复方5-氨基水杨酸控释胶囊治疗溃疡性结肠炎340例观察

目的 :为了探讨溃疡性结肠炎的药疗方案。方法 :对 380例溃疡性结肠炎病人分别接受复方 5 -氨基水杨酸 (5 -ASA)控释胶囊口服和安慰剂胶囊口服。结果 :疗效统计表明 :5 - ASA治疗组和安慰剂对照组的完全缓解率分别为 70 %和 10 % ,具有统计学意义 (P<0 .0 0 1) ;两组病人的溃疡性结肠炎活动指数下降分别为 1.5± 1.5和 7.6± 1.2 ,同样具有统计学意义 (P<0 .0 0 1)。结论 :5 - ASA控释胶囊口服对溃疡性结肠炎有理想的疗效。     

Is Asacol as effective as sulphasalazine in maintaining remission of Crohn's disease and ulcerative colitis?

To compare the efficacy of Asacol (mesalazine coated with Eudraget-S) as a maintenance therapy with that of sulphasalazine, relapse rates of patients with ulcerative colitis and Crohn''s disease, treated with sulphasalazine or Asacol were assessed in a retrospective study. A total of 164 patients were investigated, 127 on sulphasalazine and 37 on Asacol. None of the patients on Asacol was changed from sulphasalazine because of lack of efficacy to sulphasalazine. Relapse rates were measured over a 4 year period. In ulcerative colitis these were sulphasalazine 10/77 (13.0%), Asacol 5/20 (25.0%), NS; in all Crohn''s disease patients, sulphasalazine 12/50 (24.0%), Asacol 11/17 (64.7%); P less than 0.0025. In patients with Crohn''s disease with ileal involvement, relapse rates were sulphasalazine 9/28 (32.1%), Asacol 9/11 (81.6%), P less than 0.0125; without ileal involvement, sulphasalazine 3/22 (13.6%), Asacol 2/6 (33.4%), NS. This study suggests that Asacol is as effective as sulphasalazine in maintaining remission in ulcerative colitis and in patients with Crohn''s disease without ileal involvement. Sulphasalazine seems to be more effective than Asacol in maintaining remission in patients with Crohn''s disease with terminal ileal involvement.     

Detection of the level of urinary FPA in chronic nephritis with renal failure and its clinical implication

Hypercoagulablestatehasbeenfoundinthepatientswithchronicglomeru-lonephritis(chronicnephritis).Inthisstudy,the1evelsofurinaryFPAwereex-aminedbyusinghighperformanceliquidchromatography(HPLC)toexploretheclinicalimplicationofurinary'FPAinpa-tientswithchronicglomerulonephritis.1PAT1ENTSANDMETHoDS1'1SubjectsWestudied57patientswithprimarychronicnephritisselectedfromtwoaffiliat-edhospitals,XieheHospita1andTongjiHospital,ofTongjiMedicalUniversity.Theyallhadreceivedconservativetreat-ment.T…     

阿尔茨海默病患者血清补体C5a水平及其与炎症因子的相关性

目的 探讨阿尔茨海默病(Alzheimer's disease,AD)患者血清补体C5a水平及其与炎症因子的相关性,阐明其临床意义。 方法 选择杭州市第七人民医院2018年1月—2018年12月的AD患者110例作为AD组,同期健康体检者110例作为对照组。测定血清C5a水平及血清高敏C-反应蛋白(high sensitive C-reaction protein,hs-CRP)、白细胞介素1β(interleukin-1β,IL-1β)、IL-6、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平。 结果 AD组简易精神状态量表(simple mental state scale,MMSE)评分[(15.62±3.21)分]低于对照组[(29.34±3.82)分],t=28.839,P<0.05,C5a水平[(73.51±9.42)pg/mL]高于对照组[(64.29±9.34)pg/mL],t=7.290,P<0.05。AD组血清hs-CRP、IL-1β、IL-6、TNF-α水平[(5.03±0.60)pg/mL、(37.49±7.46)pg/mL、(105.34±13.13)pg/mL、(196.54±12.06)pg/mL]高于对照组(t=45.395、9.939、25.704、7.086,均P<0.05)。AD患者血清C5a、hs-CRP、IL-1β、IL-6、TNF-α水平与MMSE评分均呈负相关(r=-0.421、-0.523、-0.436、-0.445、-0.507,均P<0.05)。AD患者血清C5a与血清hs-CRP、IL-1β、IL-6、TNF-α水平均呈正相关(r=0.564、0.602、0.641、0.539,均P<0.05)。 结论 AD患者血清补体C5a水平升高,C5a水平与AD患者认知功能和血清炎症因子水平关系密切。      

