Searching for the Vascular Component of the Arterial Baroreflex

Short-term regulation of arterial blood pressure is accomplished by complex interactions between feedback and feed-forward information from the arterial and cardiopulmonary baroreceptors that combine with other local and neural factors to modulate cardiac output (heart rate and stroke volume) and total peripheral vascular resistance. In this paper we used transfer function analysis and autoregressive moving average analysis to explore the interrelationships between central venous pressure as an input to the cardiopulmonary baroreflex and mean arterial blood pressure as an input to the arterial baroreflex in the regulation of total peripheral resistance. We further compared the peripheral vascular responses with those of the cerebrovascular system where the dominant factor regulating cerebral blood flow is accepted to be dynamic autoregulation. The results indicate that the peripheral vascular system responds with a myogenic response and that arterial baroreflex does not play an important role in modulating arterial vascular resistance in supine rest or mild orthostatic stress. The cardiopulmonary baroreflex was important in the regulation of total peripheral resistance. The blood pressure to vascular resistance relationship was qualitatively similar in the peripheral and the cerebrovascular systems pointing to the dominance of vascular autoregulation.     

基于SIRIMA模型的新冠肺炎疫情对猩红热流行影响的分析——以上海市松江区为例

目的 建立松江区猩红热病例的时间预测模型,了解新型冠状病毒肺炎疫情对上海市松江区猩红热发病的影响。方法 收集中国疾病预防控制信息系统“传染病监测”模块中报告的2011—2020年上海市松江区猩红热病例数据,使用SARIMA模型对2011年1月—2019年6月猩红热月报告病例数进行模拟构建模型,依据2019年7—12月猩红热实际发生值评估模型的预测效果,并采用最优模型预测2020年猩红热发生情况,分析新型冠状病毒肺炎疫情对2020年松江区猩红热流行情况产生的影响。结果 2011—2020年上海市松江区累计报告猩红热病例4 438例,年均报告444例,年均报告发病率23.27/10万;疫情呈现季节性,呈双峰分布。最终SARIMA(1,1,0)(2,1,1)₁₂拟合效果最优,AIC、BIC、MAPE值分别为90.93、105.93、7.68%,残差检验为白噪声序列,预测值与实际值走势基本相符。受新冠肺炎疫情影响,松江区2020年猩红热实际发生94例,比预期发生值低84.09%。结论 SARIMA模型较好地拟合了松江区猩红热的发病趋势;受新型冠状病毒肺炎疫情影响,松江区2...     

超声检查评估克罗恩病活动性的价值

目的分析克罗恩病患者超声声像图特征,探讨超声检查评估克罗恩病活动性的价值。方法 2011年8月至2012年8月上海第十人民医院收治的克罗恩病患者25例。其中克罗恩病活动指数(CDAI)评分150分(缓解期)12例,150～450分(活动期)13例。每例患者均行内镜(结肠镜或小肠镜)检查、腹部超声检查。非炎性病变(缓解期)和炎症(活动期)肠段肠壁厚度比较采用两独立样本t检验。以内镜检查结果作为金标准,能量多普勒超声判断克罗恩病活动性与CDAI评分判断克罗恩病活动性的符合率比较采用χ2检验。结果 25例克罗恩病患者经内镜检查判断活动期20例,缓解期5例。所有患者均能获得满意的超声图像。本组超声诊断克罗恩病22例,诊断准确率为88%(22/25)。超声检测非炎性病变(缓解期)肠段肠壁厚度为(2.06±0.62)mm,低于炎症(活动期)肠段肠壁厚度(7.90±2.90)mm,且差异有统计学意义(t=2.53,P0.05)。本组25例克罗恩病患者能量多普勒超声判断缓解期7例,活动期18例。能量多普勒超声判断克罗恩病活动性的符合率为92%(23/25);而根据CDAI评分判断克罗恩病活动性的符合率仅为64%(16/25),低于能量多普勒超声判断克罗恩病活动性的符合率,且差异有统计学意义(χ2=9.39,P0.05)。超声检查发现腹腔脓肿1例,腹腔淋巴结肿大7例,腹腔积液2例。结论超声检查对肠壁厚度、结构层次、回声及肠外并发症的观察具有一定的优势,能准确评估克罗恩病活动性,对克罗恩病的诊治具有指导意义。     

