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Mou DX, Wu XD, Zhao NQ, Yuan JY, Ding N, Dong GF, Wang X. [Longdan Xiegan Decoction and its interpretation from the perspective of meridians]. Zhonghua Yi Shi Za Zhi 2024; 54:10-16. [PMID: 38475680 DOI: 10.3760/cma.j.cn112155-20230715-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
By systematically examing through Longdan Xiegan Decoction in medical books of the past dynasties, it was found that the Longdan Xiegan Decoction recorded in Lan Shi Mi Cang mainly targeted men's genital odor at frist. After Xue Ji's addition and subtraction, the scope of the prescription was gradually generalized and expanded, and confusion its name, composition and source of the prescription appeared, which was particularly prominent in Jingyue Quanshu and Yifang Jijie.Doctors used to interpret this prescription from the perspective of viscera. In order to better understand the main treatment rules of Longdan Xiegan Decoction, it is necessary to change the perspective and reinterpreted it from the perspective of meridians.Attributing the symptoms of the perineum to Liver Meridian of Foot-Jueyin,hypochondriac pain, deafness and other symptoms to the Gallbladder Meridian of Foot-Shaoyang, and adding or subtracting herbs according to the specific conditions, is not only conducive to a comprehensive and in-depth understanding of the prescription to achieve accurate clinical syndrome differentiation and medication, but also prompts modern researchers to rethink the important role of meridian theory in the formation and development of the theoretical system of traditional Chinese medicine.
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Affiliation(s)
- D X Mou
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700,China
| | - X D Wu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700,China
| | - N Q Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700,China
| | - J Y Yuan
- School of Acu-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029,China
| | - N Ding
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700,China
| | - G F Dong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700,China
| | - X Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700,China
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2
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Tang H, Wang H, Fang Y, Zhu JY, Yin J, Shen YX, Zeng ZC, Jiang DX, Hou YY, Du M, Lian CH, Zhao Q, Jiang HJ, Gong L, Li ZG, Liu J, Xie DY, Li WF, Chen C, Zheng B, Chen KN, Dai L, Liao YD, Li K, Li HC, Zhao NQ, Tan LJ. Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy followed by minimally invasive esophagectomy for locally advanced esophageal squamous cell carcinoma: a prospective multicenter randomized clinical trial. Ann Oncol 2023; 34:163-172. [PMID: 36400384 DOI: 10.1016/j.annonc.2022.10.508] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neoadjuvant therapy is recommended for locally advanced esophageal cancer, but the optimal strategy remains unclear. We aimed to evaluate the safety and efficacy of neoadjuvant chemoradiotherapy (nCRT) versus neoadjuvant chemotherapy (nCT) followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS Eligible patients staged as cT3-4aN0-1M0 ESCC were randomly assigned (1 : 1) to the nCRT or nCT group stratified by age, cN stage, and centers. The chemotherapy, based on paclitaxel and cisplatin, was administered to both groups, while concurrent radiotherapy was added for the nCRT group; then MIE was carried out. The primary endpoint was 3-year overall survival. This study is registered with ClinicalTrials.gov (NCT03001596). RESULTS A total of 264 patients were eligible for the intention-to-treat analysis. By 30 November 2021, 121 deaths had occurred. The median follow-up was 43.9 months (interquartile range 36.6-49.3 months). The overall survival in the intention-to-treat population was comparable between the nCRT and nCT strategies [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.58-1.18; P = 0.28], with a 3-year survival rate of 64.1% (95% CI 56.4% to 72.9%) versus 54.9% (95% CI 47.0% to 64.2%), respectively. There were also no differences in progression-free survival (HR 0.83, 95% CI 0.59-1.16; P = 0.27) and recurrence-free survival (HR 1.07, 95% CI 0.71-1.60; P = 0.75), although the pathological complete response in the nCRT group (31/112, 27.7%) was significantly higher than that in the nCT group (3/104, 2.9%; P < 0.001). Besides, a trend of lower risk of recurrence was observed in the nCRT group (P = 0.063), while the recurrence pattern was similar (P = 0.802). CONCLUSIONS NCRT followed by MIE was not associated with significantly better overall survival than nCT among patients with cT3-4aN0-1M0 ESCC. The results underscore the pending issue of the best strategy of neoadjuvant therapy for locally advanced bulky ESCC.
