[Evaluation of the efficacy and safety of intravenous infusion of ferric derisomaltose in the treatment of iron deficiency anemia: a single-center retrospective analysis]

Objective: To investigate the clinical efficacy and safety of ferric derisomaltose injection versus iron sucrose injection in the treatment of iron deficiency anemia (IDA) . Methods: A total of 120 patients with iron deficiency anemia admitted from June 2021 to March 2023 were given intravenous iron supplementation with ferric derisomaltose to assess the efficacy and safety of hemoglobin (HGB) elevation before and after treatment. Simultaneously, the clinical effects of iron supplementation with iron sucrose were compared to those of inpatient patients during the same period. Results: Baseline values were comparable in both groups. Within 12 weeks of treatment, the elevated HGB level in the ferric derisomaltose group was higher than that of the iron sucrose group, with a statistical difference at all time points, and the proportion of HGB increased over 20 g/L in the patients treated for 4 weeks was higher (98.7%, 75.9% ). During the treatment with ferric derisomaltose and iron sucrose, the proportion of mild adverse reactions in the ferric derisomaltose group was slightly lower than that of the iron sucrose group, and neither group experienced any serious adverse reactions. The patients responded well to the infusion treatment, with no reports of pain or pigmentation at the injection site. Conclusion: The treatment of IDA patients with ferric derisomaltose has a satisfactory curative effect, with the advantages of rapidity, accuracy, and safety. Therefore, it is worthy of widespread clinical use.

[Research progress on the effects of proanthochanidins in reshaping microbiota and suppressing inflammation]

Proanthocyanidins (PCs) are a class of polyphenols that are composed of flavanate monomers and their polymers, which have antibacterial and anti-inflammatory properties with very few side effects. This article reviews the mechanism by which PCs differentially regulate microbiota, reshape microflora diversity and play a role in suppressing inflammation, providing a reference for the basic research of PCs in improving female vaginal health, and is expected to provide a new idea and breakthrough for the combined use of PCs with other antibacterial drugs in the treatment of vaginitis.

[Role and clinical significance of MUC4 gene mutations in thrombotic events in patients with classic paroxysmal nocturnal hemoglobinuria]

Objective: This study aimed to investigate the role and clinical significance of MUC4 gene mutations in thrombotic events in patients with classic paroxysmal nocturnal hemoglobinuria (PNH) patients. Methods: A retrospective analysis was conducted on the clinical data and gene sequencing results of 45 patients with classic PNH admitted to the Department of Hematology, Tianjin Medical University General Hospital, from June 2018 to February 2022. MUC4 gene mutations in patients with classic PNH were summarized, and the risk factors for thrombotic events in these patients were analyzed. Additionally, the effects of MUC4 gene mutations on the cumulative incidence and survival of thrombotic events in patients with classic PNH were determined. Results: The detection rate of MUC4 gene mutations in patients with classic PNH who experienced thrombotic events (thrombotic group) was 68.8% (11/16), which was significantly higher than that in the non-thrombotic group [10.3% (3/29) ] (P<0.001). All mutations occurred in exon 2. MUC4 mutation (OR=20.815, P=0.010) was identified as an independent risk factor for thrombotic events in patients with classic PNH. The cumulative incidence of thrombotic events was 78.6% (11/14) in the MUC4 gene mutation group (mutation group) and 16.1% (5/31) in the non-mutation group, showing a statistically significant difference between the two groups (P<0.001). Survival analysis showed a lower overall survival (OS) rate in the thrombotic group compared with that in the non-thrombotic group [ (34.4±25.2) % vs. (62.7±19.3) % ] (P=0.045). The OS rate of patients was (41.7±29.9) % in the mutation group and (59.1±18.3) % in the non-mutation group (P=0.487) . Conclusion: MUC4 gene mutations are associated with an increased incidence of thrombotic events in classic PNH patients, highlighting their role as independent risk factors for thrombosis in this population. These mutations can be considered a novel predictive factor that aids in evaluating the risk of thrombosis in patients with classic PNH.

[Utilizing ultra-small volume graft in auxiliary liver transplantation for portal hypertension]

Objective: To examine the clinical effect of auxiliary liver transplantation with ultra-small volume graft in the treatment of portal hypertension. Methods: Twelve cases of portal hypertension treated by auxiliary liver transplantation with small volume graft at Liver Transplantation Center,Beijing Friendship Hospital, Capital Medical University between December 2014 and March 2022 were studied retrospectively. There were 8 males and 4 females,aged 14 to 66 years. Model for end-stage liver disease scores were 1 to 15 points and Child scores were 6 to 11 points. The grafts was derived from living donors in 9 cases,from split cadaveric donors in 2 cases,from whole cadaveric liver of child in 1 case. The graft recipient body weight ratios of 3 cadaveric donor livers were 0.79% to 0.90%, and of 9 living donor livers were 0.31% to 0.55%.In these cases, ultra-small volume grafts were implanted. The survivals of patient and graft, complications, portal vein blood flow of residual liver and graft, abdominal drainage and biochemical indexes of liver function were observed. Results: All the grafts and patients survived. Complications included outflow tract torsion in 2 cases, acute rejection in 1 case, bile leakage in 1 case, and thyroid cancer at the later stage of follow-up in 1 case, all of which were cured. The torsion of outflow tract was attributed to the change of anastomotic angle after the growth of donor liver. After the improvement of anastomotic method, the complication did not recur in the later stage. There was no complication of portal hypertension. The measurement of ultrasonic portal vein blood flow velocity showed that the blood flow of residual liver decreased significantly in the early stage after operation, and maintained a very low blood flow velocity or occlusion in the long term after operation, and the blood flow of transplanted liver was stable. Conclusions: Auxiliary liver transplantation can implant ultra-small donor liver through compensation of residual liver. This method may promote the development of living donor left lobe donation and split liver transplantation. However, the auxiliary liver transplantation is complex, and it is difficult to control the complications. Therefore, this method is currently limited to centers that are skilled in living related liver transplantation and that have complete ability to monitor and deal with complications.

KLF11 protects chondrocytes via inhibiting p38 MAPK signaling pathway

OBJECTIVE

The purpose of this study was to explore the effects of Kruppel like factors 11 (KLF11) on oxidative stress, apoptosis, and endoplasmic reticulum stress (ERS) in osteoarthritis (OA) and its mechanism.

