食管静脉曲张硬化治疗术后并发黏膜下血肿的临床治疗分析(附5例报道)

目的了解食管静脉曲张硬化剂治疗术(EIS)后形成食管血肿(EH)的诊断、内镜下治疗及预后分析,并对EIS后EH形成的病因及预防措施做进一步探讨。方法共有5例患者诊断EH纳入研究,其中4例EH患者接受内镜下胃肠管置入术并联合肠内营养治疗,1例单纯内科药物保守治疗。结果 5例患者恢复良好。相比较于单纯内科药物保守治疗的患者,接受内镜引导下胃肠管置入术的患者可缩短治疗疗程并明显改善患者一般状况。4例接受胃肠管置入术的患者均未发生明显治疗相关不良反应。结论内镜下胃肠管置入术尽早行肠内营养联合积极药物治疗对EIS后形成EH有效,规范术中操作及术后积极的处理措施有助于EH的预防。

Clinical features of acute hepatitis E super-infections on chronic hepatitis B

AIM To examine the clinical features and risk factors for adverse outcomes in chronic hepatitis B(CHB) superimposed with hepatitis E virus(HEV).METHODS This retrospective cohort study included 228 patients with acute HEV infection(showing clinical acute hepatitis symptomology and positivity for anti-HEV immunoglobulin M) with underlying CHB(confirmed by positivity for hepatitis B surface antigen and/or hepatitis B virus(HBV) DNA over 6 mo) who had been admitted to the Shanghai Public Health Clinical Center, which represents the regional tertiary hospital for infectious diseases in Shanghai city, China. Data for adverse outcomes were collected, and included severe liver diseases(defined as liver failure and/or acute liver decompensation) and liver-related mortality. Logistic regression modeling was performed to determine the risk factors for adverse outcomes.RESULTS The symptoms caused by superimposed acute hepatitis E(AHE) were much more severe in cirrhotic patients(n = 94) than in non-cirrhotic patients(n = 134), as evidenced by significantly higher liver complications(77.7% vs 28.4%, P < 0.001) and mortality rate(21.3% vs 7.5%, P = 0.002). Most of the cirrhotic patients(n = 85, 90.4%) had no prior decompensation. Among the non-cirrhotic patients, superimposed AHE caused progressively more severe diseases that corresponded with the CHB disease stages, from immune tolerant to immune reactivation phases. Few risk factors were identified in the cirrhotic patients, but risk factors for non-cirrhotic patients were found to be intermediate HBV DNA levels(OR: 5.1, P = 0.012), alcohol consumption(OR: 6.4, P = 0.020), and underlying diabetes(OR: 7.5, P = 0.003) and kidney diseases(OR: 12.7, P = 0.005). Only 28.7% of the cirrhotic patients and 9.0% of the non-cirrhotic patients had received anti-HBV therapy previously and, in all cases, the efficacy had been suboptimal. CONCLUSION CHB-related cirrhosis and intermediate HBV DNA level were associated with severe disease in superinfected patients, and successful antiviral treatment might counter this outcome.

Detection and clinical significance of immune function, inflammatory factors and ESR levels in children with Mycoplasma pneumoniae infection

Objective:To explore the detection and clinical significance of immune function, inflammatory factors and ESR levels in children with Mycoplasma pneumoniae infection.Methods: A total of 122 children with Mycoplasma pneumoniae from September 2015 to February 2017 were selected as the observation group, while 120 healthy children were selected as the control group. The differences of immunoglobulin, T lymphocyte subsets, inflammatory factors and erythrocyte sedimentation rate (ESR) were compared in the two groups, and the correlation between ESR and inflammatory factors was analyzed.Results: There was a significant difference in peripheral blood T lymphocyte level between the two groups;CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly lower than those in the control group, while CD8+ was significantly higher in the observation group than in the control group. The IgA of the observation group was significantly lower than that of the control group, and there was no significant difference between IgG and the control group, and IgM was significantly higher than that of the control group. The two groups of hypersensitive C reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and ESR expression level were significant differences;the hs-CRP, TNF-α, IFN-γ and ESR in the observation group were significantly higher than those in the control group;the ESR of the children with mycoplasma pneumonia was positively correlated with the level of hs-CRP, TNF-α and IFN-γ, which was statistically significant.Conclusions:The cell immunity, humoral immune function of children with Mycoplasma pneumoniae infection are relatively low, and the inflammatory reaction is more severe, and the inflammatory factors of the body are positively related to the level of ESR expression.

