细胞间粘附分子-1在腹膜炎症过程中的作用及己酮可可碱的保护效应

目的 探讨细胞间粘附分子—1(ICAM—1)在连续不卧床性腹膜透析(CAPD)患的腹膜炎症过程中的作用及己酮可可碱的保护效应。方法 采用体外腹膜间皮细胞(PMC)与巨噬细胞共同培养的方法，观察抗ICAM—1MMb对巨噬细胞促进PMC增殖的影响及己酮可可碱的保护效应。结果 抗ICAM—1MAb对巨噬细胞促进PMC的增殖具有抑制作用，呈剂量依赖性；己周可可碱可抑制INF-α诱导的PMC与巨噬细胞粘附。结论 ICAM—1参与、影响腹膜炎症的过程，己酮可可碱在腹腔局部防御过程中发挥重要作用。     

慢性心力衰竭患者Th17细胞的检测及意义

目的:探讨慢性心力衰竭(CHF)患者外周血Th17细胞水平及意义.方法:采用流式细胞分析法检测66例CHF患者(CHF组)和23例正常对照者(对照组)外周血Th17细胞比例.结果:CHF患者外周血Th17/cD4+T细胞比例[(2.4±1.6)%]显著高于对照组[(0.4±0.3)%].Th17/CD4+T比例在缺血性心脏病者与非缺血性心脏病者间差异无统计学意义,但心功能NYHA分级Ⅲ～Ⅳ级者[(3.3±1.1)%]比例明显高于Ⅰ～Ⅱ级者[(1.7±0.9)%].结论:CHF患者外周血外周血Th17细胞比例增加,且与心功能有一定关系.Th17细胞可能参与了心力衰竭的发生发展.     

慢性乙肝患者外周血PBMC凋亡相关因子和Th1/Th2型细胞因子的水平变化及意义

目的探讨慢性乙型肝炎患者外周血单个核细胞(PBMC)凋亡相关因子和Th1/Th2型细胞因子水平变化及意义。方法前瞻性选取2017年1月至2017年12月在航空工业三六三医院治疗的慢性乙型肝炎患者102例,其中轻度32例,中度40例,重度30例,健康志愿者40例作为对照组。检测含半胱氨酸的天冬氨酸蛋白水解酶-9(Caspase-9)、Caspase-8、Caspase-3、白细胞介素-2(IL-2)、IL-4、IL-10和干扰素-γ(IFN-γ)水平。记录慢性乙型肝炎患者HBV DNA定量检测结果,分析HBV DNA与各指标相关性。结果轻度组、中度组和重度组Caspase-9、Caspase-8和Caspase-3水平明显高于对照组(P 0. 05),其中轻度组Caspase-9、Caspase-8和Caspase-3明显高于中度组和重度组(P 0. 05);轻度组、中度组和重度组IL-2和IFN-γ水平明显低于对照组(P 0. 05),而IL-4和IL-10明显高于对照组(P 0. 05),其中轻度组IL-2和IFN-γ也明显高于中度组和重度组(P 0. 05),而IL-4和IL-10则明显低于中度组和重度组(P 0. 05);病毒载量与Caspase-9、Caspase-8、Caspase-3、IL-2和IFN-γ呈正相关(r=0. 370,r=0. 364,r=0. 355,r=0. 341和r=0. 360,P 0. 05),与IL-4、IL-10呈负相关(r=-0. 411,r=-0. 403,P 0. 05)。结论慢性乙肝患者外周血PBMC凋亡增强,Th1/Th2免疫调节紊乱,可能在疾病发生发展中起一定作用,且与病毒载量有一定相关性。     