PATIENTS AND METHODS

Human articular cartilage tissue was used to study the correlation between KLF11 and OA. Furthermore, human chondrocytes were used to explore the effects of KLF11 on oxidative stress, apoptosis, and ERS in chondrocytes by overexpressing KLF11 and using the OA inducer IL-1β. The p38MAPK signaling pathway agonist P79350 was used to study the effect of KLF11 on the p38 MAPK signaling pathway.

RESULTS

Articular cartilage tissue in OA patients and IL-1β-induced chondrocytes expressed higher KLF11. Overexpression of KLF11 significantly reduced oxidative stress levels, apoptosis levels, and activity of ERS-related pathways in chondrocytes. Moreover, P79350 attenuated the protective effect of KLF11 on chondrocytes by activating the p38MAPK signaling pathway.

CONCLUSIONS

KLF11 protects against OA by inhibiting oxidative stress, apoptosis, and ERS in chondrocytes by inhibiting p38MAPK signaling pathway.

Metformin inhibits LPS-induced inflammatory response in VSMCs by regulating TLR4 and PPAR-γ

OBJECTIVE

This study aims to explore whether the inhibitory role of metformin could inhibit LPS-induced inflammatory response in vascular smooth muscle cells (VSMCs) and its underlying mechanism.

MATERIALS AND METHODS

VSMCs were extracted from aorta of Sprague Dawley rats. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay was performed to detect VSMCs viability after treatment with different concentrations of metformin. Levels of monocyte chemoattractant protein-1 (MCP-1), interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) in VSMCs were detected by ELISA (enzyme-linked immunosorbent assay) and qRT-PCR (quantitative Real time-polymerase chain reaction). Protein and mRNA levels of toll like receptor 4 (TLR4) and peroxisome proliferators activated receptor γ (PPAR-γ) in VSMCs were detected by Western blot and qRT-PCR, respectively. Finally, VSMCs were treated with the PPAR-γ antagonist GW9662 and inflammatory indicators in cells were detected.

RESULTS

No significant difference in VSMCs viability was found after 0-2 mM metformin treatment or 500 μg/L LPS induction for 24 h. After 500 μg/L LPS induction in VSMCs for 24 h, levels of MCP-1, TNF-α and IL-6 were remarkably elevated. Both mRNA and protein levels of TLR4 in VSMCs were upregulated after 500 μg/L LPS induction for 24 h, which were remarkably reversed by the treatment of different concentrations of metformin. Knockdown of TLR4 remarkably inhibited LPS-induced inflammatory response in VSMCs, manifesting as decreased levels of MCP1, TNF-α and IL-6, which were further downregulated after combination treatment of TLR4 knockdown and 20 mM metformin. Furthermore, both mRNA and protein levels of PPAR-γ in VSMCs were downregulated after 500 μg/L LPS induction for 24 h, which were remarkably reversed by the treatment of different concentrations of metformin. GW9662 treatment resulted in elevated expressions of MCP-1, TNF-α and IL-6, which were reversed by metformin treatment.

CONCLUSIONS

Metformin can effectively inhibit the mRNA and protein expressions of IL-6, MCP-1, and TNF-α in LPS-induced VSMCs. The anti-inflammatory effects of metformin inhibit the inflammatory response through downregulating rely on the downregulation of TLR4 expression and upregulation ofng PPAR-γ activity.

[Investigations on occupational hazards in a kitchen waste treatment plant]

Objective: To explore the distribution and intensity of kitchen waste treatment plant, providing scientific basis for occupational diseases prevention and treatment in that industry. Methods: 30 operating personnel in a kitchen waste disposal enterprise were selected as the research group and 16 non-operating personnel as the control group. The epidemiological survey was carried out in June 2015 and July 2016, and the results of occupational hazards and occupational health monitoring during 2015 to 2017 were analyzed. Results: The results of various occupational hazards factors during 2015 to 2017 were all in accordance with the occupational health limit, but the results of occupational health examination were abnormal. The occupational correlation could not be ruled out by the abnormality of electrical audiometry, electrocardiogram and Department of Dermatology examination. Conclusion: Workers in kitchen waste treatment plant are likely to suffer low-intensity, continuous health damage. There is occupational health risk in that industry. The accumulation of basic information and the improvement of relevant standards and methods are needed for further study.

[Characteristic and function of peripheral blood mononuclear cells-induced macrophages in patients with myelodysplastic syndrome]

目的

观察骨髓增生异常综合征（MDS）患者单个核细胞诱导的巨噬细胞的功能，分析其与MDS疾病发展的关系。

方法

以2014年9月至2015年12月天津医科大学总医院血液科24例MDS患者为病例组，以15名健康志愿者为正常对照组。收集外周血标本并分离单个核细胞，体外以GM-CSF诱导分化形成巨噬细胞。在光学显微镜下观察巨噬细胞的形态；使用流式细胞术检测巨噬细胞的数量及其表面受体CD206、SIRPα的表达水平；分别采用流式细胞术和免疫荧光显微镜检测巨噬细胞的吞噬功能。

结果

①MDS来源的巨噬细胞形态较正常对照差（形态不规则、细胞体积小、异形明显、无足突、数量减少），MDS外周血单个核细胞转化为巨噬细胞的转化率为（5.17±3.47）%，显著低于正常对照组的（66.18±13.43）%（t=3.529，P=0.001）；②MDS来源的巨噬细胞表面识别受体CD206的表达水平[（9.73±2.59）%]显著低于正常对照组[（51.15±10.82）%]（t=4.551，P<0.001），SIRPα的表达水平[（0.51±0.09）%]显著低于正常对照组[（0.77±0.06）%]（t=2.102，P=0.043）；③MDS来源的巨噬细胞吞噬免疫微球的吞噬指数、吞噬百分率分别为0.45±0.08、（23.69±3.22）%，显著低于正常对照组的0.92±0.07、（42.75±2.13）%（P值均<0.05），MDS来源的巨噬细胞吞噬单个核细胞的吞噬指数（0.24±0.04）显著低于正常对照组（0.48±0.96，t=3.464，P=0.001）。