Association of serum uric acid levels with the progression of Parkinson’s disease in Chinese patients

Background  Uric acid (UA) is suspected to play a neuro-protective role in Parkinson’s disease (PD). This study aimed to evaluate whether the serum UA level was associated with the disease progression of PD in a relatively large population of Chinese patients.

Methods  Serum UA levels were measured from 411 Chinese PD patients and 396 age-matched controls; following the uric acid colorimetric method, the serum creatinine (Scr) levels were also measured to reduce the bias caused by possible differences in renal excretion function. The disease progression was scored by Hoehn and Yahr (H&Y) scales and disease durations; PD group was divided into 3 subgroups according to H&Y scales. Independent-samples t test was performed to analyze the differences between PD group and control group. Multiple analysis of covariance was performed to analyze the differences between PD subgroups. Spearman rank-correlation was performed to evaluate the associations between serum UA or Scr level and disease progression.

Results  PD patients were found to have significantly lower levels of serum UA than controls ((243.38±78.91) vs. (282.97±90.80) µmol/L, P <0.01). As the disease progression, the serum UA levels were gradually reduced. There was a significantly inverse correlation of UA levels with H&Y scales (Rs= –0.429, P <0.01) and disease duration (Rs= –0.284, P <0.01) in PD patients of both females and males. No significant difference of the Scr level between PD patients and controls was found ((70.01±14.70) vs. (69.84±16.46) µmol/L), and the Scr level was not involved in disease progression.

Conclusion  Lower serum UA levels may possess a higher risk of PD, which may be a potential useful biomarker to indicate the progression of PD.

     

Effect of Shengmai injection (生脉注射液) on vascular endothelial and heart functions in patients with coronary heart disease complicated with diabetes mellitus

Objective： To study the effect of Shengmai injection （生脉注射液, SMI） on vascular endothelial and heart functions in coronary heart disease patients complicated with diabetes mellitus （CHD-DM）. Methods： One hundred and twenty patients with CHD-DM, their diagnosis confirmed by coronary arteriography, were equally randomized into a control group treated with conventional treatment and a treated group treated with conventional treatment plus SMI. The changes in blood levels of nitric oxide （NO）, endothelin-1 （ET-1） and angiotensin Ⅱ （Ang Ⅱ）, as well as endothelium-dependent vascular dilating function and heart function in the patients were observed before treatment and after the 3-week treatment. Results： After being treated with SMI for 3 weeks, in the treated group, blood level of NO was raised significantly from 69.8±33.1 μmol/L to 120.1±50.8μmol/L, and ET-1 was lowered from 70.1±32.1 ng/L to 46.2±21.3 ng/L, respectively （P〈0.01）; that of Ang Ⅱ was lowered from 81.3±24.3 ng/L to 50.2±27.3 ng/L （P〈0.01）; brachial arterial post-congestion blood flow increasing rate was raised from 389.4±26.3% to 459.3±27.8% （P〈0.01）; and the improvement in heart function as seen through the ejection fraction （EF） was increased from 44±5% to 68±6% （P〈0.01）, all the changes being more significant than those in the control group （all P〈0.01）. Conclusion： SMI can improve not only the endothelial function in CHD-DM patients, but also heart contraction significantly.     

