RESUMEN
Diabetic wounds are characterized by incomplete healing and delayed healing, resulting in a considerable global health care burden. Exosomes are lipid bilayer structures secreted by nearly all cells and express characteristic conserved proteins and parent cell-associated proteins. Exosomes harbor a diverse range of biologically active macromolecules and small molecules that can act as messengers between different cells, triggering functional changes in recipient cells and thus endowing the ability to cure various diseases, including diabetic wounds. Exosomes accelerate diabetic wound healing by regulating cellular function, inhibiting oxidative stress damage, suppressing the inflammatory response, promoting vascular regeneration, accelerating epithelial regeneration, facilitating collagen remodeling, and reducing scarring. Exosomes from different tissues or cells potentially possess functions of varying levels and can promote wound healing. For example, mesenchymal stem cell-derived exosomes (MSC-exos) have favorable potential in the field of healing due to their superior stability, permeability, biocompatibility, and immunomodulatory properties. Exosomes, which are derived from skin cellular components, can modulate inflammation and promote the regeneration of key skin cells, which in turn promotes skin healing. Therefore, this review mainly emphasizes the roles and mechanisms of exosomes from different sources, represented by MSCs and skin sources, in improving diabetic wound healing. A deeper understanding of therapeutic exosomes will yield promising candidates and perspectives for diabetic wound healing management.
Asunto(s)
Exosomas , Células Madre Mesenquimatosas , Cicatrización de Heridas , Exosomas/metabolismo , Humanos , Animales , Células Madre Mesenquimatosas/metabolismo , Diabetes Mellitus/metabolismo , Piel/metabolismo , Estrés Oxidativo , Complicaciones de la DiabetesRESUMEN
Triple-negative breast cancer (TNBC) is a highly heterogeneous breast tumor type that is highly malignant, invasive, and highly recurrent. Ferroptosis is a unique mode of programmed cell death (PCD) at the morphological, physiological, and molecular levels, mainly characterized by cell death induced by iron-dependent accumulation of lipid peroxides, which plays a substantial role in a variety of diseases, including tumors and inflammatory diseases. TNBC cells have been reported to display a peculiar equilibrium metabolic profile of iron and glutathione, which may increase the sensitivity of TNBC to ferroptosis. TNBC possesses a higher sensitivity to ferroptosis than other breast cancer types. Ferroptosis also occurred between immune cells and tumor cells, suggesting that regulating ferroptosis may remodel TNBC by modulating the immune response. Many ferroptosis-related genes or molecules have characteristic expression patterns and are expected to be diagnostic targets for TNBC. Besides, therapeutic strategies based on ferroptosis, including the isolation and extraction of natural drugs and the use of ferroptosis inducers, are urgent for TNBC personalized treatment. Thus, this review will explore the contribution of ferroptosis in TNBC progression, diagnosis, and treatment, to provide novel perspectives and therapeutic strategies for TNBC management.
Asunto(s)
Ferroptosis , Neoplasias de la Mama Triple Negativas , Humanos , Apoptosis , Muerte Celular , HierroRESUMEN
OBJECTIVE: Previous studies have found that obese people have lower levels of vitamin B, but most have focused on obesity as defined by body mass index (BMI), and its relationship with other types of obesity is unclear. The aim of this study was to explore the relationship between vitamin B levels and obesity assessed by different definitions among Chinese middle-aged and older community-dwelling adults. METHODS: This cross-sectional study included 887 participants aged 45 years and older (45-82 years). The concentrations of vitamin B (B1, B2, B6, and B9) were measured by robotic dry blood spot extraction systems in combination with liquid chromatography-tandem mass spectrometry. BMI, body fat percentage (BF%), visceral fat area (VFA), and waist circumference (WC) were used to diagnose obesity. VFA and BF% were assessed by bioelectrical impedance analysis. The logistic regression model was used to assess the associations between vitamin B levels and the odds of obesity. RESULTS: The average age of all participants was 60.77 (SD 6.33) years. The prevalence of obesity varied from 8.6% to 52.4% depending on different diagnostic criteria. After adjusting for covariates, a negative correlation was observed between vitamin B1 level and obesity according to the criteria of WC, VFA, and BF%, and the adjusted odds ratio (OR) was 0.47, 0.52, and 0.46, respectively. When using WC and BF% to define obesity, higher quartiles of vitamin B2 were negatively associated with the odds of obesity (OR: 0.62 and 0.62, respectively). Vitamin B6 was inversely associated with VFA-defined and BF%-defined obesity (OR: 0.64 and 0.64, respectively). When using VFA and BF% to define obesity, a negative correlation was observed in vitamin B9 (OR: 0.61 and 0.67, respectively). CONCLUSIONS: Vitamin B (B1, B2, B6, and B9) level was negatively related to obesity (defined by WC, VFA, or BF%) in Chinese middle-aged and older adults.