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Affiliation(s)
- H Tang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai
| | - H Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai
| | - Y Fang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai
| | - J Y Zhu
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai; Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai
| | - J Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai
| | - Y X Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai
| | - Z C Zeng
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai; Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai
| | - D X Jiang
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai
| | - Y Y Hou
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai
| | - M Du
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - C H Lian
- Department of General Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi
| | - Q Zhao
- Department of General Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi
| | - H J Jiang
- Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin
| | - L Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin
| | - Z G Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai
| | - J Liu
- Department of Radiotherapy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai
| | - D Y Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - W F Li
- Department of Radiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - C Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou
| | - B Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou
| | - K N Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), The First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing
| | - L Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), The First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing
| | - Y D Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - K Li
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - H C Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - N Q Zhao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - L J Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai.
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Ivison GT, Vendrame E, Martínez-Colón GJ, Ranganath T, Vergara R, Zhao NQ, Martin MP, Bendall SC, Carrington M, Cyktor JC, McMahon DK, Eron J, Jones RB, Mellors JW, Bosch RJ, Gandhi RT, Holmes S, Blish CA. Natural Killer Cell Receptors and Ligands Are Associated With Markers of HIV-1 Persistence in Chronically Infected ART Suppressed Patients. Front Cell Infect Microbiol 2022; 12:757846. [PMID: 35223535 PMCID: PMC8866573 DOI: 10.3389/fcimb.2022.757846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
The latent HIV-1 reservoir represents a major barrier to achieving a long-term antiretroviral therapy (ART)-free remission or cure for HIV-1. Natural Killer (NK) cells are innate immune cells that play a critical role in controlling viral infections and have been shown to be involved in preventing HIV-1 infection and, in those who are infected, delaying time to progression to AIDS. However, their role in limiting HIV-1 persistence on long term ART is still uncharacterized. To identify associations between markers of HIV-1 persistence and the NK cell receptor-ligand repertoire, we used twin mass cytometry panels to characterize the peripheral blood NK receptor-ligand repertoire in individuals with long-term antiretroviral suppression enrolled in the AIDS Clinical Trial Group A5321 study. At the time of testing, participants had been on ART for a median of 7 years, with virological suppression <50 copies/mL since at most 48 weeks on ART. We found that the NK cell receptor and ligand repertoires did not change across three longitudinal samples over one year-a median of 25 weeks and 50 weeks after the initial sampling. To determine the features of the receptor-ligand repertoire that associate with markers of HIV-1 persistence, we performed a LASSO normalized regression. This analysis revealed that the NK cell ligands CD58, HLA-B, and CRACC, as well as the killer cell immunoglobulin-like receptors (KIRs) KIR2DL1, KIR2DL3, and KIR2DS4 were robustly predictive of markers of HIV-1 persistence, as measured by total HIV-1 cell-associated DNA, HIV-1 cell-associated RNA, and single copy HIV-RNA assays. To characterize the roles of cell populations defined by multiple markers, we augmented the LASSO analysis with FlowSOM clustering. This analysis found that a less mature NK cell phenotype (CD16+CD56dimCD57-LILRB1-NKG2C-) was associated with lower HIV-1 cell associated DNA. Finally, we found that surface expression of HLA-Bw6 measured by CyTOF was associated with lower HIV-1 persistence. Genetic analysis revealed that this was driven by lower HIV-1 persistence in HLA-Bw4/6 heterozygotes. These findings suggest that there may be a role for NK cells in controlling HIV-1 persistence in individuals on long-term ART, which must be corroborated by future studies.
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Affiliation(s)
- Geoffrey T Ivison
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.,Program in Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Elena Vendrame
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Giovanny J Martínez-Colón
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Thanmayi Ranganath
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Rosemary Vergara
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Nancy Q Zhao
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Program in Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Maureen P Martin
- Basic Science Program, Frederick National Laboratory for Cancer Research, National, Cancer Institute, Frederick, MD, United States.,Laboratory of Integrative Cancer, Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Sean C Bendall
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Mary Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, National, Cancer Institute, Frederick, MD, United States.,Laboratory of Integrative Cancer, Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.,Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, MA, United States
| | - Joshua C Cyktor
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States
| | - Deborah K McMahon
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Joseph Eron
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - R Brad Jones
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - John W Mellors
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ronald J Bosch
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Rajesh T Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for AIDS Research, Harvard University, Boston, MA, United States
| | - Susan Holmes
- Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, United States
| | - Catherine A Blish
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Chan Zuckerberg Biohub, San Francisco, CA, United States
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Wilk AJ, Lee MJ, Wei B, Parks B, Pi R, Martínez-Colón GJ, Ranganath T, Zhao NQ, Taylor S, Becker W, Jimenez-Morales D, Blomkalns AL, O’Hara R, Ashley EA, Nadeau KC, Yang S, Holmes S, Rabinovitch M, Rogers AJ, Greenleaf WJ, Blish CA. Multi-omic profiling reveals widespread dysregulation of innate immunity and hematopoiesis in COVID-19. J Exp Med 2021; 218:e20210582. [PMID: 34128959 PMCID: PMC8210586 DOI: 10.1084/jem.20210582] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022] Open
Abstract
Our understanding of protective versus pathological immune responses to SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is limited by inadequate profiling of patients at the extremes of the disease severity spectrum. Here, we performed multi-omic single-cell immune profiling of 64 COVID-19 patients across the full range of disease severity, from outpatients with mild disease to fatal cases. Our transcriptomic, epigenomic, and proteomic analyses revealed widespread dysfunction of peripheral innate immunity in severe and fatal COVID-19, including prominent hyperactivation signatures in neutrophils and NK cells. We also identified chromatin accessibility changes at NF-κB binding sites within cytokine gene loci as a potential mechanism for the striking lack of pro-inflammatory cytokine production observed in monocytes in severe and fatal COVID-19. We further demonstrated that emergency myelopoiesis is a prominent feature of fatal COVID-19. Collectively, our results reveal disease severity-associated immune phenotypes in COVID-19 and identify pathogenesis-associated pathways that are potential targets for therapeutic intervention.