结论

MDS患者外周血单个核细胞诱导形成巨噬细胞能力下降，吞噬识别受体减少，吞噬能力减弱。

Automated E-FRET microscope for dynamical live-cell FRET imaging

Acceptor-sensitised 3-cube fluorescence resonance energy transfer (FRET) imaging (also termed as E-FRET imaging) is a popular fluorescence intensity-based FRET quantification method. Here, an automated E-FRET microscope with user-friendly interfaces was set up for dynamical online quantitative live-cell FRET imaging. This microscope reduces the time of a quantitative E-FRET imaging from 12 to 3 s. After locating cells, calibration of the microscope and E-FRET imaging of the cells can be performed automatically by clicking 'Capture' button on interfaces. E-FRET imaging was performed on the microscope for living cells expressing different FRET tandem constructs. Dynamical E-FRET imaging on the microscope for live cells coexpressing CFP-Bax and YFP-Bax treated by staurosporine (STS) revealed three Bax redistribution stages: Bax translocation from cytosol to mitochondria within 10 min, membrane insertion with conformational change on mitochondrial membrane within about 30 min, and subsequent oligomerisation within about 10 min. Because of excellent user-friendly interface and stability, the automated E-FRET microscope is a convenient tool for quantitative FRET imaging of living cell. LAY DESCRIPTION: Acceptor-sensitised 3-cube fluorescence resonance energy transfer (FRET) imaging (also termed as E-FRET) is a popular fluorescence intensity-based FRET quantification methods. E-FRET measurements are currently performed manually, and a complete FRET measurement takes about 12 s. E-FRET measurement necessitates not only a skilled operator and specialised equipment but also expertise in the interpretation of FRET signals, a considerable challenge in the application of FRET technology in living cells. Furthermore, manual E-FRET microscope is hard to perform dynamical quantitative FRET measurement, the ever-increasing applications in mapping the biochemical signal transduction within cells. Here, an automated E-FRET microscope with user-friendly interfaces was set up for dynamical online quantitative live-cell FRET imaging. This microscope reduces the time of a quantitative E-FRET imaging from 12 to 3 s. After locating cells, calibration of the microscope and E-FRET imaging of the cells can be performed automatically by clicking 'Capture' button on interfaces. Because of excellent user-friendly interface and stability, the automated E-FRET microscope is a convenient tool for quantitative FRET imaging of living cell.

[Computer aided design and three-dimensional printing for apicoectomy guide template]

OBJECTIVE

To establish an apicoectomy guide template design and manufacturing method, based on multi-source data fusion, computer aided design (CAD) and fused deposition modeling (FDM). The feasibility of the guide template was preliminary evaluated by the in vitro model experiment.

METHODS

An extracted upper anterior tooth, after root canal treatment, was optical scanned, after which the extracted upper anterior tooth was poured in an apicoectomy plaster model. Cone-beam computed tomography (CBCT) scanning of the apicoectomy plaster model was performed, after which optical scanning of the plaster model for apical resection surgery was carried out. All of the relevant CBCT and optical scanning data of the extracted upper anterior tooth and the apicoectomy plaster model were introduced into the Geomagic Studio 2012 software. The multi-source data fusion technology was used to virtually simulate the three-dimensional positional relationship of the extracted tooth, the dentition, the alveolar bone and the gingival, based on which, the three-dimensional design of the apicoectomy guide template was completed in the Geomagic Studio 2012 software. With the technology of fused deposition modeling, the apical resection surgical guide template was three-dimensionally printed with the material of polylactic acid (PLA). Under the guidance of the surgical guide template, the root apical resection was performed on the plaster model. After the apicoectomy, the extracted upper anterior tooth was taken off from the apicoectomy plaster model and then was given the optical scanning. The apical resection length and angle were calculated by the function of distance measurement and angle measurement, and the results were compared with the preset values.

RESULTS

The length of the apical resection was 2.88 mm along the direction of the long axis of the tooth, which was 0.12 mm lower than the preset 3 mm. The included angle between the apical resection plane and the long axis of the tooth was 77.9°, 12.1° lower than the preset 90°.

CONCLUSION

This study successfully established a digital design and production method of apicoectomy guide template by combing the multi-source data fusion, CAD and FDM technology. The design route and the production method are feasible. The study will provide a technology and methodology reference for the development of domestic special software for the digital design of apicoectomy guide template.

Complication Follow-up With Ultrasonographic Analyses of 91 Cases With Donor Gallbladder Preservation in Living Donor Liver Transplantation of Left Lateral Sectionectomies

BACKGROUND

Preserving the donor's gallbladder during living donor liver transplantation (LDLT) is a better method for liver transplantation surgery, but not enough is known about gallbladder complications after the operation.

METHODS

We retrospectively investigated postsurgical donor gallbladder complications in clinical LDLT with gallbladder preservation. The feasibility of retaining the gallbladder during liver graft procurement is discussed. Ninety-one donors with retained gallbladder after LDLT with the hepatic left lateral sectionectomy (from June 2013 to October 2015) were retrospectively analyzed. Donors were followed for 12.6 to 40.7 months after surgery (median 26.1 months). Sonography was used to evaluate gallbladder characteristics before and after surgery.

RESULTS

Gallbladder function had recovered to almost normal 1 month after transplantation. Four donors (4.40%) experienced gallbladder enlargement that resolved after 3 days. Thickening of the gallbladder wall in 31 donors (34.07%) was restored within 2 to 75 days. Biliary sludge appeared in 9 donors (9.89%); 6 of them recovered within 3 to 34 days. Three (3.30%) and 1 donor (1.10%) suffered gallstone and gallbladder polyps, respectively, which persisted until the last follow-up.

CONCLUSION

The rate of postoperative complications of the gallbladder in donors was relative low. Preserving the gallbladder in liver transplantation donors during liver graft procurement is feasible and safe.

Outcomes of Pediatric Liver Transplantation: Deceased Donor Liver Transplantation vs Living Donor Liver Transplantation

BACKGROUND

The use of pediatric donor liver for pediatric liver transplantation (LT) remains controversial and few studies have focused on pediatric deceased donors. To address this issue, we decided to perform a retrospective research, trying to compare the clinical effects between deceased donor LTs (DDLTs) and living donor LTs (LDLTs).

METHODS

A retrospective review of pediatric LTs using grafts from deceased donors and living donors from June 2013 to August 2016 was performed. The children were divided into a DDLT group and a LDLT group based on their donor styles. The incidence of early vascular complications (VC), biliary complications, and graft and patient survival rates were observed between the 2 groups.

