first cloned as a T cell specific transcription factor in 1991 and its importance in the transcriptional control of T helper type 2 cell （Th2） differentiation was established in the mid to late 90＇s. A role for GATA-3 during thymic development has long implied by its continuous and regulated expression through out T lineage development, but the absolute requirement for GATA-3 during early T lymphoid commitment/survival previously precluded definitive answers to this question. Several technical breakthroughs have fueled fruitful investigation in recent years and uncovered unexpected and critical roles for GATA-3 in CD4 thymocyte survival, invariant natural killer T cell generation and function, and also in beta selection. Not only does GATA-3 participate in nearly every stage of T cell development from common lymphoid progenitor to Th2, conditional knockout studies have indicated that the influence of GATA-3 also extends beyond the immune system. Cellular ＆ Molecular Immunology. 2007; 4（1）： 15-29.
基金supported by the Natural Science Foundation of China International/Regional Research Collaboration Project(72061137001)Natural Science Foundation of China Excellent Young Scientists Fund(82022064)+2 种基金Chongqing Talents Program for Innovative and Entrepreneurial Pioneers(cstc2021ycjh-bgzxm0097)Chongqing Natural Science Foundation Project(cstc2021jcyj-msxmX1171)Chinese State Key Laboratory of Infectious Disease Prevention and Control(2021SKLID303).
文摘Sexual lifestyles are closely related to overall human health and well-being.Few studies have focused on sexual lifestyles among older adults living with HIV(OALHIV),especially in low-and middle-income countries.This study is a part of the sexual well-being among older adults in China(SWELL)study,which is a multicenter cross-sectional study focused on sexual health among older adults aged 50 years and older.Participants were 680 OALHIV(≥50 years old)from the SWELL study conducted from June 2020 to December 2022.Data were collected through one-on-one interviews.We used logistic regression to assess the correlates of sexual activity and sexual satis-faction.Among all participants,37.1%were sexually active.Being older,male,in a steady relationship and employed were associated with being sexually active.The prevalence of sexual satisfaction was 69.8%among sexually active OALHIV.Being homosexual and reporting a better general health status were associated with sexual satisfaction.The OALHIV who have depressive symptoms were less likely to report sexual satisfaction.To support holistic healthy aging among OALHIV,it is important for healthcare providers to be educated about the importance of enquiring about sexual activity,satisfaction and problems and addressing concerns while conveying sex-positive attitudes during clinical reviews,as these are still critical aspects of their health and well-being.