Asunto(s)
Pueblos del Este de Asia , Obesidad , Persona de Mediana Edad , Humanos , Anciano , Estudios Transversales , Obesidad/epidemiología , Obesidad/diagnóstico , Circunferencia de la Cintura , Índice de Masa Corporal , VitaminasRESUMEN
The present randomized controlled study aimed to investigate the effects of TopClosure® tension-relief system (TRS) on patients with breast cancer undergoing mastectomy. A total of 402 female patients with breast cancer who came to the Renmin Hospital of Wuhan University between March 2014 and June 2018 were involved in the present study. All patients receiving mastectomy were randomly divided into the TRS group (n=201) and the control group (n=201). Serum levels of high-sensitivity C-reactive protein, TNF-α, IL-6 and procalcitonin were measured using ELISA. Vancouver Scar Scale was recorded at 2 weeks and 1-3 and 6 months following the operation. The 36-Item Health Survey Scales were performed for all patients at 1 month after surgery. The TRS reduced the incidence of flap necrosis, infection and the duration of hospital stay. In addition, the TRS was found to attenuate inflammation and improve scar outcomes as well as the quality of life. It was concluded that the TRS could significantly improve the clinical outcomes.
RESUMEN
Antibacterial, anti-inflammatory, and pro-angiogenic properties are prerequisites for dressing materials that accelerate the healing process of infected wounds. Herein, we report a magnesium-doped silica bioactive glass (SiO2/MgO) nanofiber membrane prepared by electrospinning. Our results demonstrate that this SiO2/MgO nanofiber membrane has good flexibility and hydrophilicity, which give it intimate contact with wound beds. In vitro assessments illustrate its good cytocompatibility and bioactivity that contribute to its robust cell proliferation and angiogenesis. It shows capacity in modulating the cellular inflammatory response of murine macrophages. In addition, in vitro assays prove its good antibacterial activity against both Gram-positive and Gram-negative strains. In a full-thickness skin defect inoculated with Staphylococcus aureus in mice, it effectively inhibits bacterial infection. Both gene expression and histological/immunohistochemical analyses confirmed the down-regulated pro-inflammatory factors, up-regulated anti-inflammatory factors, and enhanced angiogenesis. Taken together, these desirable properties work in concert to contribute to the rapid healing of infected wounds and make it a good candidate for wound dressing materials.
Asunto(s)
Nanofibras , Infecciones Estafilocócicas , Ratones , Animales , Magnesio/farmacología , Dióxido de Silicio , Nanofibras/química , Óxido de Magnesio , Antibacterianos/farmacología , Antibacterianos/química , AntiinflamatoriosRESUMEN
The adverse consequences resulting from diabetes are often presented as severe complications. Diabetic wounds are one of the most commonly occurring complications in diabetes, and the control and treatment of this is costly. Due to a series of pathophysiological mechanisms, diabetic wounds remain in the inflammatory phase for a prolonged period of time, and face difficulty in entering the proliferative phase, thus leading to chronic non-healing wounds. The current consensus on the treatment of diabetic wounds is through multidisciplinary comprehensive management, however, standard wound treatment methods are still limited and therefore, more effective methods are required. In recent years, defensins have been found to play diverse roles in a variety of diseases; however, the molecular mechanisms underlying these activities are still largely unknown. Defensins can be constitutively or inductively produced in the skin, therefore, their local distribution is affected by the microenvironment of these diabetic wounds. Current evidence suggests that defensins are involved in the diabetic wound pathogenesis, and can potentially promote the early completion of each stage, thus making research on defensins a promising area for developing novel treatments for diabetic wounds. In this review, we describe the complex function of human defensins in the development of diabetic wounds, and suggest potential thera-peutic benefits.