A Case of Acute Myocarditis as the Initial Presentation of Crohn's Disease

We experienced a case of acute myocarditis as the initial presentation of Crohn''s disease. A 19-year-old woman was admitted with impaired consciousness, shock, and respiratory failure. She had suffered from frequent diarrhea and abdominal pain for several years. Cardiac troponin I and creatine kinase-MB fraction levels were elevated to 5.32 and 16.66 ng/mL, respectively. A 12-lead electrocardiogram showed sinus tachycardia, and a chest radiograph revealed interstitial pulmonary edema. An echocardiogram showed dilated ventricles with akinesia of the basal to apical inferoseptal, anteroseptal, anterior, and inferior left ventricular walls and severely impaired systolic function. Intensive care with inotropic support was effective, and her clinical condition gradually improved. Two weeks later, a colonoscopy revealed ulceration with stenosis in the terminal ileum and multiple aphthous ulcers in the rectum. A biopsy of the rectum revealed non-caseating granulomatous inflammation. She was diagnosed with Crohn''s disease presenting with acute myocarditis.     

英夫利西单抗治疗克罗恩病的疗效分析

目的 探讨TNFα单克隆抗体英夫利西(infliximab,IFX)单抗治疗活动性克罗恩病(CD)的疗效与安全性.方法 对传统药物治疗后未能完全缓解、手术治疗后复发或对药物不耐受的CD患者,于0、2、6周时静脉输注IFX(5 mg/kg)诱导缓解治疗,并对第一次输注后14周内的临床疗效,包括疾病活动度、血生化指标及结肠镜表现作出评估.结果 10例患者接受了IFX治疗,其中男8例,女2例,中位年龄31.4岁.5例患者IFX治疗1周后即感症状得到改善,主观症状评分从2.2±0.6降为1.2±0.4(P<0.05);简化CD活动性指数(H-B指数)从6.6±1.6降为2.1±1.0(P<0.05);ESR、C反应蛋白、血清总蛋白及白蛋白也有明显改善;内镜下CD严重度指数也得到明显改善.治疗过程中未观察到输注反应;1例患者在第3次IFX输注后,血ALT及AST暂时性升高;1例患者输注后35周出现严重贫血(三系列均减少).结论 经3次IFX静脉输注方案治疗,本组患者的临床症状及结肠镜下表现可获得较快、较好的改善.IFX长期应用的安全性尚需进一步扩大样本的研究.     

英夫利西单抗治疗克罗恩病3例报道

英夫利西单抗目前是治疗克罗恩病的有效手段,特别是对五氨基水杨酸及激素耐药的病例,可以有效提高临床缓解率,其维持治疗尤其重要。     

Anal ulcerations in Crohn’s disease: Natural history in the era of biological therapy

BackgroundThe natural history of anal ulcerations in Crohn’s disease remains unknown.AimsTo assess the long-term outcomes of anorectal ulcerations.MethodsData from consecutive patients with perineal Crohn’s disease were prospectively recorded. The data of patients with anal ulceration were extracted.ResultsAnal ulcerations were observed in 154 of 282 patients (54.6%), and 77 cases involved cavitating ulcerations. The cumulative healing rates were 47%, 70% and 82% at 1, 2 and 3 years, respectively. Patients with a primary fistula phenotype had a shorter median time to healing of their anal ulceration (28 [13–83] weeks) than those with a stricture (81 [28–135] weeks) or those with isolated ulceration (74 [31–181] weeks) (p = 0.004). Among patients with ulcerations but no fistula at referral (n = 67), only 4 (6%) developed de novo abscesses and/or fistula during follow-up. There was no benefit associated with introducing or optimising biologics, nor with combining immunosuppressants and biologics.ConclusionAnal ulceration in Crohn’s disease usually requires a long time to achieve sustained healing. Determining the impact of biologics on healing rates will require dedicated randomised trials although it does not show a significant healing benefit in the present study.     

提高克罗恩病早诊早治水平改善疗效和预后

克罗恩病的早诊早治是一个复杂而有挑战的临床问题.克罗恩病的早诊早治对于疗改善效和预后,促进疾病缓解、减少并发症、预防复发、提高生活质量都有非常重要意义.结合临床表现、内镜、病理、实验室、影像等资料综合判断是早期诊断的重要手段,早期积极治疗力争黏膜愈合是改善克罗恩病疗效和预后的重要途径.     