RESULTS

There were 217 cases of pediatric LTs performed in our hospital from June 2013 to August 2016 (83 DDLTs and 134 LDLTs). The 1-year cumulative survival rates of grafts and recipients were 89.16% and 91.57% in DDLTs, and 95.47% and 95.52% in LDLTs, respectively (P > .05). The incidence of early VC was lower in LDLTs than that in DDLTs (3.7% vs 19.3%, P < .001). The incidence of HAT in children aged less than 1 year was significantly higher in the DDLT group (P < .001) and can be up to 31.82%. The incidence of biliary complications was similar in the 2 groups (8.4% vs 13.5%, P = .285).

CONCLUSIONS

Pediatric DDLTs have similar graft and patient survival rates with LDLT. The incidence of early VC was higher in DDLTs, and children aged less than 1 year are at a higher risk of developing HAT.

Anti-TNF-α antibody alleviates insulin resistance in rats with sepsis-induced stress hyperglycemia

PURPOSE

To explore the effects and mechanisms of anti-tumor necrosis factor-α (TNF-α) antibody on insulin resistance (IR) in rats with sepsis-induced stress hyperglycemia.

METHODS

The sepsis-induced stress hyperglycemic rat model was constructed by cecal ligation and puncture combined with the intraperitoneal injection of lipopolysaccharide. The rats were randomly divided into six groups: normal control (NC) group, surgical rats (Cntl) group, high-dose anti-TNF-α antibody therapy (TNF, 6 mg/kg) group, low-dose anti-TNF-α antibody therapy (Tnf, 3 mg/kg) group, insulin therapy (INS) group, and INS + Tnf group. The blood glucose and serum insulin concentrations were detected, followed by analysis of intraperitoneal glucose tolerance test (IPGTT) and hyperinsulinemic-euglycemic clamp. Finally, the expression levels of phospho-Akt (p-Akt), Akt, p-mTOR, mTOR, nuclear factor-κB (NFκB), I kappa beta kinase (IKKβ), and suppressor of cytokine signaling (SOCS-3) were detected by western blotting.

RESULTS

There was no significant difference in blood glucose concentrations among these groups, while the serum insulin concentration in TNF and Tnf groups was lower than that in the Cntl group at postoperative 6 h (P < 0.05). IPGTT analysis revealed that blood glucose level was lower in the TNF group than that in the Cntl group (P < 0.05). The glucose infusion rate in the Cntl group was lower than that in the Tnf and TNF groups (P < 0.05). The p-Akt/Akt, p-mTOR/mTOR ratio, and expression levels of NFκB, IKKβ and SOCS-3 were lower in the drug intervention than that in the Cntl group (P < 0.05).

CONCLUSIONS

Anti-TNF-α antibody could reduce IR by inhibiting AKt/mTOR signaling pathway and the expression levels of NFκB, IKKβ, and SOCS-3 in rats with sepsis-induced stress hyperglycemia.

[Research on the negative immune regulation of NK cells in patients with primary immune thrombocytopenia]

目的

探讨原发免疫性血小板减少症（ITP）患者外周血中NK细胞及其相关细胞因子IFN-γ、IL-10、TGF-β的变化。

方法

以22例初诊ITP患者（初诊组）、20例治疗后完全缓解ITP患者（完全缓解组）为研究对象，以20名健康志愿者为对照组。采用ELISA法检测三组受试者血清IFN-γ及IL-10水平；用流式细胞术检测NK细胞（CD3⁻CD56⁺）及其Bright亚群（CD3⁻CD56^bright CD16⁻）、Dim亚群（CD3⁻CD56^dim CD16⁺）水平；采用免疫磁珠法分离NK细胞，实时荧光定量PCR检测IFN-γ、IL-10、TGF-β基因mRNA的表达，并将以上测得结果做相关性分析。

结果

①初诊组ITP患者血清IFN-γ浓度[（653.0±221.6）ng/L]高于完全缓解组[（484.4±219.5）ng/L]和对照组[（390.9±253.5）ng/L]（P值分别为0.022、0.001），血清IL-10浓度低于对照组[（52.09±26.66）ng/L对（79.44±38.43）ng/L，P=0.007]。②初诊组、完全缓解组患者外周血NK细胞比例[（9.53±3.93）%、（9.03±3.78）%]均低于对照组[（13.72±7.42）%]（P=0.013，P=0.007）；初诊患者外周血Bright亚群占NK细胞的比例高于对照组[（6.85±4.43）%对（4.05±2.81）%，P=0.032]；初诊组外周血Dim亚群占NK细胞的比例低于对照组[（93.14±4.43）%对（95.94±2.81）%，P=0.032]。③初诊组、完全缓解组及对照组NK细胞IFN-γ基因mRNA表达差异无统计学意义（P>0.05），初诊组NK细胞IL-10、TGF-β基因mRNA表达高于对照组（1.82±1.32对1.02±1.03，P=0.023；2.80±2.31对1.46±1.37，P=0.028）。外周血Bright细胞占NK细胞的比例与NK细胞IL-10及TGF-β基因mRNA表达呈正相关（r=0.424，P=0.001；r=0.432，P<0.001）。

结论

NK细胞可能通过加强分泌免疫负调控因子来代偿其数量的不足，在疾病中起保护作用。

Correlation Between Survival Interval and CD4+ T-Cell Intracellular ATP Levels in Liver Transplant Recipients

OBJECTIVE

The objectives of this study were to analyze the potential correlation between post-liver transplantation survival interval and CD4⁺ T-cell intracellular ATP (iATP) levels, and to describe the distribution of CD4⁺ T-cell iATP levels in liver transplant recipients.

METHODS

This was a retrospective analysis of clinical data of 273 patients who underwent liver transplantation from July 2010 to October 2012 in our center and achieved long-term stable survival. CD4⁺ T-cell iATP level was detected using Cylex ImmuKnow assay. Post-liver transplantation survival was analyzed.

RESULTS

CD4⁺ T-cell iATP level significantly differed among patients with different post-liver transplantation survival intervals. The peak CD4⁺ T-cell iATP levels typically occurred within the first 3 postoperative months.

CONCLUSIONS

Post-liver transplantation survival interval is correlated with CD4⁺ T-cell iATP levels.

Reconstruction of the Outflow Tract in Cross-Auxiliary Double-Domino Donor Liver Transplantation

BACKGROUND

Auxiliary liver transplantation is accepted as an effective manner to expand the liver donor pool. A difficult surgical technical challenge of the procedure is hepatic vein reconstruction of the graft.