心力衰竭患者血浆白细胞介素-12、白细胞介素-18和γ-干扰素水平变化及意义

目的探讨白细胞介素-12(IL-12)、白细胞介素-18(IL-18)及γ-干扰素(IFN-γ)在心力衰竭发生与发展中的作用及相互关系。方法应用酶联免疫吸附法测定36例心力衰竭患者和20例正常人血浆IL-12、IL-18和IFN-γ水平,并分析他们之间的相互关系以及与心力衰竭病情程度的关系。结果心力衰竭患者血浆IL-12、IL-18及IFN-γ水平分别为(181.5±38.5)ng/L、(378.4±185.3)ng/L及(1.86±0.52)ng/L,均显著高于正常人水平[(22.4±4.5)ng/L、(228.5±77.5)ng/L、(0.08±0.03)ng/L](P<0.01),而三者相互呈密切正相关(P<0.05或P<0.01),且3种细胞因子水平在不同心功能的心力衰竭患者间亦有显著性差异(P<0.05或P<0.01),并随心功能的恶化而升高(P<0.05或P<0.01)。结论IL-12、IL-18和IFN-γ可能共同构成一局部网络,并可能参与心力衰竭的发生及发展过程。监测三者的血浆水平可能对判断心力衰竭病情有一定的参考价值。     

慢性心力衰竭患者血清sFas、白细胞介素-1β水平及临床意义

目的探讨慢性心力衰竭患者血清可溶性 Fas( s Fas)、白细胞介素 -1β( IL-1β)水平及其临床意义。方法 6 2例慢性心力衰竭组患者 ,按心功能分级 ( NYHA)又分为 3组 : 级组 2 0例 , 级组 2 0例 , 级组 2 2例 ,另设 15例健康人作对照。血清 s Fas、IL -1β含量测定采用酶联免疫吸附法 ( ELISA)。结果慢性心力衰竭患者血清 s Fas、IL -1β含量显著高于健康对照组 ,慢性心力衰竭患者心功能分级组间血清 s Fas、IL-1β含量也有显著性差异。结论慢性心力衰竭患者血清 s Fas、IL-1β含量的变化是影响慢性心力衰竭时心肌细胞凋亡机制之一。     

IgA肾病患者外周血Th1、Th2、Th3细胞水平的变化及意义

目的观察IgA肾病（IgA nephropathy,IgAN）患者外周血中Th1、Th2、Th3细胞亚群的表达,探讨其在IgAN免疫发病机制中的作用。方法采用流式细胞仪检测23例IgAN患者（IgAN组）及20例健康体检者（正常对照组）外周血Th1、Th2、Th3细胞比例,并用Spearman或Pearson相关分析法对其分布变化与IgAN各项临床指标进行相关性分析。结果 IgAN组外周血中Th1细胞比例较正常对照组减少,差异无统计学意义（P〉0.05）;IgAN组外周血中Th2、Th3细胞比例均显著高于正...     

重症胰腺炎早期Th1/Th2型细胞因子变化的实验研究

目的研究辅助性T淋巴细胞Th1、Th2型细胞因子及Th1/Th2比值在重症胰腺炎(SAP)早期的变化,探讨Th1/Th2比值与SAP严重程度的关系。方法将56只Wistar大鼠[体质量(250±30)g]随机分为假手术组(A组,n=28)和SAP组(B组,n=28),A组和B组又分为2、6、12、24h组,每组7只。B组行逆行胰胆管匀速注射5%牛磺胆酸钠;A组开腹后仅翻动胃十二指肠数次。然后按规定时间(2、6、12、24h)处死大鼠,观察腹水量和胰腺病理严重程度,检测腹水淀粉酶、血清淀粉酶和Th1、Th2型细胞因子及Th1/Th2比值的变化。结果 (1)A组胰腺无炎症反应,Th1、Th2型细胞因子及Th1/Th2比值无明显变化(P>0.05);(2)B组随着SAP病情的加重Th1型细胞因子逐步降低,Th2型细胞因子逐步升高,Th1/Th2比值降低(P<0.05)。结论 SAP早期Th1/Th2比值呈失衡状态,趋向Th1抑制和Th2极化,其失衡程度与SAP严重程度有关。     

类风湿关节炎血清和滑液Th1／Th2细胞因子的水平及意义

目的初步探讨类风湿关节炎患者免疫功能紊乱的机制.方法采用酶联免疫吸附法(ELISA)检测类风湿关节炎患者血清和关节滑膜液中Th1细胞分泌的细胞因子IL-2、IFN-γ和Th2细胞分泌的细胞因子IL-6、IL-10的水平.结果类风湿关节炎患者血清及滑膜液中IL-2、IFN-γ的水平与正常对照组相比明显升高,差异具有显著性(p＜0.01或p＜0.05),而IL-6、IL-10的水平降低,差异具有显著性(p＜0.01或p＜0.05).结论在类风湿关节炎患者血清及滑膜液中Th1/Th2细胞分泌的细胞因子水平存在着明显失衡,两者以Th1细胞分泌细胞因子占优势,这可能与其发病机制密切相关.     