E-health: Web-guided therapy and disease self-management in ulcerative colitis. Impact on disease outcome, quality of life and compliance

Ulcerative Colitis (UC) together with Crohn's disease (CD) belongs to inflammatory bowel diseases (IBD). IBD is to date as frequent as Insulin Dependent Diabetes (IDDM) and is second to Rheumatoid Arthritis (RA) in its chronicity. The majority (91%) of patients with UC have a mild to moderate disease course eligible for 5-ASA treatment. Poor adherence in UC is a well known phenomenon, which is associated with a 5-fold increased risk of relapse and increased health care costs. Web-based treatment solution with self-initiated 5-ASA treatment in UC based on the patient's pattern recognition of the disease course had not been published previously. The aims of the thesis were: 1) In a European evidence based consensus to assess the IBD patients' need for Quality of Health Care (QoHC); 2) To validate the influence of a Patient Educational Center (PEC) and a web-based treatment solution program, www.constant-care.dk, on patients' disease self-management, adherence, Quality of Life, and disease course after 1 year of self-initiated 5-ASA treatment. UC patients in a conventional out-patient setting were used as controls; 3) To validate two new quantitative rapid tests (RT scanning and HT photo) for Faecal Calprotectin (FC) measurement, and to assess whether HT photo can be useful as a home test to help the patients deciding on self-initiated treatment. The ECCO Consensus found evidence for optimising QoHC by "information"; "education", "benchmarking", and "psychological analysis", which could help to improve patient compliance, QoL, and to decrease depression and anxiety. UC patients, educated in the PEC, significantly improved the level of disease specific knowledge. Patient education and training on www.constant-care.dk, being validated on first 21 Danish patients and subsequently on 233 Danish and 100 Irish patients, showed that the new web guided approach was feasible, safe, and cost effective for the selected group of the patients included in the trial. Use of the web concept increased patients adherence to acute 5-ASA treatment, (p = 0.005) and community effectiveness up to 33%, improved Quality of Life, (p = 0.004), increased patients' ability to sufficient self-initiated treatment and reduce out-patient visits, (p < 0.0001). Patients' morbidity and depression remained unchanged. Median duration of relapse in the web-group was 59 days shorter than in the control-group possibly due to high dose of systemic 5-ASA treatment, (p < 0.0001). We found that the new rapid home test (HT photo) was accurate and comparable with the Enzyme-Linked Immunosorbent Assay (ELISA) with a 90% specificity and a 96% sensitivity. The rapid test can be useful in clinical settings concerning disease self-monitoring at home, which would decrease the use of endoscopy in some cases. The findings corresponded well with action plan for a European e-Health Area and could be a helpful tool to provide more efficient health care for UC patients. Widespread implementation of the "Constant-Care" is possible, but it may require a reshaping of the current health care for IBD patients both legally and economically. It may also empower patients in disease self-management and reduce dependency on doctors. Future long-term studies are needed to investigate, if this concept could possibly change the natural disease course.     

Risk factors for cardiovascular disease in a healthy young population: Family matters

BackgroundIndia faces an epidemic of cardiovascular disease (CVD). This study sought the effect of family history of CVD and/or its risk factors (CVD-risk) on the presence of risk factors for CVD, in a healthy young college population.MethodsBlood pressure (BP), heart rate (HR), anthropometric variables, fasting blood sugar and lipid fractions were measured in two hundred healthy individuals (163 men and 37 women), aged 17–22 years. Data were analysed to elicit effect of CVD-risk on measured parameters.ResultsAll but one subject, had family history of a CVD-risk. Men with family history of coronary heart disease had higher diastolic BP (79.24 ± 7.7 vs 75.99 ± 7.49 mmHg, p = 0.007) and triglycerides (118.66 ± 57.98 vs 85.82 ± 50.89 mg/dL, p < 0.0001) compared with those without similar family history. Men with family history of hypertension (HTN) had higher diastolic BP (78.75 ± 7.15 vs 75.84 ± 8.37 mmHg, p = 0.019) and low-density lipoprotein (86.24 ± 25.38 vs 78.21 ± 17.93 mg/dL, p = 0.019), as well as lower high-density lipoprotein (50.27 ± 8.4 vs 53.96 ± 10.38 mg/dL, p = 0.019). Women with family history of diabetes mellitus had lower high-density lipoproteins (49.89 ± 8.05 vs 59.53 ± 11.44, p = 0.006). Family history of dyslipidaemia was associated with significantly higher triglycerides (146.14 ± 46.19 vs 98.44 ± 56.19 mg/dL, p = 0.002) in men and in subjects across sex. HDL was contrarily higher, in women with family history of cerebrovascular accident/HTN and men with family history of coronary heart disease/HTN. The proportion of pre-HTN, overweight/obese, impaired fasting glucose and borderline high triglycerides was 88.3%, 36.8%, 11% and 38.7% in men and 64.9%, 37.8%, 18.9% and 48.7% in female subjects.ConclusionYoung adults with a family history of CVD-risk already have an incomplete/atypical CVD risk profile.     