METHODS

To resolve this problem, complex techniques are used to perform an innovative outflow tract reconstruction in the world's first cross-auxiliary double-domino donor liver transplantation with two whole liver grafts. The inferior vena cava-sparing hepatectomy technique was applied at harvest in the two domino liver donors. For each donor, the three major hepatic veins (right, middle, and left) were joined together to create one single orifice, but there was no sufficient tissue to perform a direct anastomosis.

RESULTS

The hepatic vein was reconstructed with the use of a longitudinally opened iliac vein graft from a cadaveric donor to prolong the outflow tract for the piggyback suturing.

CONCLUSIONS

This new technique might provide an innovative surgical approach for reconstructing the complex outflow tract of domino transplantation.

[Quantities and function of NK cells in patients with immune thrombocytopenia]

Objective: To investigate natural killer (NK) cell quantities and function in patients with immune thrombocytopenia (ITP) . Methods: A total of 66 ITP patients (34 newly diagnosed and 32 in complete remission) were collected from September 2015 to May 2016 in Tianjin Medical University General Hospital, and 30 healthy volunteers were recruited as controls. The percentages of NK cells and their subsets in peripheral blood, the expression of activating receptor (NKp44), inhibitory receptor (NKG2A) and CD16, perforin and granzyme β were detected by flow cytometry. The correlation between the above parameters and patients' immune status and platelet level were evaluated. Results: (1)The percentage of CD3(-)CD56(+) NK cells in newly diagnosed patients (10.99%±4.89%)and patients in complete remission (9.73%±6.75%) were significantly lower than that in healthy controls (14.67%±7.24%)(P=0.023, 0.003). The percentage of NK cells Bright subset was significantly lower in the newly diagnosed patients(0.48%±0.23%)and those in complete remission (0.41%±0.33%) than in healthy controls(0.64%±0.32%)(P=0.037, 0.002); the percentage of Dim subset was also significantly lower in the newly diagnosed (10.16%±5.02%) and patients in complete remission (8.07%±5.74%) than in healthy controls(14.16%±7.19%) (P=0.009, 0.007). (2)The proportion of Bright subset in total NK cells in new diagnosed ITP patients (6.48%±4.33%) was significantly higher than that in healthy controls (4.21%±2.70%)(P=0.020); the proportion of Dim NK cells subset in new diagnosed ITP patients (93.51%±4.33%) was significantly lower than that in healthy controls(95.79%±2.70%) (P=0.020). (3)The expression of activating receptor NKp44 in new diagnosed ITP patients was significantly lower than that in complete remission group and healthy controls[0.28%(0.95%)vs 0.61%(2.05%), 0.92%(0.90%); P=0.047, 0.048]; the expression of inhibitory receptor NKG2A in new diagnosed ITP patients was significantly higher than that in healthy controls(42.34%±23.86% vs 29.25%±12.83%, P=0.009). The proportion of CD16 was significantly lower in the newly diagnosed patients than in healthy controls(93.51%±4.33%95.79%±2.70%, P=0.020). (4)The expression of perforin in the newly diagnosed ITP patients was significantly lower than that in healthy controls [87.52%(25.29%)vs 91.55%(8.29%), P=0.025]; the expression of granzyme β in ITP patients and controls showed no statistically significant difference. (5)The level of NK cells in ITP patients was negatively correlated with CD3(+) CD8(+) T cells (r=-0.387, P=0.012) and CD5(+) CD19(+) B cells in peripheral blood (r=-0.273, P=0.028), positively correlated with the ratio of CD3(+) CD4(+) /CD3(+) CD8(+) (r=0.358, P=0.028) and peripheral platelet count (r=0.314, P=0.011). Conclusion: Deceased quantities and impaired total NK function, insufficient suppression of autoreactive T and B cells might play a role in the pathogenesis of ITP.

Correlation Between Immunosuppressive Therapy and CD4(+) T-Cell Intracellular Adenosine Triphosphate Levels in Liver Transplant Recipients

OBJECTIVE

The aim of this work was to analyze the correlation between immunosuppressive therapy and CD4(+) T-cell intracellular adenosine triphosphate (iATP) levels after liver transplantation and to describe the distribution characteristics of iATP in CD4(+) T cells among liver transplant recipients.

METHODS

We studied 172 patients who were followed regularly after liver transplantation with long-term stable conditions from July 2010 to October 2012. CD4(+) T-cell iATP levels were detected with the use of the Cylex Immuknow Assay method and analyzed retrospectively according to immunosuppressive therapy protocol.

RESULTS

There was a significant difference in CD4(+) T-cell iATP level among the recipients receiving different immunosuppressive therapy protocols after liver transplantation. CD4(+) T-cell iATP level in the FK506 group and FK506 + prednisone (Pred) groups was higher than in the FK506 + mycophenolate mofetil (MMF), FK506 + MMF + Pred, and rapamycin (Rapa) groups. CD4(+) T-cell iATP level in patients receiving an MMF protocol was lower than in the group without MMF.

CONCLUSIONS

There is a relationship between distribution immunosuppressive therapy protocol and CD4(+) T-cell iATP level after liver transplantation. MMF and Rapa lower the CD4(+) T-cell iATP level significantly.

Do environmental pollutants increase obesity risk in humans?

OBJECTIVES

Obesity has become a global epidemic and threat to public health. A good understanding of the causes can help attenuate the risk and spread. Environmental pollutants may have contributed to the rising global obesity rates. Some research reported associations between chemical pollutants and obesity, but findings are mixed. This study systematically examined associations between chemical pollutants and obesity in human subjects.

METHODS

Systematic review of relevant studies published between 1 January 1995 and 1 June 2016 by searching PubMed and MEDLINE®.

RESULTS

Thirty-five cross-sectional (n = 17) and cohort studies (n = 18) were identified that reported on associations between pollutants and obesity measures. Of them, 16 studies (45.71%) reported a positive association; none reported a sole inverse association; three (8.57%) reported a null association only; six (17.14%) reported both a positive and null association; seven (20.00%) reported a positive and inverse association; and three studies (8.57%) reported all associations (positive, inverse and null). Most studies examined the association between multiple different pollutants, different levels of concentration and in subsamples, which results in mixed results. Thirty-three studies reported at least one positive association between obesity and chemicals, such as polychlorinated biphenyls, biphenyl A, dichlorodiphenyltrichloroethane, dichlorodiphenyldichloroethylene and more. Certain chemicals, such as biphenyl A, were more likely to have high ORs ranging from 1.0 to 3.0, whereas highly chlorinated polychlorinated biphenyls were more likely to have negative ORs. Effects of chemicals on the endocrine system and obesity might vary by substance, exposure level, measure of adiposity and subject characteristics (e.g. sex and age).