RESUMEN
Scorpion peptides have good therapeutic effect on chronic ulcer of diabetic foot, but the related pharmacological mechanism has remained unclear. The different proteins and bacteria present in ulcer exudates from chronic diabetic foot patients, treated with scorpion antimicrobial peptide at different stages, were analyzed using isobaric tags for quantification-labeled proteomics and bacteriological methods. According to the mass spectrometry data, a total of 1865 proteins were identified qualitatively, and the number of the different proteins was 130 (mid/early), 401 (late/early), and 310 (mid, late/early). In addition, functional annotation, cluster analysis of effects and the analysis of signal pathway, transcription regulation, and protein-protein interaction network were carried out. The results showed that the biochemical changes of wound microenvironment during the treatment involved activated biological functions such as protein synthesis, cell proliferation, differentiation, migration, movement, and survival. Inhibited biological functions such as cell death, inflammatory response, immune diseases, and bacterial growth were also involved. Bacteriological analysis showed that Burkholderia cepacia was the main bacteria in the early and middle stage of ulcer exudate and Staphylococcus epidermidis in the late stage. This study provides basic data for further elucidation of the molecular mechanism of diabetic foot.
Asunto(s)
Diabetes Mellitus , Pie Diabético , Animales , Péptidos Antimicrobianos , Pie Diabético/tratamiento farmacológico , Pie Diabético/metabolismo , Exudados y Transudados/metabolismo , Humanos , Proteómica , Escorpiones , ÚlceraRESUMEN
Background: Formerly, the community pharmacists' work was mainly focused on drug supply. However, during the COVID-19 epidemic outbreak, community pharmacists in Wuhan played an important role in control and prevention of SARS-CoV-2 and in providing pharmaceutical care. Due to a lack of adequate knowledge and skills, many community pharmacists were not able to cope with healthcare work timely and efficiently. To improve community pharmacists' specialized knowledge and enhance their professional competence through systemic training in the post-COVID-19 era. Methods: Based on the O-AMAS (Objective, Activation, Multi-learning, Assessment and Summary) teaching model and flipped classroom, an online continuing training program containing four sections was developed. It was a semi-experimental study with no control group. Quantitative tests before and after training as well as questionnaire were used to evaluate the outcome of this training program for community pharmacists. Results: A total of twenty-six community pharmacists were invited to participate in continuing education, and twenty-five trainees finished this training program with a completion rate of 96.2 %. Quantitative tests before and after training and anonymous questionnaires were carried out to comprehensively evaluate the outcomes of this training program. Compared with the test scores before training (61.6 ± 6.6), the score after training was statistically higher, reaching 80.9 ± 7.5 (P < 0.001). Twenty-three questionnaires were received (returns ratio, 92.0%). Notably, most of the pharmacists were satisfied with the training program. The percentage of positive responses for each item in this anonymous questionnaire was more than 85 %. Conclusion: It was suggested that the O-AMAS model and the flipped classroom-based continuing educational program achieved the expected training effects. It is a promising on-the-job training approach for pharmacy continuing education. Moreover, our study also demonstrated that online learning had advantages of no geographic constraints, flexible learning beyond time and easy interaction, over traditional face-to-face training style, especially in the post-pandemic era.