The value of 5-aminosalicylic acid in inflammatory bowel disease for patients intolerant or allergic to sulphasalazine

The use of sulphasalazine in inflammatory bowel disease is often limited by intolerance or allergy. In previous studies 5-aminosalicylic acid (5ASA), the active ingredient of sulphasalazine, coated with an acrylic resin, has been shown to be as effective as sulphasalazine in maintaining remission. In this study coated 5ASA was given to 37 patients intolerant or allergic to sulphasalazine. Thirty-three patients have tolerated 5ASA satisfactorily, and most experienced improved control of their disease. Four patients reported similar side effects with sulphasalazine and 5ASA.     

血清PLA2R抗体与膜性肾病患者病情的相关性

目的  探讨血清磷脂酶A2受体（PLA2R）抗体与膜性肾病（MN）患者病情的相关性。方法  选取2013年5月-2015年2月河南省南阳市中心医院收治的膜性肾病患者193例,根据肾组织活检病理结果分为特发性膜性肾病（IMN组）和继发性膜性肾病（SMN组）,选取同期到该院进行体检的健康者30例（对照组）,比较3组受试者的血清白蛋白、血清总蛋白、24 h尿蛋白定量、血肌酐水平、PLA2R抗体浓度及阳性率。分析实验室指标与PLA2R抗体的相关性,并计算PLA2R抗体检测的特异性和阳性预测值。结果  IMN组和SMN组患者的血清白蛋白、血清总蛋白水平明显低于对照组（P <0.05）,24 h尿蛋白定量、血肌酐明显高于对照组（P < 0.05）。IMN组和SMN组各项实验室指标的组间比较差异无统计学意义（P >0.05）。IMN组、SMN组、对照组患者的血清PLA2R抗体水平分别为（12.149±5.207）μg/ml、（8.492±3.218）μg/ml及（0.003±0.001）μg/ml,阳性率分别为68.99%、18.75%及0.00%,差异有统计学意义（P <0.05）。血清白蛋白水平与MN患者血清PLA2R抗体呈负相关（r =-0.625,P =0.023）,24 h尿蛋白定量水平与MN患者血清PLA2R抗体呈正相关（r =0.796,P = 0.015）。ELISA法PLA2R抗体检测的特异度为96.67%,阳性预测值为99.01%。结论  血清PLA2R抗体水平与膜性肾病病情有明显相关性,其阳性表达与肾组织活检结果符合度较高。

     

白术芍药散联合美沙拉嗪治疗溃疡性结肠炎的疗效及对NGAL、MMP-9的影响

目的：探讨白术芍药散联合美沙拉嗪治疗溃疡性结肠炎(ulcerative colitis, UC)的临床疗效及对中性粒细胞明胶酶相关载脂蛋白(NGAL)、基质金属蛋白酶9(MMP-9)的影响。方法：选取UC患者80例,随机分为观察组和对照组。对照组给予美沙拉嗪1.0g qid,观察组在对照组基础上联合白术芍药散汤剂 bid。疗程共8周。比较两组的治疗效果;采用实时荧光定量PCR法(RT-PCR)检测肠黏膜中NGAL、MMP-9 mRNA表达水平;采用酶联免疫吸附法(ELISA)检测血清中NGAL、MMP-9 蛋白表达水平。结果：经治疗后,观察组的临床症状改善总有效率(85.00%)显著优于对照组(70.00%),差异有统计学意义(P&lt;0.05)。     

Effect of Yangyin Humo Decoction (养阴护膜饮) on oral mucomembranous reaction to radiotherapy

Objective:To observe the effect of Yangyin Humo Decoction(养阴护膜饮,YHD)on oral mucomembranous reaction in patients with head-neck tumor undergoing radiotherapy.Methods:Fortytwo patients with head-neck tumor undergoing radiotherapy were randomized equally into two groups.The conventional Western medical treatment was administered to all,including intravenous dripping of 2%lidocaine 20 mL,dexamethasone 5 mg,gentamycin 80 000 units,vitamin B_(12) 5 mg,dissolved in saline 250 mL,and 5% sodium bicarbonate soluti...     