CONCLUSIONS

Accumulated evidences show positive associations between pollutants and obesity in humans. Future large, long-term, follow-up studies are needed to assess impact of chemical pollutants on obesity risk and related mechanisms.

Measles Virus Infection in Pediatric Liver Transplantation Recipients

OBJECTIVE

This study was conducted to analyze the clinical characteristics and outcome of measles in pediatric liver transplant recipients.

METHODS

This study includes a retrospective data analysis of five pediatric liver transplant recipients with measles who were treated at the Liver Transplant Section, Beijing Friendship Hospital, China, from March to April 2014.

RESULTS

The clinical manifestations of measles in pediatric liver transplant recipients were serious. There were three cases complicated with pneumonia, and one with laryngitis. Two cases presented with severe measles pneumonia that developed into severe respiratory failure requiring mechanical ventilation. Four patients recovered after treatment and one patient died of respiratory failure.

CONCLUSION

Pediatric liver transplant recipients with measles are at high risk of severe pneumonia. Measles pneumonitis is frequently fatal to immunocompromised pediatric patients. Treatment should be initiated as soon as possible.

Paediatric liver re-transplantation after primary partial liver graft transplantation: a report of four cases

OBJECTIVE

To discuss rules of anatomic shifting of the porta hepatis structures of the original graft and dissection techniques for the portal vein (pull-out technique) in pediatric liver re-transplantation.

METHOD

We summarized four cases of paediatric liver re-transplantation. The main donor type is partial liver graft especially using the left lateral lobe.

RESULT

In paediatric liver re-transplantation, gross morphological changes were observed in the liver, and the spatial position of the porta hepatis structures was shifted clockwise (with the anastomosis of the hepatic vein as the origin). Preoperative three-dimensional imaging showed that segment 3 of the liver graft increased in a compensatory manner. The pull-out technique could expose the surgical field without dissection and separation, and reduce the technical difficulty of identifying and dissociating the anatomical structures.

CONCLUSION

Changes in the spatial location and structure of the liver portal anatomy increase the difficulties and risks of surgery. We can reduce the difficulty of surgical anatomy, and the risk of bleeding and injury and increase the safety of paediatric liver re-transplantation by evaluation and the application of special techniques.

Electron transfer driven highly valent silver for chronic wound treatment

This paper shows that reducing the dose of silver, additionally conferring electron transfer potential, could simultaneously achieve good biocompatibility and strong bactericidal ability without introducing extra chemical residuals for chronic wound treatment.

Investigation of several biomarkers associated with diabetic nephropathy

OBJECTIVE

The aim of this study was to facilitate the systematic discovery of diagnostic biomarkers of diabetic nephropathy (DN).

METHODS

3 publicly available independent cohorts were got from Gene Expression Omnibus database. Gene expression array were used to screen for genome-wide relative significance (GWRS) and genome-wide global significance (GWGS). The most significant up- and down-regulated top 100 gene signatures were identified using a fold change based model. Then the protein-protein interaction (PPI) network was constructed, while the hub genes in this PPI network were identified by centrality analysis. Modules detection was performed to explore the functions of the modules. Meanwhile, gene enrichment analysis was performed to illuminate the biological pathways and processes associated with DN.

RESULTS

The most significant up- and down-regulated top 100 gene signatures were identified and a PPI network was established. Several hub genes (VEGFA, IL8, MYC, CD14, ALB) were discovered. Several functional modules were revealed. Biological pathways including cytokine-cytokine receptor interaction and p53 signaling pathway, and processes including inflammatory response, response to wounding and enzyme linked receptor protein signaling pathway were identified.

CONCLUSION

Our study displayed underlying biomarkers including biological pathways and several hub genes of DN.

Danshensu-mediated protective effect against hepatic fibrosis induced by carbon tetrachloride in rats

The culprit of hepatic fibrosis (HF) is linked to suprathreshold deposition of collagen. Thus, collagen reduction by improved metabolism contributes to HF management. In this study, we aimed to investigate the hepatoprotective effects of Danshensu (DSS) against carbon tetrachloride (CCl4)-induced HF rats. The results showed that DSS-administrated rats resulted in decreasing in hepatosomatic indexes, and lowering serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Meanwhile, the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) were increased, while the content of malonaldehyde (MDA) was lessened in liver tissue of DSS administration group. In addition, the pro-fibrotic markers of hydroxyproline (Hyp), type III procollagen (PCIII) and hyaluronic acid (HA) contents were decreased. Histopathological examination confirmed that the hepatotoxicity in CCl4-injured rats was alleviated following the DSS administration. Furthermore, intrahepatic protein expressions of alpha-smooth muscle actin (α-SMA), phosphorylated JAK2 (p-JAK2) and phosphorylated STAT3 (p-STAT3) were effectively down-regulated, respectively. Overall, this work demonstrates that DSS played the protective effect against CCl4-induced cytotoxicity in liver tissue, which the probable mechanism is associated with attenuation of lipid peroxidation, collagen accumulation and enhancement of anti-oxidative defense capability, as well as regulation of intrahepatic JAK/STAT pathway for maintaining collagenic homoeostasis.

Methylated Glutathione S-transferase 1 (mGSTP1) is a potential plasma free DNA epigenetic marker of prognosis and response to chemotherapy in castrate-resistant prostate cancer

Background:

Glutathione S-transferase 1 (GSTP1) inactivation is associated with CpG island promoter hypermethylation in the majority of prostate cancers (PCs). This study assessed whether the level of circulating methylated GSTP1 (mGSTP1) in plasma DNA is associated with chemotherapy response and overall survival (OS).

Methods:

Plasma samples were collected prospectively from a Phase I exploratory cohort of 75 men with castrate-resistant PC (CRPC) and a Phase II independent validation cohort (n=51). mGSTP1 levels in free DNA were measured using a sensitive methylation-specific PCR assay.

Results:

The Phase I cohort identified that detectable baseline mGSTP1 DNA was associated with poorer OS (HR, 4.2 95% CI 2.1–8.2; P<0.0001). A decrease in mGSTP1 DNA levels after cycle 1 was associated with a PSA response (P=0.008). In the Phase II cohort, baseline mGSTP1 DNA was a stronger predictor of OS than PSA change after 3 months (P=0.02). Undetectable plasma mGSTP1 after one cycle of chemotherapy was associated with PSA response (P=0.007).