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Affiliation(s)
- Aaron J. Wilk
- Stanford Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Madeline J. Lee
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bei Wei
- Department of Genetics, Stanford University School of Medicine, Stanford, CA
| | - Benjamin Parks
- Department of Genetics, Stanford University School of Medicine, Stanford, CA
- Graduate Program in Computer Science, Stanford University School of Medicine, Stanford, CA
| | - Ruoxi Pi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Thanmayi Ranganath
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nancy Q. Zhao
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Shalina Taylor
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA
| | - Winston Becker
- Department of Genetics, Stanford University School of Medicine, Stanford, CA
| | | | | | - Andra L. Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Ruth O’Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Euan A. Ashley
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Kari C. Nadeau
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA
| | - Samuel Yang
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Susan Holmes
- Department of Statistics, Stanford University, Stanford, CA
| | - Marlene Rabinovitch
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA
| | - Angela J. Rogers
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - William J. Greenleaf
- Department of Genetics, Stanford University School of Medicine, Stanford, CA
- Department of Applied Physics, Stanford University, Stanford, CA
| | - Catherine A. Blish
- Stanford Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Chan Zuckerberg Biohub, San Francisco, CA
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5
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Vendrame E, McKechnie JL, Ranganath T, Zhao NQ, Rustagi A, Vergara R, Ivison GT, Kronstad LM, Simpson LJ, Blish CA. Profiling of the Human Natural Killer Cell Receptor-Ligand Repertoire. J Vis Exp 2020. [PMID: 33283785 DOI: 10.3791/61912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Natural killer (NK) cells are among the first responders to viral infections. The ability of NK cells to rapidly recognize and kill virally infected cells is regulated by their expression of germline-encoded inhibitory and activating receptors. The engagement of these receptors by their cognate ligands on target cells determines whether the intercellular interaction will result in NK cell killing. This protocol details the design and optimization of two complementary mass cytometry (CyTOF) panels. One panel was designed to phenotype NK cells based on receptor expression. The other panel was designed to interrogate expression of known ligands for NK cell receptors on several immune cell subsets. Together, these two panels allow for the profiling of the human NK cell receptor-ligand repertoire. Furthermore, this protocol also details the process by which we stain samples for CyTOF. This process has been optimized for improved reproducibility and standardization. An advantage of CyTOF is its ability to measure over 40 markers in each panel, with minimal signal overlap, allowing researchers to capture the breadth of the NK cell receptor-ligand repertoire. Palladium barcoding also reduces inter-sample variation, as well as consumption of reagents, making it easier to stain samples with each panel in parallel. Limitations of this protocol include the relatively low throughput of CyTOF and the inability to recover cells after analysis. These panels were designed for the analysis of clinical samples from patients suffering from acute and chronic viral infections, including dengue virus, human immunodeficiency virus (HIV), and influenza. However, they can be utilized in any setting to investigate the human NK cell receptor-ligand repertoire. Importantly, these methods can be applied broadly to the design and execution of future CyTOF panels.