The Relationship between a Nutritional Index and Acute Physiology Score in Critical Illness

Prognostic indices derived from available physiological data (SAPS), complex nutritional and biochemical tests (PNI), grip strength and serum albumin were calculated in 16 critically ill patients receiving intravenous nutrition over a six week period. The aim was to compare these independently derived prognostic indices, to assess their response to feeding, and to determine suitability for use in Irish intensive care units. Mean SAPS (7.6±0.92),PNI (3.1±0.29),serum albumin (30.3±1.03g/l) and grip strength (17.9±1.3%) were all suggestive of an “at risk” group. Significant associations were found between the accepted SAPS index and both PNI (r=0.6, p<0.001, n=35) and grip strength (r=-0.68, p<0.001, n=44) but not with serum albumin. No consistent improvement was seen in response to feeding in any of the derived indices.     

Thiopurine methyltransferase gene polymorphisms and activity in Chinese patients with inflammatory bowel disease treated with azathioprine

Background  The thiopurine drugs are well established in the treatment of inflammatory bowel disease (IBD). However, uncertainty regarding the risk for neutropenia and hepatotoxicity deters its using. Thiopurine methyltransferase (TPMT) is the key enzyme in the metabolism of thiopurine. The aim of this study was to investigate the association of TPMT polymorphisms and activity with azathioprine (AZA)-related adverse events and clinical efficacy in Chinese Han patients with IBD.

Methods  Fifty-two Han IBD patients treated with AZA were assessed for TPMT*2, *3A, *3B, and *3C, and for adverse events. Then, using reverse-phase high-performance liquid chromatography, TPMT activity was measured in 13 patients to analyze its correlation with AZA-related toxicity and clinical efficacy.

Results  Of the 52 patients, five experienced myelotoxicity and one experienced hepatotoxicity during treatment. No TPMT*2, *3A, *3B or *3C polymorphisms were detected in any of the 52 patients. In the 13 patients with TPMT activity measurement, TPMT activity ranged from 7.2 to 28.8 U/ml packed red blood cells (pRBCs). Among the 5 patients who suffered from myelotoxicity, 3 were affected in the early stage of AZA therapy. In these 3 patients, TPMT levels were significantly lower than those in patients without myelotoxicity, which reached statistical significance ((9.3±2.1) U/ml pRBC vs. (18.0±6.2) U/ml pRBC; P=0.046). One patient who had higher TPMT activity (28.8 U/ml pRBC) suffered from hepatotoxicity during AZA therapy. Patients who achieved a clinical response had lower TPMT activity than those failed to respond ((13.7±3.5) U/ml pRBC vs. (22.0±5.5) U/ml pRBC; P=0.009).

Conclusions  TPMT variants do not completely account for the AZA-related myelotoxicity in Chinese Han IBD patients. However, measurement of TPMT activity may be helpful in reducing the risk of toxicity, and predicting the therapeutic efficacy.

     

Microalbuminuria does not predict cardiovascular disease in a normal general practice population

Recent studies have suggested that microalbuminuria is relatively common (9.4%) in non-diabetic subjects and that it is an excellent marker for increased cardiovascular risk. In an attempt to assess the prevalence of microalbuminuria in Northern Ireland where there is a high incidence of coronary heart disease, we studied 400 males, age 35-65 years, chosen at random from a Belfast general practice. There was a 73% response rate (n=273). Sixteen per cent of the population has ischaemic heart disease. Microalbuminuria was defined as an increased urinary albumin excretion rate of 20-200 ug min^-1. Thirteen subjects (4.7 %) had an albumin excretion rate of 20 ug min^-1 or more. After exclusion of subjects with diabetes mellitus or renal diseases, the group with microalbuminuria (n=8), was compared to those without microalbuminuria (n=256) There was no significant difference in the incidence of ischaemic heart disease between the two groups, nor did the group with microalbuminuria have a more adverse profile of vascular risk factors, apart from serum triglyceride (1.8 ± 0.2 v 1.3 ± 0.0 mmol 1^-1, p<0.05) and plasma glucose (53 ± 0.3 v 5.1 ± 0.3 mmol 1^-1, p<0.05) levels. We conclude that in a general practice from an area at high risk of ischaemic heart disease, the prevalence of microalbuminuria was low. Contrary to previous reports, microalbuminuria was not helpful in predicting subjects at risk of ischaemic heart disease.     