Role of Nitric Oxide and Endothelin-1 in a Portal Hypertensive Rat Model

Background: Portal hypertension is often accompanied by a hyperdynamic circulation state. Some reports have suggested that nitric oxide (NO) plays an important role in this hyperdynamic state. On the other hand, although endothelin (ET)-1, a powerful vasoconstrictor, was recently identified, little is known about its role in portal hypertension or about the interaction between NO and ET-1. The aim of this study was therefore to investigate whether or not the inhibitor of NO synthase (NOS) might improve portal hypertension, and also to clarify the relationship between NO and ET-1. Methods: Portal hypertensive (PHT) rats, in which hypertension was induced by a two-step ligation of the portal vein (PVL), were used. The mean arterial pressure (MAP), portal pressure (PP), visceral blood flow volume (BFV), and serum levels of NO and ET-1 were determined in PVL rats treated with two NOS inhibitors with different functions: NG-nitro-L-arginine methyl ester (L-NAME) and aminoguanidine (AG). Control (CTR) rats, treated by a sham operation (SO), were also studied. Results: Two-step PVL treatment induced a significant increase in the serum level of NO3- and ET-1 in the portal vein. L-NAME and AG administration significantly decreased PP at doses of 50 mg/kg in PHT rats after 60 min administration, while no inhibitor effected any modification in the CTR rats. Both NOS inhibitors increased MAP and decreased PP and BFV in the portal vein, gastric mucosa, and spleen, in addition to decreasing the serum levels of NO3- and ET-1 in the PHT rats, while neither blockade modified any parameters in the CTR rats. In PHT rats, L-arginine, a NO substance, reversed the effect of L-NAME, while it did not induce any recovery from the AG effect. Conclusions: In PHT rats, NO seems to contribute to portal hypertension. PVL increases not only the serum level of NO3-, but also that of ET-1 in the portal vein. Both L-NAME and AG reduce PP and BFV of the portal vein, spleen, gastric mucosa, and liver. In addition, the inhibition of NOS diminishes the serum level not only of NO, but also of ET-1. Use of an appropriate NOS inhibitor may therefore positively affect the hyperdynamic state in portal hypertension.     

克罗恩病的内镜及临床特点

目的总结克罗恩病（CD）的内镜及临床特点。方法收集1975年6月至2005年6月经结肠镜及病理学检查确诊的155例CD患者的相关资料，分析其内镜下表现及临床病理特点。结果1975—1990年和1991—2005年两组中，经结肠镜及病理学检查确诊的CD患者占同期镜检总数的比例从0．45％升至0．53％。患者男女之比为1．21：1；平均发病年龄42．6岁，高峰年龄段男为20～39岁及50～59岁，女为50～59岁；病程大于10年者占80％；临床主要表现为腹痛、腹泻、血便等肠道症状，以及贫血、发热、消瘦等全身症状；病变部位小肠为主者占43．87％、结肠为主者占23．23％、回结肠为主者占32．90％。结论CD的发病率有上升趋势，临床表现多样化，结肠镜结合病理学检查是目前诊断CD的主要方法。     

Comparison of Long-term Outcomes of Infliximab versus Adalimumab in 1,488 Biologic-Naive Korean Patients with Crohn’s Disease

Background/AimsData on the comparative effectiveness of infliximab (IFX) or adalimumab (ADA) in patients with Crohn’s disease (CD) are rare, particularly for Asian patients. We compared the key clinical outcomes (surgery, hospitalization, and corticosteroid use) of use of these two drugs in biologic-naive Korean patients with CD.MethodsUsing National Health Insurance claims, we collected data on patients who were diagnosed with CD and exposed to IFX or ADA between 2010 and 2016.ResultsWe included 1,488 new users of biologics (1,000 IFX users and 488 ADA users). Over a median follow-up period of 2.1 years after starting biological therapy, no significant differences were found between IFX and ADA users in the risks for surgery (ADA vs IFX adjusted hazard ratio [aHR], 1.22; 95% confidence interval [CI], 0.81 to 1.84), hospitalization (aHR, 1.02; 95% CI, 0.81 to 1.28), and corticosteroid use (aHR, 0.82; 95% CI, 0.56 to 1.19). These results were unchanged even when only patients who used biologics for over 6 months were analyzed (aHR [95% CI] surgery, 1.31 [0.82 to 2.11]; hospitalization, 1.02 [0.80 to 1.30]; corticosteroid use, 0.80 [0.54 to 1.18]). Additionally, these results were unchanged in patients treated with biologics as monotherapy or in combination with immunomodulators.ConclusionsIn this nationwide population-based study, no significant difference was found in the long-term effectiveness of IFX and ADA in the real-world setting of biologic-naive Korean patients with CD. In the absence of trials to directly compare IFX and ADA, our study indicates that the selection of one of these two biologics can be determined by patient and/or physician preference.     