Asunto(s)
COVID-19 , Farmacéuticos , COVID-19/prevención & control , Educación Continua en Farmacia , Humanos , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
BACKGROUND: Hypoalbuminemia is common among individuals with obesity who qualify for bariatric surgery, but its relevance to clinical outcomes after bariatric surgery remains to be established. OBJECTIVES: To examine the association of preoperative serum albumin with 30-day postoperative outcomes. SETTING: Data from the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files were used. METHODS: Preoperative serum albumin level was categorized as hypoalbuminemia (<3.5 g/dL), and normoalbuminemia (3.5-5.5 g/dL) among patients who underwent bariatric surgery. Multivariate logistic regression models were used to determine the association of preoperative hypoalbuminemia with 30-day postoperative mortality and other co-morbid outcomes. RESULTS: Among 633,011 adult patients, 85.1% were women and the mean (standard deviation) age was 44.8 (12.0) years. The prevalence of hypoalbuminemia was 6.13% (n = 38,792). After adjustment for procedure type and demographic, lifestyle, and co-morbidity covariates, the odds ratio (OR) (95% confidence interval [CI]) for mortality was 1.42 (1.10, 1.82) for hypoalbuminemia. For all other outcomes, the ORs (95% CIs) for hypoalbuminemia ranged from 1.03 (.67-1.60) for cardiac arrest requiring CPR to 2.32 (1.66-3.25) for failure to be discharged by day 30. The ORs for several associations were higher for severe hypoalbuminemia than marginal hypoalbuminemia. CONCLUSION: Preoperative hypoalbuminemia was associated with several negative 30-day postoperative bariatric surgery outcomes and tended to be worse for severe hypoalbuminemia compared with marginal hypoalbuminemia. These findings suggest that serum albumin may be a useful biomarker to screen for negative bariatric surgery outcomes.
Asunto(s)
Cirugía Bariátrica , Hipoalbuminemia , Adulto , Cirugía Bariátrica/efectos adversos , Femenino , Humanos , Hipoalbuminemia/complicaciones , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica/metabolismo , Resultado del TratamientoRESUMEN
Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases.
Asunto(s)
COVID-19 , Trasplante de Pulmón , Úlcera por Presión , Anciano , Humanos , Masculino , SARS-CoV-2 , Colgajos QuirúrgicosRESUMEN
ABSTRACT: Currently, the wide-spread use of screening mammography has led to dramatic increases in ductal carcinoma in situ (DCIS). However, DCIS of Chinese Americans, the largest Asian subgroup in American, has rarely been comprehensively studied over the past decade. This work compared the DCIS characteristics and prognosis of Chinese American patients with White Americans in the USA to determine the characteristics and prognosis of DCIS patients of Chinese Americans.The data were obtained using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. The diagnosis and treatment variables between the two groups were compared by means of Chi-square tests. Survival was determined with the use of the Kaplan-Meier method and the multivariable Cox proportional hazard regression model.From 1975 to 2016, 81,745 White Americans and 2069 Chinese Americans were diagnosed with ductal carcinoma in situ. Compared with the white patients, the Chinese Americans were younger (Pâ<â.001) with smaller tumors (Pâ<â.001) and higher family income (Pâ<â.001). DCIS patients of Chinese American group accounted for a higher percentage of all breast cancers than the whites (Pâ<â.001). In the multivariable Cox proportional hazard regression analysis, Chinese American was an independent favorable prognostic factor in terms of overall survival (OS) (HR, 0.684; 95% CI, 0.593-0.789; Pâ<â.001) compared with the white group.In conclusion, DCIS characteristics of the Chinese group, which exhibited a higher proportion of younger age, a higher DCIS ratio, and a better prognosis, were distinct from those of the White Americans.
Asunto(s)
Neoplasias de la Mama/etnología , Carcinoma Intraductal no Infiltrante/etnología , Adulto , Anciano , Asiático/estadística & datos numéricos , Mama/patología , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/mortalidad , Carcinoma Intraductal no Infiltrante/patología , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Programa de VERF , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
Non-muscle myosin IIA (NMIIA) has been reported to be involved in the carcinogenesis and malignant progression of various human tumors. However, the role and potential mechanism of NMIIA in the biological functions and apoptosis in colorectal cancer (CRC) remain elusive. In this study, we found that NMIIA was overexpressed in CRC tissues and significantly associated with poor survival in CRC patients. In addition, NMIIA promoted CRC cell proliferation and invasion via activating the AMPK/mTOR pathway in vitro, and NMIIA knockdown inhibited CRC growth in vivo. Meanwhile, NMIIA knockdown downregulated the CSCs markers (CD44 and CD133) expression in CRC cells. Furthermore, AMPK/mTOR pathway activation effectively reversed the NMIIA knockdown-induced inhibition of proliferation, invasion and stemness in CRC cells. Finally, NMIIA protects CRC cells from 5-FU-induced apoptosis and proliferation inhibition through the AMPK/mTOR pathway. Taken together, these results indicate that NMIIA plays a pivotal role in CRC growth and progression by regulating AMPK/mTOR pathway activation, and it may act as a novel therapeutic target prognostic factor in CRC.