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Affiliation(s)
- Elena Vendrame
- Department of Medicine, Stanford University School of Medicine
| | - Julia L McKechnie
- Department of Medicine, Stanford University School of Medicine; Program in Immunology, Stanford University School of Medicine
| | | | - Nancy Q Zhao
- Department of Medicine, Stanford University School of Medicine; Program in Immunology, Stanford University School of Medicine
| | - Arjun Rustagi
- Department of Medicine, Stanford University School of Medicine
| | | | - Geoffrey T Ivison
- Department of Medicine, Stanford University School of Medicine; Program in Immunology, Stanford University School of Medicine
| | - Lisa M Kronstad
- Department of Medicine, Stanford University School of Medicine
| | - Laura J Simpson
- Department of Medicine, Stanford University School of Medicine
| | - Catherine A Blish
- Department of Medicine, Stanford University School of Medicine; Program in Immunology, Stanford University School of Medicine; Chan-Zuckerberg BioHub;
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6
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Zhao NQ, Vendrame E, Ferreira AM, Seiler C, Ranganath T, Alary M, Labbé AC, Guédou F, Poudrier J, Holmes S, Roger M, Blish CA. Natural killer cell phenotype is altered in HIV-exposed seronegative women. PLoS One 2020; 15:e0238347. [PMID: 32870938 PMCID: PMC7462289 DOI: 10.1371/journal.pone.0238347] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/14/2020] [Indexed: 12/17/2022] Open
Abstract
Highly exposed seronegative (HESN) individuals present a unique setting to study mechanisms of protection against HIV acquisition. As natural killer (NK) cell activation and function have been implicated as a correlate of protection in HESN individuals, we sought to better understand the features of NK cells that may confer protection. We used mass cytometry to phenotypically profile NK cells from a cohort of Beninese sex workers and healthy controls. We found that NK cells from HESN women had increased expression of NKG2A, NKp30 and LILRB1, as well as the Fc receptor CD16, and decreased expression of DNAM-1, CD94, Siglec-7, and NKp44. Using functional assessments of NK cells from healthy donors against autologous HIV-infected CD4+ T cells, we observed that NKp30+ and Siglec-7+ cells had improved functional activity. Further, we found that NK cells from HESN women trended towards increased antibody-dependent cellular cytotoxicity (ADCC) activity; this activity correlated with increased CD16 expression. Overall, we identify features of NK cells in HESN women that may contribute to protection from HIV infection. Follow up studies with larger cohorts are warranted to confirm these findings.
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Affiliation(s)
- Nancy Q. Zhao
- Department of Medicine, Division of Infection Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States of America
- Immunology Program, Stanford University, Stanford, CA, United States of America
| | - Elena Vendrame
- Department of Medicine, Division of Infection Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States of America
| | - Anne-Maud Ferreira
- Department of Statistics, Stanford University, Stanford, CA, United States of America
| | - Christof Seiler
- Department of Statistics, Stanford University, Stanford, CA, United States of America
| | - Thanmayi Ranganath
- Department of Medicine, Division of Infection Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States of America
| | - Michel Alary
- Centre de Recherche du CHU de Québec–Université Laval, Québec, Canada, Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada, Institut National de Santé Publique du Québec, Québec, Canada
| | - Annie-Claude Labbé
- Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, Canada, Service de maladies infectieuses et microbiologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | | | - Johanne Poudrier
- Laboratoire d’Immunogénétique, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Canada, Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, Canada
| | - Susan Holmes
- Department of Statistics, Stanford University, Stanford, CA, United States of America
| | - Michel Roger
- Laboratoire d’Immunogénétique, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Canada, Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, Canada
- * E-mail: (CAB); (MR)
| | - Catherine A. Blish
- Department of Medicine, Division of Infection Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States of America
- Immunology Program, Stanford University, Stanford, CA, United States of America
- Chan Zuckerberg Biohub, San Francisco, CA, United States of America
- * E-mail: (CAB); (MR)
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7
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Wilk AJ, Rustagi A, Zhao NQ, Roque J, Martínez-Colón GJ, McKechnie JL, Ivison GT, Ranganath T, Vergara R, Hollis T, Simpson LJ, Grant P, Subramanian A, Rogers AJ, Blish CA. A single-cell atlas of the peripheral immune response in patients with severe COVID-19. Nat Med 2020; 26:1070-1076. [PMID: 32514174 PMCID: PMC7382903 DOI: 10.1038/s41591-020-0944-y] [Citation(s) in RCA: 1026] [Impact Index Per Article: 256.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Abstract
