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Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums

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World Journal of Critical Care Medicine 2015年第3期4卷 202-212页

作者： Sachin Gupta Ravindranath Tiruvoipati cameron green John Botha Huy Tran Department of Intensive Care Medicine Frankston Hospital School of Public Health Faculty of Medicine Nursing and Health Sciences Monash University Department of Oncology Frankston Hospital

Thrombocytopenia is often noted in critically ill patients. While there are many reasons for thrombocytopenia, the use of heparin and its derivatives is increasingly noted to be associated with thrombocytopenia. Heparin induced thrombocytopenia syndrome(HITS) is a distinct entity that is characterised by the occurrence of thrombocytopenia in conjunction with thrombotic manifestations after exposure to unfractionated heparin or low molecular weight heparin. HITS is an immunologic disorder mediated by antibodies to heparin-platelet factor 4(PF4) complex. HITS is an uncommon cause of thrombocytopenia. Reported incidence of HITS in patients exposed to heparin varies from 0.2% to up to 5%. HITS is rare in ICU populations, with estimates varying from 0.39%-0.48%. It is a complex problem which may cause diagnostic dilemmas and management conundrum. The diagnosis of HITS centers around detection of antibodies against PF4-heparin complexes. Immunoassays performed by most pathology laboratories detect the presence of antibodies, but do not reveal whether the antibodies are pathological. Platelet activation assays demonstrate the presence of clinically relevant antibodies, but only a minority of laboratories conduct them. Several anticoagulants are used in management of HITS. In this review we discuss the incidence, pathogenesis, diagnosis and management of HITS.

关键词： Heparin Thrombocytopenia Critically ill Diagnosis Management

Construction and expression of a Rev-dependent TNF-R1 expressing HIV-infected-cell injurious vectors

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Chinese Medical Journal 2005年第24期118卷 2063-2071页

作者： SHI Wei-min Dean Baylis Damian Purcell Paul U cameron Department of Dermatology and Venereology Tongji HospitalTongji University Shanghai 200065 China Department of Microbiology and Immunology University ofMelbourne Parkville Victoria 3052 Australia

Background Rev is necessary for exporting unspliced and incompletely spliced intron containing HIV mRNAs and for HIV replication. The aim of this study is to develop a kind of selective suicide construct that can specifically and directly induce HIV infected cells into apoptosis based on the high affinity of Rev and Rev response element （RRE）. Methods Molecular-cloning technique was used to synthesis Rev dependent TNF-R1 expression construct pDM128-TNF-R1 （pT128） that contains RRE and TNFR1 gene. Restriction digestion, Polymerase Chain Reaction （PCR） and DNA sequencing were processed and the exactness and correctness of the inserted TNF-R1 gene in pT128 were confirmed repeatedly. The expression of pT128 co-transfected with different combination of other plasmids by calcium phosphate-DNA co-precipitation in Helas and by gene gun transfection in keratinocytes was further tested by flow-cytometry and cell counted under microscope. Results The new plasmid specifically expressed TNF-R1 in Helas when co-transfected with pRev but did not when without pRev. Indirect expression of TNF-R1 from pT128 was slower than the direct expression of that from Hu p60 TNFR1 in pDC302 （pT60） , but all those pT60 or pT128 transfected cells showed apoptosis at last while TNF-R1 was sufficiently expressed. Other kinds of Rev expression construct such as pAD8 and a chimeric HIV vaccine also can switched on the selective expression of pT128. Not only Rev-dependent expression in Helas, pT128 also normally expressed its TNF-R1 in keratinocytes. Co-transfected with prey or pAD8 that expressed Rev, pT128 expressed TNF-R1 and induced apoptosis of green fluorescent keratinocytes in skin explant. The number of green fluorescent keratinocytes co-transfected by pT128 plus prey or pAD8 was gradually outnumbered by that co-transfected by pT128 only. The difference was more significant after culturing for 72 hours. Conclusions Rev dependent pT128 is able to selectively induce apoptosis of HIV-infect

关键词： human immunodeficiency virus tumor necrosis factor receptor apoptosis vaccine

Resilient and Inclusive Prosperity within Planetary Boundaries

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China & World Economy 2014年第5期22卷 76-92页

作者： cameron Hepburn Eric Beinhocker J.Doyne Farmer Alexander Teytelboym Institute for New Economic Thinking at Oxford Martin School the Smith School of Enterprise and the Environment University of Oxford the Grantham Research Institute at the London School of Economics and Political Science Institute for New Economic Thinking at the Oxford Martin School Blavatnik School of Government University of Oxford Mathematical Institute University of Oxford University of Oxford Laboratory for Information and Decision Systems Massachusetts Institute of Technology