Asunto(s)
Proteínas Quinasas Activadas por AMP/metabolismo , Neoplasias Colorrectales/metabolismo , Cadenas Pesadas de Miosina/metabolismo , Serina-Treonina Quinasas TOR/metabolismo , Anciano , Animales , Apoptosis , Proliferación Celular , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Ratones , Ratones Desnudos , Cadenas Pesadas de Miosina/genética , Células Tumorales CultivadasRESUMEN
Clinical fungal infections always cause a negative impact on human health. Moreover, during the interaction of pathogenic fungi with the environment and host, many biologically active substances are produced. Here, we report a new toxin-like defensin of purlisin derived from a clinical pathogenic isolate of Purpureocillium lilacinum. The analysis of its genomic and mRNA sequences revealed an open reading frame of 444 bp without introns. The deduced precursor peptide was composed of 147 amino acids, and the mature peptide were identified at protein level by LC-ESI-Q-TOF-MS/MS. After posttranslational processing, the precursor peptide of purlisin was split into two independent peptides. The two mature defensins, purlisin-NT and purlisin-CT, are consisting of 36 and 38 amino acid residues, which can form three and four intramolecular disulfide bonds, respectively. The results of circular dichroism and homology modeling revealed that they adopted a representative cysteine-stabilized α-helical and ß-sheet motif. The purlisin-NT showed a dose-dependent selective inhibition of immune-related hKv1.3 target channel with IC50 value of 0.2 ± 0.04 µM but no obvious antibacterial activity, while the purlisin-CT displayed antimicrobial activities against gram-positive bacteria as well as clinical isolates of MRSA and low affinities for potassium channels. Our findings suggest that purlisin-NT with immunosuppressive effects and purlisin-CT possessing antibacterial activities are adapted to the survival and pathogenicity of clinical P lilacinumis. Moreover, they can also be used as templates for the design of novel antibacterial peptide and immunosuppressive agents.
Asunto(s)
Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Defensinas/farmacología , Proteínas Fúngicas/metabolismo , Hypocreales/química , Fragmentos de Péptidos/farmacología , Bloqueadores de los Canales de Potasio/farmacología , Secuencia de Aminoácidos , Secuencia de Bases , Proteínas Fúngicas/genética , Humanos , Canales de Potasio/química , Homología de SecuenciaRESUMEN
OBJECTIVE: To investigate olfactory and gustatory dysfunction in patients with coronavirus disease 2019 (COVID-19) in Wuhan using a telephone interview. METHODS: This retrospective telephone survey investigated 196 consecutive patients with COVID-19 at 3 months after discharge from two hospitals in Wuhan, China. The characteristics of the patient's disease course and time to recovery from olfactory and/or gustatory dysfunction (OD and/or GD) were collected by telephone interview. Demographic data were collected from the patient medical records. RESULTS: A total of 196 patients with COVID-19 completed the study. The most prevalent general symptoms were fever, cough, and fatigue. Overall, 19.9% of the patients reported OD and/or GD. In 87.2% of these cases, OD or GD appeared after the general symptoms. The time to recovery from OD and/or GD was more than 4 weeks in 51.4% of the patients. Patients with COVID-19 and OD and/or GD had significantly higher rates of cardiovascular disease than patients without OD and/or GD (p = 0.002). CONCLUSIONS: Recovery from chemosensory dysfunction (OD and/or GD) was slow, with over half of the patients taking more than 4 weeks to recover. Cardiovascular disease might be related to the development of olfactory or taste disorders in patients with COVID-19.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Trastornos del Olfato/epidemiología , Neumonía Viral/complicaciones , Trastornos del Gusto/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , COVID-19 , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Olfato/fisiopatología , Pandemias , Prevalencia , Recuperación de la Función , Estudios Retrospectivos , SARS-CoV-2 , Trastornos del Gusto/fisiopatologíaRESUMEN