Conclusions:

We identified plasma mGSTP1 DNA as a potential prognostic marker in men with CRPC as well as a potential surrogate therapeutic efficacy marker for chemotherapy and corroborated these findings in an independent Phase II cohort. Prospective Phase III assessment of mGSTP1 levels in plasma DNA is now warranted.

Knockdown of cancerous inhibitor of protein phosphatase 2A may sensitize NSCLC cells to cisplatin

Cancerous inhibitor of protein phosphatase 2A (CIP2A) is a recently identified human oncoprotein that can stabilize some proteins by inhibiting degradation mediated by protein phosphatase 2A (PP2A) and it increases the proliferation of several cancer cells. Recent studies have highlighted a potential role for CIP2A in promoting tumor progression and metastasis. However, whether CIP2A could increase chemoresistance of cancer cells to chemotherapeutic agent cisplatin remains unclear. To determine whether CIP2A serves as a potential therapeutic target of human non-small-cell lung cancer (NSCLC), we utilized small interference RNA (siRNA) to knock down CIP2A expression in human NSCLC cells and analyzed their phenotypic changes. The data demonstrated that CIP2A silencing led to decreased proliferation, impaired clonogenicity and enhanced chemosensitivity and apoptosis to cisplatin in human NSCLC cells, as well as reduced Akt phosphorylation. In addition, overexpression of CIP2A diminished NSCLC cell chemosensitivity to cisplatin by inducing activation of Akt pathway, suggesting critical roles of CIP2A in NSCLC cell chemoresistance to cisplatin and rasing the possibility of CIP2A inhibition as a promising approach for lung cancer therapy.

Fas/FasL in the immune pathogenesis of severe aplastic anemia

Fas/FasL protein expression of bone marrow hematopoietic cells was investigated in severe aplastic anemia (SAA) patients. Fas expression was evaluated in CD34(+), GlycoA(+), CD33(+), and CD14(+) cells labeled with monoclonal antibodies in newly diagnosed and remission SAA patients along with normal controls. FasL expression was evaluated in CD8(+) cells in the same manner. In CD34(+) cells, Fas expression was significantly higher in the newly diagnosed SAA group (46.59 ± 27.60%) than the remission (6.12 ± 3.35%; P < 0.01) and control (8.89 ± 7.28%; P < 0.01) groups. In CD14(+), CD33(+), and GlycoA(+) cells, Fas levels were significantly lower in the newly diagnosed SAA group (29.29 ± 9.23, 46.88 ± 14.30, and 15.15 ± 9.26%, respectively) than in the remission (47.23 ± 31.56, 67.22 ± 34.68, and 43.56 ± 26.85%, respectively; P < 0.05) and normal control (51.25 ± 38.36, 72.06 ± 39.88, 50.38 ± 39.88%, respectively; P < 0.05) groups. FasL expression of CD8(+) cells was significantly higher in the newly diagnosed SAA group (89.53 ± 45.68%) than the remission (56.39 ± 27.94%; P < 0.01) and control (48.63 ± 27.38%; P <0.01) groups. No significant differences were observed between the remission and control groups. FasL expression in CD8(+) T cells was significantly higher in newly diagnosed patients, and CD34(+), CD33(+), CD14(+), and GlycoA(+) cells all showed Fas antigen expression. The Fas/FasL pathway might play an important role in excessive hematopoietic cell apoptosis in SAA bone marrow. Furthermore, CD34(+) cells are likely the main targets of SAA immune injury.

Development of a mini-tablet of co-grinded prednisone-Neusilin complex for pediatric use

The purpose of this study is to enhance the dissolution rate of prednisone by co-grinding with Neusilin to form a complex that can be incorporated into a mini-tablet formulation for pediatrics. Prednisone-Neusilin complex was co-grinded at various ratios (1:1, 1:3, 1:5, and 1:7). The physicochemical properties of the complex were characterized by various analytical techniques including: differential scanning calorimetry (DSC), X-ray powder diffraction (XRPD), scanning electron microscope (SEM), particle size, surface area, solubility, and dissolution rate. The co-grinded prednisone-Neusilin complex (1:7) was blended with other excipients and was formulated into a 2-mm diameter mini-tablet. The mini-tablets were further evaluated for thickness, weight, content uniformity, and dissolution rate. To improve taste masking and stability, mini-tablets were coated by dip coating with Eudragit® EPO solution. DSC and XRPD results showed that prednisone was transformed from crystalline state into amorphous state after co-grinding with Neusilin. Particle size, surface area, and SEM results confirmed that prednisone was adsorbed to Neusilin's surface. Co-grinded prednisone-Neusilin complex (1:7) had a solubility of 0.24 mg/mL and 90% dissolved within 20 min as compared to crystalline prednisone which had a solubility of 0.117 mg/mL and 30% dissolved within 20 min. The mini-tablets containing co-grinded prednisone-Neusilin complex (1:7) exhibited acceptable physicochemical and mechanical properties including dissolution rate enhancement. These mini-tablets were successfully dip coated in Eudragit® EPO solution to mask the taste of the drug during swallowing. This work illustrates the potential use of co-grinded prednisone-Neusilin to enhance solubility and dissolution rate as well as incorporation into a mini-tablet formulation for pediatric use.

Celiac artery compression syndrome: a radiological finding without clinical symptoms?

The aim of the paper is to determine the incidence of celiac artery compression (CAC) based on computed tomography (CT) scan and correlate the findings to the clinical presentation of patients presenting for CT scan in a hospital. Abdominal CT scans of patients were reviewed between September 2010 and November 2010. CAC was diagnosed if the celiac axis appeared to have a hook or U-shaped appearance with stenosis. The medical records of the patients were reviewed for gastrointestinal symptoms (abdominal pain, nausea, vomiting, constipation, diarrhea), as well as food fear and weight loss. Patients with CAC had lower incidence of symptoms compared with those without CAC (42.1 versus 65.3%, P = 0.042). A total of 450 patients were evaluated. In the end, 284 had both complete medical records and CT scans. The mean age for all patients was 51.3 ± 1.2 years. There were 124 men (42.6%) and 160 (57.4%) women. Nineteen (6.7%) patients had radiological evidence of CAC. CAC is not an uncommon CT finding in patients presenting for CT scan.