The current model of economic growth generated unprecedented increases in human wealth and prosperity during the 19th and 2Oth centuries. The main mechanisms have been the rapid pace of technological and social innovation, human capital accumulation, and the conversion of resources and natural capital into more valuable forms of produced capital. However, there is evidence emerging that this model may be approaching environmental limits and planetary boundaries, and that the conversion of natural capital needs to slow down rapidly and then be reversed Some commentators have asserted that in order for this to occur, we will need to stop growing altogether and, instead, seek prosperity without growth. Others argue that environmental concerns are low-priority luxuries to be contemplated once global growth has properly returned to levels observed prior to the 2008 financial crisis. A third group argues that there is no trade-off and, instead,, promotes green growth： the （politically appealing） idea is that we can simultaneously grow and address our environmental problems. This paper provides a critical perspective on this debate and suggests that asubstantial researc＇h agenda is required to come to grips with these challenges. One place to start is with the relevant metrics： measures of per-capitawealth, and, eventually, quantitative measures of prosperity, alongside a dashboard of other sustainability indicators. A public andpoliticalfocus on wealth （a stock）, and its annual changes, could realistically complement the current focus on market-based gross output as measured by GDP （a flow）. This could have important policy implications, but deeper changes to governance and business models will be required.

关键词： green growth limits to growth planetary boundaries resilience sustainable prosperity

Rev依赖性人类免疫缺陷病毒检测结构的合成与表达

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上海医学 2003年第S1期26卷 30-33页

作者：施伟民 Paul U cameron Damian JF Purcell 同济大学附属同济医院皮肤科上海200065 Department of Microbiology and Immunology Melbourne University Macfalane Burnet Centre for Medical Research

目的　利用人类免疫缺陷病毒 (HIV)低变异的调节蛋白Rev与Rev反应区 (RRE)的高亲和性 ,尝试合成一种不受变异影响的特异性病毒表达检测结构。方法　采用分子克隆技术合成含有RRE和增强的绿荧光蛋白 (EGFP)的Rev依赖性荧光表达质粒 ,采... 详细信息

目的　利用人类免疫缺陷病毒 (HIV)低变异的调节蛋白Rev与Rev反应区 (RRE)的高亲和性 ,尝试合成一种不受变异影响的特异性病毒表达检测结构。方法　采用分子克隆技术合成含有RRE和增强的绿荧光蛋白 (EGFP)的Rev依赖性荧光表达质粒 ,采用流式细胞仪检测新质粒的表达功能。结果　新合成的质粒pDM 12 8 EGFP (pE12 8)含氨苄青霉素受体 (AmpR)选择子、SV40 启动子、EGFP基因及HIV 1 RRE片段 ,BssSI酶切后产生 3 .6、1.9和 1.5kb片断 ,HindⅢ酶切后产生 3 470、2 72 5和 879bp 3个片断 ,PCR扩增提示EGFP基因完整插入。pE12 8在Hela细胞中显示Rev依赖性表达 ,pRev不存在时 ,几乎没有EGFP表达 ;pRev存在时 ,EGFP显著表达 (P <0 .0 1)。绿荧光Hela细胞百分比随pRev比例的增加而渐次增加。结论　pE12 8能特异、敏感、快速和直观地检测HIV的表达 ,对反映HIV的感染性及病情的转归及对获得性免疫缺陷综合征 (AIDS)

关键词： RNA结合蛋白 Rev反应区绿荧光蛋白分子克隆流式细胞仪

拥抱绿色发展新范式:中国碳中和政策框架研究

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世界经济 2023年第3期46卷 3-30页

作者：朱民 Nicholas Stern Joseph E.Stiglitz 刘世锦张永生李俊峰 cameron Hepburn 中国国际经济交流中心中国人民银行英国伦敦政治经济学院格兰瑟姆研究所哥伦比亚大学商学院全国政协经济委员会中国环境与发展合作委员会中国社会科学院生态文明研究所红杉中国牛津大学马丁学院

中国以及全球范围的碳中和共识与行动标志着工业革命后形成的传统发展范式逐渐落幕,一个新的绿色发展范式开始兴起。本文分析工业革命以来旧有发展范式的不可持续性,揭示绿色发展范式在发展目的、发展内容、发展方式以及发展普适性上,... 详细信息

中国以及全球范围的碳中和共识与行动标志着工业革命后形成的传统发展范式逐渐落幕,一个新的绿色发展范式开始兴起。本文分析工业革命以来旧有发展范式的不可持续性,揭示绿色发展范式在发展目的、发展内容、发展方式以及发展普适性上,是对传统发展范式的一次深刻革命。在新的绿色发展范式框架下,本文重新思考经济学的基本问题如价值理论、财富的内涵和测度,以及个人和集体行为等,分析新发展范式转变对于重塑中国重要经济部门和系统的政策含义,并讨论了转型过程中体制机制、金融和技术创新等方面的重要保障,以及如何实现协调和平衡的转型。本文同时提出中国如何引领世界碳中和治理机制建设,并讨论了同世界实现绿色合作共赢的机遇和政策。

关键词：碳中和范式转变政策框架经济发展国际合作