Role of immune tolerance in BALB/c mice with anaphylactic shock after Echinococcus granulosus infection.

This study tested the hypothesis that immune tolerance mediated by regulatory T (Treg) cells is protective against cystic echinococcosis (CE)-induced anaphylactic shock. BALB/c mice were inoculated with protoscoleces of Echinococcus granulosus. After 3 months, the presence of cysts in the peritoneal cavity was confirmed after which a subset of mice was sensitized using a cyst fluid suspension to induce anaphylactic shock. While IgE levels were significantly higher in both groups inoculated with E. granulosus as compared to the healthy control group (both P < 0.01), sensitized mice had higher IgE levels as compared with those with E. granulosus alone (P < 0.05). Mice inoculated with E. granulosus alone and sensitized mice both had significantly higher histamine levels as compared to the healthy controls. The proportion of CD4(+)CD25(+)Foxp3(+) Treg cells relative to CD4(+) cells was significantly higher in mice inoculated with E. granulosus alone (P < 0.0167); significantly higher interleukin-10 (IL-10) and tumor growth factor-ß (TGF-ß1) levels were also noted in this group (all P < 0.01). In contrast, IL-13 and IL-17A levels were significantly higher in the sensitized mice (both P < 0.05). Taken together, these data suggest that the biphasic changes in Treg cell and cytokine levels may be associated with anaphylactic shock induced by CE.

Identification of a new SERPINC1 mutation in a Kazak family that alters the heparin binding capacity of antithrombin.

INTRODUCTION: Given its central role in mediating heparin-induced anti-coagulation, antithrombin (AT) gene mutations may result in heparin resistance. This study investigates the relationship between familial AT gene mutations and tolerance to heparin. METHODS: The medical history of a male patient with heparin resistance who received heart surgery and six of his family members was reviewed. Activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib), D-dimer (D=D), and platelet count were determined to assess coagulation function. AT activity and the AT gene were also analyzed. For the newly identified gene mutations, polymorphisms were excluded in 120 healthy Kazak controls. RESULTS: Two mutations were identified in exon 7 of the AT gene, SERPINC1: g.1267G>A (p.A391T) found in five participants, including the index patient, and g.1334G>A, a silent mutation, in two family members. The g.1267G>A mutation may alter focal AT protein conformation. Neither of these mutations was observed in the healthy Kazak controls. Although all coagulation parameters and AT activity were within the normal ranges for the index patient and his family members, the platelet levels were significantly lower than that observed for the healthy Kazak controls (p=0.001). There was no significant difference in AT antigen levels between the groups; however, participants with the g.1267G>A mutation had a 44.25% reduction in heparin binding compared to the control group (p<0.001). CONCLUSION: We identified a novel hereditary mutation, g.1267G>A (p.A391T), in the AT gene, which reduces its heparin binding capacity and might be associated with resistance to heparin.

Evaluation of effectiveness and analysis of goal-directed blood transfusion in peri-operation of major orthopedic surgery in elderly patients.

Through the establishment of blood transfusion-effectiveness assessment criteria, we aimed to evaluate and analyze the effectiveness of peri-operative red blood cell transfusion for major orthopedics in elderly patients. Male and female patients (n=106) with American Society of Anesthesiologists (ASA) stage II-III, aged 60-80 years and scheduled for elective orthopedic surgery were randomly divided into 2 groups: group I (n=52), received the traditional method of red blood cell transfusion and group II (n=54) received hemoglobin (Hb) and hematocrit (Hct) goal-directed red blood cell (RBC) transfusion. We compared the changes in Hb, Hct, RBC, platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), alveolar-arterial oxygen partial pressure [P(A-a)O(2)], oxygenation index (OI) and Vigileo monitoring indicators following RBC composition transfusion before and after surgery. We also monitored wound healing time, number of hospitalization days and intensive care unit (ICU) transfer rate. Blood transfusion-effectiveness assessment criteria were used to evaluate the efficacy and safety of Hb and Hct goal-directed RBC transfusion in orthopedic elderly patients. The two groups demonstrated an efficiency of 61.5 and 72.2%, respectively (P>0.05). The P(A-a)O(2) and OI in the two groups were not significantly different (P>0.05). Compared with the traditional RBC transfusion group, the Hb and Hct goal-directed RBC transfusion group presented increased RBC, Hb and Hct, as well as decreased PT and APTT and shorter wound healing time. The number of days of hospitalization and ICU transfer rate also decreased (P<0.05). The Hb and Hct goal-directed method for RBC transfusion was found to be more effective as a form of peri-operative RBC transfusion for major orthopedics in elderly patients.