Oesophageal squamous cell carcinoma: relationship between fluorine-18 fludeoxyglucose positron emission tomography CT maximum standardised uptake value, metabolic tumour volume, and tumour, node and metastasis classification

OBJECTIVES

We aimed to evaluate the relationships between primary tumour, maximum standardised uptake value, metabolic tumour volume and seventh edition American Joint Committee on Cancer (AJCC) classification in oesophageal squamous cell carcinoma (OSCC) patients.

METHODS

Fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)-CT scans of 41 consecutive newly diagnosed OSCC patients were retrospectively reviewed. Maximum standard uptake value (SUV(max)) and metabolic tumour volume (MTV) were recorded. Two-tailed Spearman's correlation was used to analyse the relationships between the metabolic parameters and the AJCC staging system.

RESULTS

Positive correlations were observed between SUV(max), MTV and tumour (T) stage, in addition to node (N) stage and AJCC stage. Both metabolic parameters were independent variables that significantly affected the N stage and AJCC stage, and SUV(max) was the only independent variable that significantly affected the T stage.

CONCLUSION

The metabolic parameters derived from (18)F-FDG PET-CT were positively correlated with T, N and AJCC stage in primary OSCC. Our findings may suggest a complementary role of these parameters to seventh-edition AJCC staging in the prognostication of OSCC patients.

Operative treatment of clavicle midshaft fractures using a locking compression plate: comparison between mini-invasive plate osteosynthesis (MIPPO) technique and conventional open reduction

HYPOTHESIS

The goal of the present study was to compare minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and conventional open reduction with LCP for the treatment of clavicle midshaft fractures in adults in a randomized, controlled, clinical trial with a minimum of 1-year follow-up.

MATERIALS AND METHODS

Between June 2006 and May 2008, 64 cases of open reduction and internal plate fixation were performed for clavicle midshaft fractures. The operative indications were complete displacement, severe comminution and marked shortening of the clavicle (>2cm). MIPPO and conventional open reduction surgery procedures with LCP were used in 32 and 32 cases, respectively.

RESULTS

The mean time to union was 13 weeks in the open reduction group compared to 12 weeks in MIPPO group (P>0.05). The MIPPO group had no significantly superior Constant shoulder scores or DASH scores at all time-points (P>0.05). However, the complications in the open reduction group were dysesthesia in the area of the incision and directly below in 10 cases, hypertrophic scarring in five cases, painful shoulder in two cases and a limitation of shoulder motion in one case (P>0.05). The complications in the MIPPO group were dysesthesia in two cases, no hypertrophic scarring, no painful shoulder, no limitation of shoulder motion were noted (P<0.05). Patients in this operative group were more satisfied with cosmetic appearance and overall outcome than those in the conventional open reduction group.

CONCLUSIONS

Operative treatment with a LCP for clavicle shaft fractures can be used to obtain stable fixation. Particularly, MIPPO of displaced midshaft clavicular fractures resulted in a lower rate of dysesthesia, hypertrophic scarring, and a better cosmetic than conventional open reduction, although the functional outcomes (Constant and DASH) were no different between the two groups. Overall satisfaction was higher in the MIPPO group than conventional open reduction group.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

Prognostic and diagnostic significance of DNA methylation patterns in high grade serous ovarian cancer

OBJECTIVE

Altered DNA methylation patterns hold promise as cancer biomarkers. In this study we selected a panel of genes which are commonly methylated in a variety of cancers to evaluate their potential application as biomarkers for prognosis and diagnosis in high grade serous ovarian carcinoma (HGSOC); the most common and lethal subtype of ovarian cancer.

METHODS

The methylation patterns of 10 genes (BRCA1, EN1, DLEC1, HOXA9, RASSF1A, GATA4, GATA5, HSULF1, CDH1, SFN) were examined and compared in a cohort of 80 primary HGSOC and 12 benign ovarian surface epithelium (OSE) samples using methylation-specific headloop suppression PCR.

RESULTS

The genes were variably methylated in primary HGSOC, with HOXA9 methylation observed in 95% of cases. Most genes were rarely methylated in benign OSE, with the exception of SFN which was methylated in all HGSOC and benign OSE samples examined. Methylation of DLEC1 was associated with disease recurrence, independent of tumor stage and suboptimal surgical debulking (HR 3.5 (95% CI:1.10-11.07), p=0.033). A combination of the methylation status of HOXA9 and EN1 could discriminate HGSOC from benign OSE with a sensitivity of 98.8% and a specificity of 91.7%, which increased to 100% sensitivity with no loss of specificity when pre-operative CA125 levels were also incorporated.

CONCLUSIONS

This study provides further evidence to support the feasibility of detecting altered DNA methylation patterns as a potential diagnostic and prognostic approach for HGSOC.

High density and scale-up cultivation of recombinant CHO cell line and hybridomas with porous microcarrier Cytopore

Using porous microcarrier Cytopore and a low-serum medium supplement BIGBEF-3, we have successfully cultivated recombinant CHO cell line CL-11G producing prourokinase and hybridomas producing anti-prourokinase monoclonal antibody in Celligen 1.5 or 5 L bioreactor. The cell density obtained ranged from 1 to 2 x 107 cells mL-1. The yields of prourokinase and monoclonal antibody increased with increasing cell density. As the cells could spontaneously release from and reattach to porous microcarriers, it was very easy to scale-up the cultivation. Thus the bead to bead cell transfer method has been used to scale up the cultivation of CL-11G cells to a 20 L reactor-scale for the pilot production of prourokinase, and also to scale-up the culture of hybridomas for the production of monoclonal antibody for the purification of prourokinase.

Untangling function: measuring the severity, type and meaning of disabilities

In this commentary, we argue that the current biomedical and psychosocial models of illness that form the basis of medicine are insufficient to describe this interface. We offer a biopsycho-ecological model of illness and disability referred to as health environmental integration (HEI) as a framework intended to encourage a more complete understanding of disability as arising at the interface between the person's internal and external worlds. By this model, person-level functional abilities as well as the subjective meaning of those functions result in part from interactions created by the exchange of energy and information between the person and his environment. Three components are essential in measuring function: severity of deficit, type of deficit, and meaning. We present functional status staging as an approach to measuring severity and type of deficit, and recovery preference exploration as a way to measure meaning. Rehabilitation medicine can come closer to bridging the gap between biological and the subjectively-based aspects of human function, by measuring all three concepts.