There is an urgent need to better understand the pathophysiology of Coronavirus disease 2019 (COVID-19), the global pandemic caused by SARS-CoV-2, which has infected more than three million people worldwide1. Approximately 20% of patients with COVID-19 develop severe disease and 5% of patients require intensive care2. Severe disease has been associated with changes in peripheral immune activity, including increased levels of pro-inflammatory cytokines3,4 that may be produced by a subset of inflammatory monocytes5,6, lymphopenia7,8 and T cell exhaustion9,10. To elucidate pathways in peripheral immune cells that might lead to immunopathology or protective immunity in severe COVID-19, we applied single-cell RNA sequencing (scRNA-seq) to profile peripheral blood mononuclear cells (PBMCs) from seven patients hospitalized for COVID-19, four of whom had acute respiratory distress syndrome, and six healthy controls. We identify reconfiguration of peripheral immune cell phenotype in COVID-19, including a heterogeneous interferon-stimulated gene signature, HLA class II downregulation and a developing neutrophil population that appears closely related to plasmablasts appearing in patients with acute respiratory failure requiring mechanical ventilation. Importantly, we found that peripheral monocytes and lymphocytes do not express substantial amounts of pro-inflammatory cytokines. Collectively, we provide a cell atlas of the peripheral immune response to severe COVID-19.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Betacoronavirus/immunology
- COVID-19
- Case-Control Studies
- Coronavirus Infections/genetics
- Coronavirus Infections/immunology
- Coronavirus Infections/pathology
- Cytokines/genetics
- Cytokines/metabolism
- Female
- Gene Expression Profiling/methods
- Humans
- Immunity, Cellular
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/virology
- Male
- Middle Aged
- Pandemics
- Pneumonia, Viral/genetics
- Pneumonia, Viral/immunology
- Pneumonia, Viral/pathology
- RNA-Seq/methods
- SARS-CoV-2
- Sequence Analysis, RNA/methods
- Severity of Illness Index
- Single-Cell Analysis/methods
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Young Adult
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Affiliation(s)
- Aaron J Wilk
- Stanford Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Arjun Rustagi
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nancy Q Zhao
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonasel Roque
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Julia L McKechnie
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey T Ivison
- Stanford Immunology Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Thanmayi Ranganath
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosemary Vergara
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Taylor Hollis
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura J Simpson
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Philip Grant
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aruna Subramanian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela J Rogers
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Catherine A Blish
- Stanford Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
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8
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Zhao NQ, Ferreira AM, Grant PM, Holmes S, Blish CA. Treated HIV Infection Alters Phenotype but Not HIV-Specific Function of Peripheral Blood Natural Killer Cells. Front Immunol 2020; 11:829. [PMID: 32477342 PMCID: PMC7235409 DOI: 10.3389/fimmu.2020.00829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022] Open
Abstract
Natural killer (NK) cells are the predominant antiviral cells of the innate immune system, and may play an important role in acquisition and disease progression of HIV. While untreated HIV infection is associated with distinct alterations in the peripheral blood NK cell repertoire, less is known about how NK phenotype is altered in the setting of long-term viral suppression with antiretroviral therapy (ART), as well as how NK memory can impact functional responses. As such, we sought to identify changes in NK cell phenotype and function using high-dimensional mass cytometry to simultaneously analyze both surface and functional marker expression of peripheral blood NK cells in a cohort of ART-suppressed, HIV+ patients and HIV- healthy controls. We found that the NK cell repertoire following IL-2 treatment was altered in individuals with treated HIV infection compared to healthy controls, with increased expression of markers including NKG2C and CD2, and decreased expression of CD244 and NKp30. Using co-culture assays with autologous, in vitro HIV-infected CD4 T cells, we identified a subset of NK cells with enhanced responsiveness to HIV-1-infected cells, but no differences in the magnitude of anti-HIV NK cell responses between the HIV+ and HIV− groups. In addition, by profiling of NK cell receptors on responding cells, we found similar phenotypes of HIV-responsive NK cell subsets in both groups. Lastly, we identified clusters of NK cells that are altered in individuals with treated HIV infection compared to healthy controls, but found that these clusters are distinct from those that respond to HIV in vitro. As such, we conclude that while chronic, treated HIV infection induces a reshaping of the IL-2-stimulated peripheral blood NK cell repertoire, it does so in a way that does not make the repertoire more HIV-specific.