Sepsis is a severe disease, which results from the excessive inflammatory response to the infection. Dysfunction of intestinal barrier is a crucial problem in various pathological conditions. Meanwhile, microRNAs exhibit significant roles in the modulation of many diseases, including sepsis. Multiple investigations indicate that miR-199a-5p participates in different human diseases. Nevertheless, little is known on the roles of miR-199a-5p in sepsis. Herein, we evaluated the mechanism of miR-199a-5p on the intestinal barrier dysfunction in sepsis. Intestinal mucosa permeability indicators including D-lactic acid, DAO, and FD-40 levels were determined, and they were greatly increased in sepsis. Then, we proved that miR-199a-5p was induced in sepsis mice tissues and isolated intestinal epithelial cells. Moreover, miR-199a-5p increased D-lactic acid, DAO, and FD-40 while inhibition of miR-199a-5p exhibited a reversed process. Additionally, we observed that miR-199a-5p affected the oxidative damage and inflammation in the intestine tissues from sepsis mice. The content of MDA was elevated whereas SOD was remarkably repressed in the miR-199a-5p mimic group. IL-6, IL-1ß, and TNF-α were induced by miR-199a-5p overexpression while IL-10 was reduced by miR-199a-5p. Subsequently, surfactant protein D (SP-D) was predicted as the target of miR-199a-5p. The activation of NF-κB has been identified in sepsis. Herein, we demonstrated that inhibitor of miR-199a-5p contributed to IEC injury via targeting SP-D and inactivating the NF-κB pathway. These revealed miR-199a-5p exacerbated the intestinal barrier dysfunction via inhibiting SP-D and activating the NF-κB pathway in sepsis.
Asunto(s)
MicroARNs/metabolismo , Subunidad p50 de NF-kappa B/metabolismo , Proteína D Asociada a Surfactante Pulmonar/metabolismo , Sepsis/metabolismo , Animales , Apoptosis , Regulación de la Expresión Génica , Células HEK293 , Humanos , Inflamación , Mucosa Intestinal/metabolismo , Ratones , Ratones Endogámicos C57BL , Membrana Mucosa/metabolismo , Estrés Oxidativo , Permeabilidad , TransfecciónRESUMEN
Importance: Perception of weight loss requirements before bariatric surgery varies among patients, physicians, and health insurance payers. Current clinical guidelines do not require preoperative weight loss because of a lack of scientific support regarding its benefits. Objective: To examine the association of preoperative body mass index (BMI) and weight loss with 30-day mortality after bariatric surgery. Design, Setting, and Participants: This cohort study used data from 480â¯075 patients who underwent bariatric surgery from 2015 to 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which covers more than 90% of all bariatric surgery programs in the United States and Canada. Clinical and demographic data were collected at all participating institutions using a standardized protocol. Data analysis was performed from December 2018 to November 2019. Exposures: Preoperative BMI and weight loss. Main Outcomes and Measures: 30-day mortality after bariatric surgery. Results: Of the 480â¯075 patients (mean [SD] age 45.1 [12.0] years; 383â¯265 [79.8%] women), 511 deaths (0.1%) occurred within 30 days of bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted odds ratios for 30-day mortality for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.37 (95% CI, 1.02-1.83), 2.19 (95% CI, 1.64-2.92), 2.61 (95% CI, 1.90-3.58), and 5.03 (95% CI, 3.78-6.68), respectively (P for trend < .001). Moreover, compared with no preoperative weight loss, the multivariable-adjusted odds ratios for 30-day mortality for patients with weight loss of more than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater were 0.76 (95% CI, 0.60-0.96), 0.69 (95% CI, 0.53-0.90), and 0.58 (95% CI, 0.41-0.82), respectively (P for trend = .003). Conclusions and Relevance: In this study, even moderate weight loss (ie, >0% to <5%) before bariatric surgery was associated with a lower risk of 30-day mortality. These findings may help inform future updates of clinical guidelines regarding bariatric surgery.
