[Effect of macrophage-derived exosomes on promoting hepatic stellate cell activation and platelet-derived growth factor expression].

Objective: To explore the effect of macrophage-derived exosomes on the activation of hepatic stellate cells and its possible mechanism. Methods: Differential ultracentrifugation was used to extract macrophage exosomes. The exosomes were co-cultured with the mouse hepatic stellate cell line JS1, and a control group was established with phosphate buffered saline (PBS). Cell immunofluorescence was used to observe the expressional conditions of F-actin. Cell counting kit-8 (CCK8) was used to detect the survival rate of JS1 cells in the two groups. The activation indices of JS1 cells [collagen type Ⅰ (Col Ⅰ) and α-smooth muscle actin (α-SMA)] and its key signal pathway activation index expression level [transforming growth factor (TGF)-ß1/Smads, platelet-derived growth factor (PDGF)] in the two groups were determined using Western blot and RT-PCR. Data comparison between two groups was performed using an independent sample t-test. Results: The membrane structure of exosomes was clearly observed by transmission electron microscopy. The expression of exosome marker proteins CD63 and CD81 was positive, suggesting that exosomes were successfully extracted. Exosomes were co-cultured with JS1 cells. Compared with the PBS control group, there was no statistically significant difference in the proliferation rate of JS1 cells in the exosomes group (P＞0.05). The expression of F-actin was significantly increased in the exosome group. The mRNA and protein expression levels of α-SMA and ColⅠwere significantly increased in exosome group JS1 cells (all P＜0.05). The mRNA relative expression levels of α-SMA in PBS and exosome group were 0.25±0.07 and 1.43±0.19, respectively, while that of ColⅠ was 1.03±0.04 and 1.57±0.06, respectively. The mRNA and protein expressions of PDGF were significantly increased in exosome group JS1 cells (P＜0.05). The mRNA relative expression levels of PDGF in the PBS group and exosome group were 0.27±0.04 and 1.65±0.12, respectively. There were no statistically significant differences in the mRNA and protein expressions of TGF-ß1, Smad2 and Smad3 between the two groups (P＞0.05). Conclusion: Macrophage-derived exosomes significantly promote the activation of hepatic stellate cells. JS1 cells may be the underlying mechanism for the up-regulation of PDGF expression.

The correlation between tissue Doppler imaging and N-terminal pro-brain natriuretic peptide concentration during left ventricular diastolic function recovery after coronary artery bypass grafting.

OBJECTIVE: This study aims to evaluate the changes in left ventricular diastolic function after coronary artery bypass grafting through tissue Doppler imaging (TDI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and the correlation between the two. PATIENTS AND METHODS: A total of 133 patients who underwent coronary artery bypass grafting between January 2016 and December 2018 were included in this study. Echocardiography and NT-proBNP concentration were reviewed pre-operation, 1 month post-operation, and 3-6 months post-operation. The transmitral peak flow velocity (E) of the mitral valve was measured at each of the three-time points using spectral Doppler imaging. The mitral annulus displacement (Ea peak and Aa peak) was then measured at each of the time points using TDI, and the E/Ea ratio was calculated. Subsequently, the correlation of the E value, Ea value, and E/Ea ratio with NT-proBNP concentration was statistically analyzed. RESULTS: The data obtained at the three-time points were compared with the respective concentrations of NT-proBNP. Multiple linear regression analysis revealed a correlation between NT-proBNP concentration and E value, Ea value, and E/Ea ratio. CONCLUSIONS: Left ventricular diastolic function gradually recovered at 1 month and 3-6 months after coronary artery bypass grafting. There was a correlation between TDI-related values and NT-proBNP concentration.

[Surgical outcome evaluation and prediction analysis of laparoscopic left sided hepatectomy for hepatolithiasis].