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Affiliation(s)
- Nancy Q Zhao
- Immunology Program, Stanford University School of Medicine, Stanford, CA, United States.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Anne-Maud Ferreira
- Department of Statistics, Stanford University School of Medicine, Stanford, CA, United States
| | - Philip M Grant
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Susan Holmes
- Department of Statistics, Stanford University School of Medicine, Stanford, CA, United States
| | - Catherine A Blish
- Immunology Program, Stanford University School of Medicine, Stanford, CA, United States.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Chan Zuckerberg Biohub, San Francisco, CA, United States
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9
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Wilk AJ, Rustagi A, Zhao NQ, Roque J, Martinez-Colon GJ, McKechnie JL, Ivison GT, Ranganath T, Vergara R, Hollis T, Simpson LJ, Grant P, Subramanian A, Rogers AJ, Blish CA. A single-cell atlas of the peripheral immune response to severe COVID-19. medRxiv 2020. [PMID: 32511639 DOI: 10.1101/2020.04.17.20069930] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is an urgent need to better understand the pathophysiology of Coronavirus disease 2019 (COVID-19), the global pandemic caused by SARS-CoV-2. Here, we apply single-cell RNA sequencing (scRNA-seq) to peripheral blood mononuclear cells (PBMCs) of 7 patients hospitalized with confirmed COVID-19 and 6 healthy controls. We identify substantial reconfiguration of peripheral immune cell phenotype in COVID-19, including a heterogeneous interferon-stimulated gene (ISG) signature, HLA class II downregulation, and a novel B cell-derived granulocyte population appearing in patients with acute respiratory failure requiring mechanical ventilation. Importantly, peripheral monocytes and lymphocytes do not express substantial amounts of pro-inflammatory cytokines, suggesting that circulating leukocytes do not significantly contribute to the potential COVID-19 cytokine storm. Collectively, we provide the most thorough cell atlas to date of the peripheral immune response to severe COVID-19.
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10
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Liu LL, He YN, Cai QY, Zhao NQ, Zheng YJ. [Exposure-preceding-outcome regarding time sequence among cohort studies in real world]. Zhonghua Liu Xing Bing Xue Za Zhi 2018; 39:858-861. [PMID: 29936761 DOI: 10.3760/cma.j.issn.0254-6450.2018.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One of the commonly accepted merits of cohort studies (CSs) refers to the exposure precedes outcome superior to other observational designs. We use Directed Acyclic Graphs to construct a causal graph among research populations under CSs. We notice that the substitution of research population in place of a susceptible one can be used for effect estimation. Its correctness depends on the outcome-free status of the substituted population and the performance of both screening and diagnosis regarding the outcomes under study at baseline. The temporal precedence of exposure over outcome occurs theoretically, despite the opposite happens in realities. Correct effect estimate is affected by both the suitability of population substitution and the validities of outcome identification and exclusion.
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Affiliation(s)
- L L Liu
- Department of Public Health Microbiology, School of Public Health, Fudan University, Shanghai 200032 China;Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032 China
| | - Y N He
- Department of Public Health Microbiology, School of Public Health, Fudan University, Shanghai 200032 China
| | - Q Y Cai
- Department of Public Health Microbiology, School of Public Health, Fudan University, Shanghai 200032 China
| | - N Q Zhao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032 China
| | - Y J Zheng
- Department of Public Health Microbiology, School of Public Health, Fudan University, Shanghai 200032 China;Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032 China;Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, School of Public Health, Fudan University, Shanghai 200032 China
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11
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Zheng YJ, Zhao NQ. [Directed acyclic graphs: languages, rules and applications]. Zhonghua Liu Xing Bing Xue Za Zhi 2017; 38:1140-1144. [PMID: 28847071 DOI: 10.3760/cma.j.issn.0254-6450.2017.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nearly all scientific studies explore causality, which will be met by directed acyclic graphs (DAGs). This paper systematically introduces graphic language, basic and interference rules of DAGs, and their applications into identifying research questions, understanding and undertaking research designs, guiding data analysis, classifying biases, etc. DAGs play key roles in causality studies.