Asunto(s)
Cirugía Bariátrica/mortalidad , Índice de Masa Corporal , Periodo Preoperatorio , Pérdida de Peso , Canadá/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Estados Unidos/epidemiologíaRESUMEN
An increasing number of scorpion fossils indicate that the venomous telson developed from the sharp telson in sea scorpions into the extant scorpion-like telson in aquatic scorpions in the Paleozoic Era and then further evolved into the fetal venom system. This hypothesis led us to evaluate the inhibition of scorpion venom-sensitive potassium channels by hemolymph from the scorpion Mesobuthus martensii. Scorpion hemolymph diluted 1:10 inhibited Kv1.1, Kv1.2, Kv1.3 and SK3 potassium channel currents by 76.4%, 90.2%, 85.8%, and 52.8%, respectively. These discoveries encouraged us to investigate the functional similarity between the more ancient defensin ingredients in hemolymph and the evolved neurotoxins in the venom. In addition to the expression of the representative defensin BmKDfsin3 and BmKDfsin5 in both venomous and non-venomous tissues, NMR analysis revealed structural similarities between scorpion defensin and neurotoxin. Functional experiments further indicated that scorpion defensin used the same mechanism as classical neurotoxin to block the neurotoxin-sensitive Kv1.1, Kv1.2, Kv1.3 and SK3 channels. These findings emphasize the likelihood that scorpion defensins evolved into neurotoxins that were adapted to the emergence of the scorpion telson from the sharp telson of sea scorpions into the extant scorpion-like telson in aquatic scorpions in the Paleozoic Era.
Asunto(s)
Defensinas/metabolismo , Hemolinfa/metabolismo , Canales Iónicos/metabolismo , Neurotoxinas/metabolismo , Escorpiones/metabolismo , Secuencia de Aminoácidos , Animales , Canales de Potasio con Entrada de Voltaje/metabolismo , Venenos de Escorpión/metabolismo , Homología de Secuencia de AminoácidoRESUMEN
Sustained infection and chronic inflammation are the most common features and complex mechanisms of diabetic foot disease. In this study, we examined the expression and functional roles of human endogenous α defensins in diabetic foot ulcer. The expression levels of human α defensins HNP1, HNP3, and HNP4 were significantly higher in the wound center than the edge of diabetic foot ulcers. And the inflammatory cytokine interleukin IL-8 (IL-8) was also highly expressed in wound exudates. In human foreskin fibroblasts, these human α defensins were found only slightly to affect IL-8 expression directly. hemoglobin A1C (HbA1c) is the main clinical indicator of diabetic foot disease. Advanced glycation end products of bovine serum albumin (AGE-BSA), as HbA1c analogue, was found to promote IL-8 expression. Human α defensins, in the presence of AGE-BSA, further significantly promoted IL-8 expression. These findings showed that human α defensins aggravated the inflammatory response in diabetic foot ulcers patients, providing new insights in to the poor healing of diabetic foot ulcers.
Asunto(s)
Pie Diabético/fisiopatología , Glucosa/administración & dosificación , Mediadores de Inflamación/metabolismo , Interleucina-8/metabolismo , Cicatrización de Heridas , alfa-Defensinas/fisiología , Adulto , Secuencia de Aminoácidos , Pie Diabético/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , alfa-Defensinas/químicaRESUMEN
BACKGROUND: The epidermal growth factor (EGF) is recognized medicine of therapy in ulcer. However, its efficacy has been challenged. We compared scorpion venom active polypeptide and EGF of therapeutic effects in diabetic ulcer. METHODS: The scorpion venom active polypeptide is made into gel. Fourteen diabetic SD rats were randomly divided into scorpion peptide gel group (SPG group) and EGF group. Before treatment, the rat model of diabetic ulcer was created. The levels of IL-1, IL-6, IL-8, and TNF-α in the wound tissue were measured at different time points during the treatment, secretions of wound were collected for bacterial culture, and the wound healing was recorded. RESULTS: Wound healing was faster in SPG group compared to EGF group (3 weeks versus 5 weeks, t-test, p = 0.032). The levels of IL-1, IL-6, IL-8, and TNF-α were not statistically different when the wounds were formed but showed significant differences from the 2nd to the 5th week between two groups. The infection rate was higher in the EGF group (42.86% versus 0, Chi-square test, p = 0.025). CONCLUSIONS: Scorpion venom active polypeptide shortens wound healing with a stronger anti-inflammation and antibacterial effect and may be a new and effective topical drug for the treatment of diabetic ulcers.