Hemodilution on Cardiopulmonary Bypass as a Determinant of Early Postoperative Hyperlactatemia

ObjectiveThe nadir hematocrit (HCT) on cardiopulmonary bypass (CPB) is a recognized independent risk factor for major morbidity and mortality in cardiac surgery. The main interpretation is that low levels of HCT on CPB result in a poor oxygen delivery and dysoxia of end organs. Hyperlactatemia (HL) is a marker of dysoxic metabolism, and is associated with bad outcomes in cardiac surgery. This study explores the relationship between nadir HCT on CPB and early postoperative HL.DesignRetrospective study on 3,851 consecutive patients.ConclusionsHemodilution on CPB is an independent determinant of HL. This association, more evident for severe HL, strengthens the hypothesis that a poor oxygen delivery on CPB with consequent organ ischemia is the mechanism leading to hemodilution-associated bad outcomes.     

Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care

BackgroundLarge amounts of scientific evidence are generated, but not implemented into patient care (the ‘knowledge-to-care’ gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare.MethodsWe used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback.ResultsInitially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as ‘necessary’ (median score 7–9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs).ConclusionsA community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.     

EGCG在肿瘤预防及治疗中作用的分子机制

表没食子儿茶素没食子酸酯(EGCG)可多通路多途径预防和治疗肿瘤。本文综述了EGCG通过Nrf2通路预防肿瘤,从膜受体通路、线粒体通路、P53-Bax、67-LR-eEF1A、VEGF等通路促进肿瘤细胞的凋亡及周期阻滞,抑制肿瘤的侵袭和迁移的研究新进展。     

密云古石峪封山育林试验方法

要加速北京地区的绿化,除造林外,封山育林是一种有效办法。本次试验的目的就是探讨一个封山育林试验方法,寻找检查封育效果的指标。本次试验设置样地6组,12块,分别测定了环境因子、母树条件、土壤水分、植被盖度,多样性指数和生物量。通过对各测定因子进行横向(类型)和纵向(历史)的比较看出：(1)影响封育效果的主要是坡向,坡向与水分条件密切相关,其它因子也与水分相关;(2)灌木、草木植物的盖度和生物量经封山育林后有所提高。所以草、灌的盖度、牛物量等的变化可作为乔木更新前封育效果的指标。     

Disentangling Human Tolerance and Resistance Against HIV

In ecology, “disease tolerance” is defined as an evolutionary strategy of hosts against pathogens, characterized by reduced or absent pathogenesis despite high pathogen load. To our knowledge, tolerance has to date not been quantified and disentangled from host resistance to disease in any clinically relevant human infection. Using data from the Swiss HIV Cohort Study, we investigated if there is variation in tolerance to HIV in humans and if this variation is associated with polymorphisms in the human genome. In particular, we tested for associations between tolerance and alleles of the Human Leukocyte Antigen (HLA) genes, the CC chemokine receptor 5 (CCR5), the age at which individuals were infected, and their sex. We found that HLA-B alleles associated with better HIV control do not confer tolerance. The slower disease progression associated with these alleles can be fully attributed to the extent of viral load reduction in carriers. However, we observed that tolerance significantly varies across HLA-B genotypes with a relative standard deviation of 34%. Furthermore, we found that HLA-B homozygotes are less tolerant than heterozygotes. Lastly, tolerance was observed to decrease with age, resulting in a 1.7-fold difference in disease progression between 20 and 60-y-old individuals with the same viral load. Thus, disease tolerance is a feature of infection with HIV, and the identification of the mechanisms involved may pave the way to a better understanding of pathogenesis.     

沙冬青属的细胞学研究

沙冬青属(Ammopiptanthus)植物仅两个种,即蒙古沙冬青(A.mongolicus)和新疆沙冬青(A.nanus),为第三纪残遗种,是中亚荒漠唯一的常绿阔叶植物,因珍稀,临危而被列为国家重点保护植物”。国内外对该属两个种的染色体数目的记载存在着差异。本文对沙冬青属两种植物的染色体数目和核型进行了分析研究,旨在为探讨该属植物的发生和系统发育,以及开展植物多样性保护和合理开发利用积累资料。     

IL-10 and Lymphotoxin-α Expression Profiles within Marginal Zone-Like B-Cell Populations Are Associated with Control of HIV-1 Disease Progression

Understanding how the immune system facilitates or controls HIV-1 disease progression has important implications for the design of effective interventions. We report that although B-cell dysregulations associated with HIV-1 disease progression are accompanied by an overall decrease in the percentage of total blood B-cells, we observe an increase in relative frequencies of cells presenting characteristics of both transitional immature and first-line marginal zone (MZ) B-cell populations, we designated as precursor MZ-like B-cells. B-cells with similar attributes have been associated with IL-10 expression and “regulatory” potential. As such, the relative frequencies of precursor MZ-like B-cells expressing IL-10 are increased in the blood of viremic HIV-1-infected individuals when compared to HIV-negative subjects. Importantly, in aviremic HIV-1 Elite-Controllers (EC), we found unaltered relative percentages of precursor MZ-like B-cells which presented normal IL-10 expression patterns. Furthermore, EC had increased relative frequencies of blood MZ-like B-cells expressing LT-α. Thus in contrast to viremic HIV-1-infected individuals, EC present MZ-like B-cell populations which IL-10 and LT-α expression profiles may favour homeostasis of immune responses and lymphoid microenvironments.     

罗氏沼虾与克氏原螯虾血细胞的比较研究

对罗氏沼虾与克氏原螫虾血细胞的分类与组成进行了染色观察比较研究。根据染色后光镜下血细胞的核质比、颗粒的大小和数量等来对血细胞进行分类,罗氏沼虾与克氏原螯虾的血细胞均可分为透明细胞、半颗粒细胞和颗粒细胞三类;其血细胞浓度分别为1.02±0.21×10⁷ Ind·ml^-1和0.85±0.15×10⁷Ind·ml^-1。2种虾血细胞的颗粒形态存在显著差异;透明细胞、半颗粒细胞和颗粒细胞占血细胞总量的百分比在罗氏沼虾为21.3±6.3%,45.7±2.5%,33.0±6.8%:在克氏原螯虾为12.0±5.8%、49.5±5.1%和38.5±9.5%。