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Affiliation(s)
- Y J Zheng
- Department of Public Health Microbiology, School of Public Health, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China; Key Laboratory of Health Technology Assessment, Ministry of Health, Fudan University, Shanghai 200032, China
| | - N Q Zhao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China
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12
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Hatton O, Strauss-Albee DM, Zhao NQ, Haggadone MD, Pelpola JS, Krams SM, Martinez OM, Blish CA. NKG2A-Expressing Natural Killer Cells Dominate the Response to Autologous Lymphoblastoid Cells Infected with Epstein-Barr Virus. Front Immunol 2016; 7:607. [PMID: 28018364 PMCID: PMC5156658 DOI: 10.3389/fimmu.2016.00607] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/01/2016] [Indexed: 01/01/2023] Open
Abstract
Epstein-Barr virus (EBV) is a human γ-herpesvirus that establishes latency and lifelong infection in host B cells while achieving a balance with the host immune response. When the immune system is perturbed through immunosuppression or immunodeficiency, however, these latently infected B cells can give rise to aggressive B cell lymphomas. Natural killer (NK) cells are regarded as critical in the early immune response to viral infection, but their role in controlling expansion of infected B cells is not understood. Here, we report that NK cells from healthy human donors display increased killing of autologous B lymphoblastoid cell lines (LCLs) harboring latent EBV compared to primary B cells. Coculture of NK cells with autologous EBV+ LCL identifies an NK cell population that produces IFNγ and mobilizes the cytotoxic granule protein CD107a. Multi-parameter flow cytometry and Boolean analysis reveal that these functional cells are enriched for expression of the NK cell receptor NKG2A. Further, NKG2A+ NK cells more efficiently lyse autologous LCL than do NKG2A- NK cells. More specifically, NKG2A+2B4+CD16-CD57-NKG2C-NKG2D+ cells constitute the predominant NK cell population that responds to latently infected autologous EBV+ B cells. Thus, a subset of NK cells is enhanced for the ability to recognize and eliminate autologous, EBV-infected transformed cells, laying the groundwork for harnessing this subset for therapeutic use in EBV+ malignancies.
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Affiliation(s)
- Olivia Hatton
- Department of Molecular Biology, Colorado College, Colorado Springs, CO, USA; Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Nancy Q Zhao
- Program in Immunology, Stanford University School of Medicine , Stanford, CA , USA
| | - Mikel D Haggadone
- Program in Immunology, Stanford University School of Medicine , Stanford, CA , USA
| | | | - Sheri M Krams
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA; Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Olivia M Martinez
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA; Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine A Blish
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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13
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Wade C, Wang L, Zhao WJ, Cardini F, Kronenberg F, Gui SQ, Ying Z, Zhao NQ, Chao MT, Yu J. Acupuncture point injection treatment of primary dysmenorrhoea: a randomised, double blind, controlled study. BMJ Open 2016; 6:e008166. [PMID: 26733563 PMCID: PMC4716272 DOI: 10.1136/bmjopen-2015-008166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine if injection of vitamin K3 in an acupuncture point is optimal for the treatment of primary dysmenorrhoea, when compared with 2 other injection treatments. SETTING A Menstrual Disorder Centre at a public hospital in Shanghai, China. PARTICIPANTS Chinese women aged 14-25 years with severe primary dysmenorrhoea for at least 6 months not relieved by any other treatment were recruited. Exclusion criteria were the use of oral contraceptives, intrauterine devices or anticoagulant drugs, pregnancy, history of abdominal surgery, participation in other therapies for pain and diagnosis of secondary dysmenorrhoea. Eighty patients with primary dysmenorrhoea, as defined on a 4-grade scale, completed the study. Two patients withdrew after randomisation. INTERVENTIONS A double-blind, double-dummy, randomised controlled trial compared vitamin K3 acupuncture point injection to saline acupuncture point injection and vitamin K3 deep muscle injection. Patients in each group received 3 injections at a single treatment visit. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the difference in subjective perception of pain as measured by an 11 unit Numeric Rating Scale (NRS). Secondary measurements were Cox Pain Intensity and Duration scales and the consumption of analgesic tablets before and after treatment and during 6 following cycles. RESULTS Patients in all 3 groups experienced pain relief from the injection treatments. Differences in NRS measured mean pain scores between the 2 active control groups were less than 1 unit (-0.71, CI -1.37 to -0.05) and not significant, but the differences in average scores between the treatment hypothesised to be optimal and both active control groups (1.11, CI 0.45 to 1.78) and (1.82, CI 1.45 to 2.49) were statistically significant in adjusted mixed-effects models. Menstrual distress and use of analgesics were diminished for 6 months post-treatment. CONCLUSIONS Acupuncture point injection of vitamin K3 relieves menstrual pain rapidly and is a useful treatment in an urban outpatient clinic. TRIAL REGISTRATION NUMBER NCT00104546; Results.