克罗恩病合并严重骨质疏松症病例报道及文献复习

目的:探讨克罗恩病(CD)合并严重骨质疏松症的机制、临床表现及诊治方法,以提高临床医师对本病的认识及诊治水平.方法:报道1例21岁女性患者,因发热、腹痛、腹泻、便血诊断为CD,使用糖皮质激素(GC)治疗半年,剂量相当于泼尼松15～50 mg/d,患者逐渐出现双手关节、胸背及双侧肋骨疼痛,活动困难.行骨骼X光片检查及双能...     

防治过程中血吸虫病流行趋势预测方法研究

用多种预测方法处理四川省世行贷款血吸虫病防治项目调查、监测的人群血吸虫病感染资料,预测近期防治过程中血吸虫病流行趋势,认为以移动平均数法预测的结果较满意,反映了防治过程中血吸虫病流行变动规律。预测结果表明,近期血吸虫病流行将呈小幅波动、缓慢上升趋势。建议应调整、完善防治策略,加强防治力度,才能巩固、发展防治成效     

Crohn’s disease in Italy: A critical review of the literature using different data sources

BackgroundIncidence and prevalence of Crohn’s disease (CD) have increased during the last decades in several world areas. Italian data on CD are scattered between various administrative, educational and scientific sources, and findings are poorly summarized.AimsWe conducted a review focusing not only on prevalence and incidence of CD in Italy, but also on mortality, treatments, delayed diagnosis and hospitalization.MethodsIn October 2015, we searched for quantitative epidemiological data of CD using PubMed/Medline, EMBASE, and the Cochrane Database of Systematic Reviews. We also conducted searches on selected web resources for databases and educational publications.ResultsSixteen studies reporting data on incidence of CD from Italy were found. Incidence rates of CD in the early 2010’s in Italy were 3.5–4 cases per 100,000 inhabitants per year. Ten investigations provided data on CD prevalence, with large variability between Italian areas. Most studies considering data at two or more time points or across consecutive time periods reported increasing incidence or prevalence of CD.ConclusionThis review of Italian epidemiological data indicates that CD incidence and prevalence are continuing to (moderately) increase. Diagnostic delay, treatments, hospitalization and surgery for CD in Italy were also reviewed and quantified, though information is somewhat limited.     

山西省与全国布鲁杆菌病疫情的对比分析

目的 对比分析近年来山西省与全国布鲁杆菌病(简称布病)疫情流行情况,预测布病疫情发展趋势,为布病疫情监测与防控提供参考.方法 收集山西省2006年1月至2010年12月布病疫情月报告资料和中国疾病预防控制中心2005年1月至2010年12月发布的全国布病疫情报告资料,根据布病的逐年增长量、发展速度、增长速度等指标,比较山西省和全国近年来布病疫情流行现状.利用布病疫情月报告发病人数,拟合时间序列自回归移动平均模型(ARIMA),通过对拟合效果的验证,预测山西省和全国未来2年内的布病发病状况.结果 山西省布病疫情2008年达到高峰,新发病例5397例,较2007年增加了900例,从2008年后发病人数下降,2010年下降了17.67％(906/5128);全国布病发病人数从2006 - 2009年一直呈上升趋势,在2007-2008年迅速增长,增长速度高达39.16％(8442/21 560),虽然2010年布病的发病人数比2009年下降了2041例,但下降速度仅为5.14％(2041/37 734);无论山西省还是全国,5-7月均为布病发病的高峰期.拟合时间序列ARIMA模型,成功地获得了山西省和全国的ARIMA模型[(1,0,1)(1,1,0)12、(1,0,1)(0,1,1)12].验证模型的拟合效果显示,两个ARIMA模型对布病发病人数预测值的动态趋势与实际情况基本一致,全部落到了预测值的95％可信限内,模型拟合效果良好.模型预测结果显示,在未来2年内,山西省布病的发病人数总体趋势基本平稳,没有出现大的变动;全国布病发病人数在2011年和2012年预计出现小幅度的回升,每年的5-7月份是布病发病的高峰期.结论 山西省布病控制措施得力,布病发病人数呈下降趋势;ARIMA模型预测布病疫情效果好,可以为下一步疫情预测与评价提供有价值的参考.     