Signaling network controlling ROP-mediated tip growth in Arabidopsis and beyond

Cell polarity operates across a broad range of spatial and temporal scales and is essential for specific biological functions of polarized cells.Tip growth is a special type of polarization in which a single and unique polarization site is established and maintained,as for the growth of root hairs and pollen tubes in plants.Extensive studies in past decades have demonstrated that the spatiotemporal localization and activity of Rho of Plants(ROPs),the only class of Rho GTPases in plants,are critical for tip growth.ROPs are switched on or off by different factors to initiate dynamic intracellular activities,leading to tip growth.Recent studies have also uncovered several feedback modules for ROP signaling.In this review,we summarize recent progress on ROP signaling in tip growth,focusing on molecular mechanisms that underlie the dynamic distribution and activity of ROPs in Arabidopsis.We also highlight feedback modules that control ROPmediated tip growth and provide a perspective for building a complex ROP signaling network.Finally,we provide an evolutionary perspective for ROP-mediated tip growth in Physcomitrella patens and during plant–rhizobia interaction.

A positive feedback circuit for ROP-mediated polar growth

Tip growth is a special type of polarized growth in which a single and unique polarization site is established and maintained.Rho of Plants(ROP)proteins,which represent the only class of Rho GTPases in plants,regulate tip growth.The dynamic and asymmetric distribution of ROPs is critical for the establishment and maintenance of tip growth,and requires at least one positive feedback loop,which is still elusive.Here,we report a positive feedback circuit essential for tip growth of root hairs,in which ROPs,ROP activators and effectors,and AGC1.5 subfamily kinases are interconnected by sequential oligomerization and phosphorylation.AGC1.5 subfamily kinases interact with and phosphorylate two guanine nucleotide exchange factors(GEFs)of ROPs,RopGEF4 and RopGEF10.They also interact with two ROP effectors,ICR2/RIP3 and MIDD1/RIP4,which bridge active ROPs with AGC1.5.Functional loss of the AGC1.5 subfamily kinases or ICR2 and MIDD1 compromised root hair growth due to reduced ROP signaling.We found that asymmetric targeting of RopGEF4 and RopGEF10 is controlled by AGC1.5-dependent phosphorylation.Interestingly,we discovered that the ROP effectors recruit AGC1.5 to active ROP domains at the plasma membrane during root hair growth and are critical for AGC1.5-dependent phosphorylation of RopGEFs.Given the large number of AGC kinases in plants,this positive feedback circuit may be a universal theme for plant cell polar growth.

A novel bioinspired mechanism to elucidate the movement flexibility of the honeybee abdomen driven by muscles

The abdomen of a honeybee is a blueprint for bioinspired mechanical design because of its movement flexibility and compactness.However,the abdominal muscles closely related to the movement flexibility mechanism have not been fully identified,limiting the potential biological advantage of their use in bionic mechanism design.In this study,we reveal the muscle distribution of the complete muscular driving unit in a honeybee abdomen using stereoscopy and scanning electron microscopy,and the muscle distribution was effectively verified using X-ray tomography.A novel equivalent unit mechanism(EUM)was then proposed and the kinematic analysis indicated that the extension ratio,bending angle,and swing angle of the EUM reached 9.36%,1.22°,and 4.43°,respectively.The deformation ability of the EUM was consistent with the movement of the abdomen,confirming the movement flexibility.This work may provide a new perspective for distributed bionic mechanism design.