Objective: To explore the risk factors of long-term treatment outcomes and establish predicting model for laparoscopic left hepatectomy in hepatolithiasis. Methods: Clinical data of 108 patients with hepatolithiasis who underwent laparoscopic left sided hepatectomy and with complete follow-up data were retrospectively collected from June 2011 to June 2016 at the Second Affiliated Hospital of Nanchang University. Twenty-six males and 82 females were enrolled. The age was (52.4±11.7) years (range:20-80 years) , and the median follow-up time was 36 months (range: 24-83 months) . Patients were randomly divided into training group (79 cases) and validation group (29 cases) with a ratio of about 3∶1. Twenty-five preoperative and intraoperative clinical factors were selected for potential factors that might affect long-term outcomes, and quality of life was used as an surrogate evaluation index. Univariate analysis and multivariate logistic regression analysis were used to investigate the potential risk factors, and to construct and validate the predictive nomogram for surgical outcomes. Results: Among 108 patients, 10 patients (9.3%) had residual stones, 8 patients (7.4%) had recurrent stones, 12 patients (11.1%) had recurrent cholangitis and 3 patients (2.8%) died. Univariate analysis showed that history of hepatobiliary surgery, gender, activation of partial thromboplastin time, alkaline phosphatase, use of choledochoscopy, postoperative stone residual, serum creatinine, postoperative biliary drainage and operation time were risk factors that may affect long-term outcomes (all P<0.15) . Multivariate analysis showed that the history of previous hepatobiliary surgery (OR=2.305, 95% CI: 0.383-4.227, P=0.019) , postoperative biliary drainage (OR=2.043, 95% CI: 0.182-4.209, P=0.048) , operation time ≥262.5 minutes (OR=1.971, 95% CI: 0.154-4.023, P=0.045) were independent risk factor affecting long-term outcomes. Based on the above factors, the predictive nomogram model was constructed. Internal and external validations showed good discrimination (area under the curve of receiver operating curve>0.7) and calibration (Hosmer-Lemeshow test: P>0.05) performance, which indicated that the prediction effect was favorable. Conclusions: History of previous hepatobiliary surgery, postoperative biliary drainage and operation time ≥262.5 minutes are independent risk factors for long-term outcome. The predictive nomogram model based on risk factors relates to surgical outcomes presented good clinical predictive effects, which might contribute to the prediction of the long-term outcomes of laparoscopic left sided hepatectomy for hepatolithiasis.

Influence of prenatal iron and zinc supplements on supplemental iron absorption, red blood cell iron incorporation, and iron status in pregnant Peruvian women.

BACKGROUND: It is estimated that 60% of pregnant women worldwide are anemic. OBJECTIVE: We aimed to examine the influence of iron status on iron absorption during pregnancy by measuring supplemental iron absorption, red blood cell iron incorporation, and iron status in pregnant women. DESIGN: Subjects were 45 pregnant Peruvian women (33+/-1 wk gestation), of whom 28 received daily prenatal supplements containing 60 mg Fe and 250 microg folate without (Fe group, n = 14) or with (Fe+Zn group, n = 14) 15 mg Zn, which were were consumed from week 10 to 24 of gestation until delivery. The remaining 17 women (control) received no prenatal supplementation. Iron status indicators and isotopes were measured in maternal blood collected 2 wk postdosing with oral (57Fe) and intravenous (58Fe) stable iron isotopes. RESULTS: Maternal serum ferritin and folate concentrations were significantly influenced by supplementation (P < 0.05). Serum iron was also significantly higher in the Fe than in the Fe+Zn (P < 0.03) or control (P < 0.001) groups. However, the supplemented groups had significantly lower serum zinc concentrations than the control group (8.4+/-2.3 and 10.9+/-1.8 micromol/L, respectively, P < 0.01). Although percentage iron absorption was inversely related to maternal serum ferritin concentrations (P = 0.036), this effect was limited and percentage iron absorption did not differ significantly between groups. CONCLUSIONS: Because absorption of nonheme iron was not substantially greater in pregnant women with depleted iron reserves, prenatal iron supplementation is important for meeting iron requirements during pregnancy.

PIP: The influence of iron status on iron absorption during pregnancy was examined among pregnant Peruvian women. This was done by measuring supplemental iron absorption, red blood cell iron incorporation and iron status. The subjects were 45 pregnant Peruvian women (33 +or- 1 week gestation) who were divided into 2 groups. The first group of 28 pregnant women received daily prenatal supplements containing 60 mg of iron and 250 mcg of folate with or without 15 mg of zinc, from week 10 to 24 of gestation until delivery. The second group of 17 women served as the control group. The control group was not given prenatal supplementation. The iron status indicators and isotopes were measured in maternal blood collected 2 weeks postdosing with oral iron-57 and intravenous iron-58 stable isotopes. The results showed that supplementation significantly influenced the maternal serum ferritin and folate concentrations (P 0.05). The serum iron of the iron group was significantly higher than that of the iron + zinc group (P 0.03) or control group (P 0.001). However, the serum zinc concentrations were lower in the supplemented group than in the control group. Even though the percentage of iron absorption was inversely related to maternal serum ferritin concentration, the effect was limited and the percentage of iron absorption did not differ significantly between the two groups. Considering that the absorption of nonheme iron was not substantially greater in pregnant women with depleted iron reserves, it was concluded that prenatal iron supplementation is essential for meeting iron requirements, especially during pregnancy.