血清S100A12蛋白与克罗恩病活动性的相关研究

目的:研究血清S100A12蛋白水平在克罗恩病(CD)患者中的表达及其与CD活动性的关系。方法:选取44例确诊为CD的患者为研究对象,计算CD活动指数(CDAI),按照CDAI分为活动期CD患者和缓解期CD患者。同时选取16例非消化道感染的患者作为感染对照组,15名健康体检者作为正常对照组。用酶联免疫吸附法测定血清S100A12蛋白浓度。结果:CD患者血清S100A12蛋白平均浓度为875.85(575.58～1 259.9)ng/mL,明显高于正常对照组的485.3(349.2～571.2)ng/mL(Z=-4.11,P<0.05)。结论:S100A12蛋白在CD的发病机制中起作用。血清S100A12蛋白水平与CDAI相关,可以作为疾病活动度的新指标。     

我国克罗恩病的漏诊误诊情况分析

目的总结分析我国克岁恩病（CD）的漏诊误诊原因，提高CD的诊治水平。方法利用中国生物医学文献数据库（CMCC）和中文科技期刊全文数据库（VIP），检索1989年1门至2003年12月期川发表的有关CD的所有临床研究报道，逐篇查阅原文，记录分析临床特征及误诊、漏诊原因，结果共检山428篇CD的文章，其中261篇是关于CD临床研究文章．共报道CD3397例。临床表现主要为右下腹歧脐周疼痛（62．5%）、腹泻（51．5％）、腹部包块（16．6％）、消瘦（24．7％）、便血（16．6%）等病变部位主要为回肠末端（62．5％）、单纯结肠（26．9%）、回结肠同时受累（38．9%）。手术标本肉芽肿检出者61．2％．内镜活检标本为27．6％CD术前漏诊共2357例，漏诊率为69．4％，诊为肠结核（32．2％）、单纯肠梗阻（23．2％）、肿瘤并肠梗阻（6．4％）、单纯急性阑尾炎（27．9％）等。误诊情况：其他疾病跌诊为克罗恩病行389例，包括肠结核（53．5％）、小肠淋巴瘤（14．4％）、结肠癌（17．0％），结论我国CCD发病率逐年增加，其临床表现多样，误诊、漏诊率高，亟待提高对CD的认识，加强国内规范诊断程序，以提高对CD的诊治水平。     

MSCT在全面评估克罗恩病中的作用

目的 总结多层螺旋CT（MSCT）在诊断克罗恩病中的应用价值.方法 观察24例经临床、影像和病理3方面综合诊断为克罗恩病患者的MSCT表现,分析其影像学特点.结果 24例患者均表现为多节段肠壁增厚,其中直乙结肠受累2例,系膜缘增厚明显有13节段,肠壁均有不同程度强化.肠壁溃疡4例,瘘管2例,肠内瘘1例,肠梗阻8例,肠旁蜂窝织炎6例,炎性包块或腹腔脓肿6例.肠系膜淋巴结肿大13例,系膜密度增高12例,继发肠间距增宽8例,系膜血管增粗、密集12例,梳子征8例.结论 MSCT对克罗恩病肠壁的病变、肠外并发症及肠系膜、血管、淋巴结异常均有良好显示,并能判断病程,指导临床治疗,不失为一较好的影像检查方法.     

双气囊内镜在小肠克罗恩病疗效随访中的应用价值初探

目的探讨双气囊内镜（DBE）在小肠克罗恩病（CD）疗效随访中的应用和价值。方法对41例曾行DBE检查并临床确诊为小肠CD的患者进行正规药物治疗并随访，评估临床症状、血清学指标、治疗时间与DBE下黏膜修复情况之间的关系。结果治疗1个月后92．7％的患者症状缓解，2个月后97．6％C-反应蛋白恢复正常。行DBE复查黏膜无明显改善或略有改善、改善、明显改善者，平均复查时间为治疗后（7．1±4．3）、（16．5±7．1）、（25．0±12．7）个月，3组间复查时间差异有统计学意义（P〈0．01）。对于累及小肠-结肠的患者，同一个体的小肠、结肠黏膜修复程度差异无统计学意义（P=0．215）。结论小肠CD黏膜修复缓慢，明显迟于临床症状的缓解及C反应蛋白的恢复，合理的DBE复查时间为治疗后10～15个月，免疫抑制剂宜长期维持。对于同时累及小肠-结肠的患者，可行结肠镜复查。     

Toll样受体和核苷酸结合寡聚蛋白2与克罗恩病

Toll样受体(TLR)和核苷酸结合寡聚蛋白2(NOD2)在结构上都富含亮氨酸重复序列(LRR),并在肠道黏膜的多种细胞表达,介导微生物与肠道黏膜之间的固有免疫反应。近年来研究发现,TLR和NOD2介导的免疫反应紊乱对克罗恩病的发生起重要作用。