慢性阻塞性肺疾病患者血游离态25-羟基维生素D测定的临床意义

目的 探讨游离态25-羟基维生素D[25(OH)D]测定在慢性阻塞性肺疾病(COPD)患者中的临床意义.方法 对2014年11月至2015年9月在我院就诊的70例吸烟COPD患者和67例吸烟非COPD受试者分别进行COPD评估测试(CAT)问卷、肺功能测定和6 min步行试验(6MWT),检测血清总25(OH)D、维生素D结合蛋白(VDBP)及白蛋白,得出游离态25(OH)D水平.结果 吸烟COPD组患者的一秒钟用力呼气量(FEV1)、FEV1/用力肺活量(FVC)、CAT评分、6MWT分别为(1.80±0.49)L、(51±12.3)%、(18.3±4.4)分、(245.3±38.4)m,而吸烟非COPD组分别为(2.75±0.32)L、(90±5.8)%、(1.2±0.3)分、(389.6±80.3)m,差异均有统计学意义(P<0.05);吸烟COPD组患者的总25(OH)D、VDBP及游离态25(OH)D水平分别为(51.3±8.9)nmol/L、(5.29±0.68)μmol/L、(12.4±2.2)pmol/L,与吸烟非COPD组[(54.7±10.8)nmol/L、(5.07±0.41)μmol/L、(14.0±2.3)pmol/L]比较,差异均有统计学意义(P<0.05);吸烟COPD组患者总25(OH)D与FEV1、FEV1/FVC、6MWT呈正相关(r=0.327,P=0.006;r=0.391,P=0.001;r=0.385,P=0.001),游离态25(OH)D水平与FEV1、FEV1/FVC、6MWT呈正相关(r=0.572,P=0.000;r=0.595,P=0.000;r=0.404,P=0.001),总25(OH)D、游离态25(OH)D水平与CAT评分呈负相关(r=-0.418,P=0.000;r=-0.432,P=0.000).游离态25(OH)D与FEV1、FEV1/FVC、CAT评分和6MWT的相关系数均高于总25(OH)D.结论 游离态25(OH)D在评估COPD患者病情过程中可能较总25(OH)D更有价值.     

男性冠心病患者血清高敏C反应蛋白及尿酸水平的变化及其临床意义

目的 检测分析男性冠心病(CHD)患者血清高敏C反应蛋白(hs-CRP)和尿酸水平变化及其临床意义.方法 收集2016年1~7月本院心内科男性CHD住院患者158例,其中稳定性心绞痛(SA)55例、不稳定性心绞痛(UA)67例、急性心肌梗死(AMI)36例.收集同时期心内科因胸闷胸痛症状住院,经冠状动脉造影技术排除CHD的男性患者54例作为对照组.采用免疫比浊法检测所有患者血清hs-CRP和尿酸浓度,统计学分析二者水平在男性CHD各组及对照组间的差异.结果 男性CHD患者AMI组、UA组、SA组及对照组血清hs-CRP浓度依次为(44.86±48.30)mg/mL、(8.38±13.26)mg/mL、(0.75±0.74)mg/mL、(0.79±1.27)mg/mL,AMI组水平明显高于UA组、SA组及对照组,且UA组高于SA组和对照组,差异均具有显著统计学意义(P<0.01).男性CHD患者AMI组、UA组、SA组及对照组血清尿酸浓度依次为(345.66±118.82)mg/mL、(403.45±95.86)mg/mL、(343.25±75.09)mg/mL、(339.48±58.28)mg/L,UA组血清尿酸水平明显高于SA组、AMI组和对照组,差异均具有统计学意义(P<0.05).结论 血清hs-CRP和尿酸水平与男性CHD的发生发展关系密切,对于诊断评估男性CHD有一定的价值.     

Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cer- vical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases re- ceived two-level replacement. Operation time of the single-level surgery averaged 130±50 min and the time of two-level surgery was 165±53 min on average (from skin incision to skin suturing). Neurological or vascular complications during or after surgery was not observed. Japanese Orthope- dic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially re- stored, being 4.68° (3.6°-6.1°) in flexion and extension position and 3.51° (2.5°-4.6°), 3.42° (2.6° -4.3°) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recov- ery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.     

胸腺基质淋巴细胞生成素 在慢性阻塞性肺疾病急性加重患者中的表达及临床意义

目的 观察胸腺基质淋巴细胞生成素(TSLP)在慢性阻塞性肺疾病急性加重(AECOPD)患者中的表达,并探讨其对AECOPD患者的临床意义.方法 选取我院重症医学科2013年1月至2014年12月收治的41例AECOPD患者和41例非急性加重(COPD)患者.比较两组患者血清TSLP、降钙素原(PCT)及治疗前的白细胞介素-4(IL-4)、白细胞介素-5(IL-5)、白细胞介素-13(IL-13)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)等指标,并作相关分析.结果 AECOPD组患者的TSLP水平为(48.49±19.63)p·ng-1·L-1,明显高于COPD组的(29.16±4.87)p·ng-1·L-1,差异有统计学意义(P<0.05);AECOPD组患者的IL-4水平为(8.42±2.46)ng/mL,略高于COPD组的(7.94±1.02)ng/mL,但差异无统计学意义(P>0.05);AECOPD组患者的IL-5水平为(14.93±2.01)ng/mL,明显高于COPD组的(4.93±1.42)ng/mL,差异有统计学意义(P<0.05);AECOPD组患者的IL-13水平为(402.16±24.62)ng/mL,明显高于COPD组的(109.83±12.55)ng/mL,差异有统计学意义(P<0.05);AECOPD组患者的PCT[(0.28±0.19)mg/L]、hs-CRP[(0.84±0.35)mg/L]、WBC[(7.49±1.80)×109]水平均低于COPD组,差异均具有统计学意义(P<0.05).相关分析显示,AECOPD患者血清TSLP水平与患者的IL-4(r=0.114)、IL-5(r=0.052)、IL-13(r=0.101)水平呈正相关(P<0.05);血清TSLP水平与患者的PCT(r=-0.006)、hs-CRP(r=P0.110)、WBC(r=P0.130)水平呈负相关(P<0.05).结论 血清TSLP水平与AECOPD患者的病程发展有关;针对血清TSLP水平治疗急性加重慢性阻塞性肺疾病患者可能会有更显著的效果,血清TSLP水平检测可能在AECOPD患者的治疗中具有重要的价值.     

Interleukin-18 and coronary artery lesions in patients with Kawasaki disease

BackgroundInterleukin-18 (IL-18) plays an important role in mediating cytokine cascade leading to coronary artery lesions (CALs) in Kawasaki disease (KD). However, our research suggested that the literature regarding IL-18 and KD is limited. Consequently, this study aimed to evaluate the correlation between IL-18 and CALs in patients with KD.MethodsIn this prospective study of 14 children with KD (seven without and seven with CALs in the acute phase), we obtained patient measurements of a series of serum IL-18 levels in the acute, subacute, and convalescent phases. Serum IL-18 levels were measured with a Bio-Plex cytokine assay. Control samples were obtained from 18 febrile children with viral infection.ResultsCompared with febrile controls, patients with acute-stage CALs [postintravenous immunoglobulin (post-IVIG) period] had a significantly higher IL-18 level (88.4 ± 20.7 vs 56.0 ± 35.0 pg/mL, p = 0.006). However, those without acute-stage CALs (post-IVIG period) lacked similarly elevated IL-18 level readings (62.0 ± 40.6 vs 56.0 ± 35.0 pg/mL, p = 0.762). The IL-18 level of patients with acute-stage CALs did not decrease significantly until the convalescent phase (97.4 ± 55.8 vs 38.7 ± 22.6 pg/mL, p = 0.018), but for those without CALs, it decreased significantly in the subacute phase (60.2 ± 37.4 vs 23.6 ± 13.8 pg/mL, p = 0.018). In the subacute stage, there was a significant difference of IL-18 level between patients with and without acute-stage CALs (p = 0.048).ConclusionOur data show that IL-18 levels were elevated in the acute phase of KD and might be related to the formation of CALs.