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Affiliation(s)
- C Wade
- Richard & Hinda Rosenthal Center for Complementary and Alternative Medicine Research, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Institute of East West Medicine, New York, New York, USA
| | - L Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, Shanghai, China
| | - W J Zhao
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, Shanghai, China
| | - F Cardini
- Agenzia Sanitaria e Sociale Regionale dell'Emilia Romagna, (Healthcare and Social Agency of Emilia Romagna Region), Viale Aldo Moro, 21, 40127 Bologna, Italy
| | - F Kronenberg
- Richard & Hinda Rosenthal Center for Complementary and Alternative Medicine Research, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - S Q Gui
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, Shanghai, China
| | - Z Ying
- Department of Statistics, Columbia University, New York, New York, USA
| | - N Q Zhao
- Department of Statistics, School of Public Health, Fudan University, Shanghai, Shanghai, China
| | - M T Chao
- Richard & Hinda Rosenthal Center for Complementary and Alternative Medicine Research, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Osher Center for Integrative Medicine, University of California at San Francisco, San Francisco, California, USA
| | - J Yu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, Shanghai, China
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14
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Lu B, Wen J, Song XY, Dong XH, Yang YH, Zhang ZY, Zhao NQ, Ye HY, Mou B, Chen FL, Liu Y, Shen Y, Wang XC, Zhou LN, Li YM, Zhu XX, Hu RM. High prevalence of albuminuria in population-based patients diagnosed with type 2 diabetes in the Shanghai downtown. Diabetes Res Clin Pract 2007; 75:184-92. [PMID: 16893584 DOI: 10.1016/j.diabres.2006.06.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 06/05/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The prevalence of albuminuria and the risk factors associated with albuminuria were evaluated among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown. We also evaluated the variability of urinary albumin-to-creatinine ratio (ACR) among the three measurements and the relationship between diabetic retinopathy (DR) and albuminuria. METHODS The 1039 Chinese patients diagnosed with type 2 diabetes aged over 30 were investigated by randomized cluster sampling in the Shanghai downtown and 1018 patients were analyzed in this study. Body mass measurements including height, weight, waist circumference and hip circumference, resting blood pressure, fasting blood measures, urinary ACR and the digitally stored fundus images were investigated. The prevalence of albuminuria was calculated and the risk factors associated with albuminuria were evaluated by stepwise logistic regression. The concordance of urinary ACR was evaluated by observed agreement. The relationship between albuminuria and DR was also evaluated. RESULTS (1) The mean age of all patients was 66.10+/-11.54 years and the duration of diabetes was 7.89+/-7.16 years. (2) The prevalence of albuminuria was 49.6% among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown, 41.4% with microalbuminuria and 8.2% with macroalbuminuria. (3) Microalbuminuria was significantly associated with systolic blood pressure, gender and waist circumference. Macroalbuminuria was significantly associated with systolic blood pressure and duration of diabetes. (4) Observed agreement among the three urinary ACR measurement for albuminuria staging was 73.3% (first versus second), 64.5% (first versus third) and 77.5% (second versus third). Observed agreement in the albuminuria staging between the single urinary ACR measurement and all three urinary ACR measurements was 85.8% (first versus all three), 87.6% (second versus all three) and 81.9% (third versus all three). (5) The percentage of DR in the macroalbuminuric group (59.2%) was significantly higher than that in the normalbuminuria group (16.1%) and microalbuminuria group (24.6%). (6) The macroalbuminuric patients with DR had significantly increased fasting blood glucose and HbA1c compared with the macroalbuminuric patients without DR. CONCLUSION The prevalence of microalbuminuria observed in the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown reached up to 41.4% though the observations in our study might be representative of the diabetic patients of the Shanghai downtown. We agreed that at least two of the three urinary collections were done in a 3- to 6-month period because of the day-to-day variability in albumin excretion. The percentage of DR among the patients with macroalbuminuria was 59.2%, and the macroalbuminuric patients with the significantly high plasma glucose and DR were prone to diagnose DN.
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Affiliation(s)
- B Lu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University, No. 12 Wulumuqi Road, Shanghai 200040, China
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15
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Hu JM, Yu XJ, Zhao NQ, Xiao J. [Studies on the origin of different discharge pattern of the two types of phrenic motoneurones by cross-correlation analysis]. Sheng Li Xue Bao 1989; 41:163-71. [PMID: 2762842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Experiments were performed on twenty five anesthetized, paralyzed, vagotomized and artificially ventilated rabbits. Discharges of single phrenic nerve fibers were recorded. According to their discharge patterns, phrenic motoneurones were divided into two types: tonic units (TU) and phasic units (PU). A cross-correlation analysis was done between TU and TU, PU and PU, or TU and PU. In 21/36 pairs of phrenic motoneurones, the cross-correlation histogram showed a significant central peak, which represented synchronization of the pair of units resulting from a common input. There were three types of synchronization: short-term, broad peak and high frequency-oscillatory synchronization. The difference in synchronization number between heterogeneous pairs (1 TU and 1PU, 2/10 showing synchronization) and homogeneous pairs (2 TU or 2 PU, 19/26 showing synchronization) was statistically significant (x2-test, P less than 0.05). These results suggest that TU and PU have different central inputs, which result in their different discharge patterns between the TU and PU.
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