慢性乙型肝炎患者外周血单个核细胞培养上清液Th1/Th2细胞因子检测与临床意义

目的检测慢性乙型肝炎患者外周血单个核细胞(PBM C)培养上清液T h1/T h2类细胞因子(IFN-γ/IL-4)表达,探明T h1/T h2类细胞因子在慢性乙型肝炎发病机制中的作用。方法分离64例慢性乙型肝炎患者及20例正常人群外周血单个核细胞(PBM C),分别于PHA和HB cA g/HB eA g体外培养48 h,双抗体夹心EL ISA法检测PBM C培养上清液IFN-γ/IL-4水平。结果在PHA诱导下,HBV慢性感染者PBM C产生IFN-γ水平低于正常对照组,IL-4水平高于正常对照组,谷丙转氨酶(ALT)异常组和ALT正常组相比较,IFN-γ水平异常组大于正常组。HB cA g诱导下,HBV慢性感染者PBM C产生IFN-γ水平高于正常人群,IL-4水平两组间无差异,HB eA g诱导下,IFN-γ水平无显著性差异,而IL-4水平明显高于正常对照组。结论T h1/T h2类细胞平衡失调与HBV感染慢性化有关;T h1类细胞因子优势表达引起肝脏炎症反应,HB cA g倾向诱导T h1类细胞因子表达,HB eA g倾向诱导T h2类细胞因子表达。     

HBV相关肝衰竭患者Th1/Th2型细胞因子变化及与预后的关系

目的 探讨Th1/Th2型细胞因子在乙型肝炎病毒(HBV)相关慢加急性肝衰竭(HBV-ACLF)患者中的表达变化及与预后的相关性。方法 回顾性分析2021年1月至2021年12月HBV-ACLF患者69例与慢性乙型肝炎(CHB)患者70例的临床资料,并选择同期体检的70例健康人员为对照组,比较3组对象血清Th1/Th2型细胞因子表达,并比较HBV-ACLF组不同病情程度及预后患者血清Th1/Th2型细胞因子表达水平差异。结果 HBV-ACLF组患者血清IL-2、INF-、TNF-α、IL-6高于对照组及CHB组,IL-4、IL-10低于对照组及CHB组(P<0.05);随着病情的加重,INF-、IL-6水平升高(P<0.05),IL-4、IL-10水平下降(P<0.05);生存组INF-、IL-6、TNF-α水平低于死亡组,IL-4、IL-10水平高于死亡组;血清INF-、TNF-α、IL-4、IL-6、IL-10水平是影响HBV-ACLF患者预后的独立危险因素(P<0.05)。结论 血清INF-γ、TNF-α、IL-6水平在HBV-ACLF中呈升高状态,IL-...     

Decrease of serum levels of the anti-inflammatory cytokine interleukin-10 in patients with advanced chronic heart failure

Inflammation plays a significant contributory role in the pathogenesis of chronic heart failure (CHF). Many studies have shown enhanced plasma levels of proinflammatory cytokines [i.e. tumour necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6] in patients with CHF. However, there are only few reports on the regulation of anti-inflammatory cytokines such as IL-10. IL-10 has potent deactivating properties in macrophages and T-cells and thus acts as a down-regulator of cell-mediated immune responses. The aim of the present study was to assess whether serum concentrations of IL-10 significantly differ between patients with CHF and healthy control subjects. Patients with CHF [ n =50; 66.9+/-12.6 years; mean ejection fraction, 22.1+/-9.2%; New York Heart Association (NYHA) class II-IV] and 25 healthy controls (63.6+/-10.2 years) were examined. Of the 50 patients with CHF, 32 patients were taking aspirin (100 mg/day) and 33 patients had lipid-lowering therapy with a statin. Serum IL-10 as well as TNF-alpha concentrations were measured using commercially available immunoassays. Patients with CHF showed significantly lower IL-10 concentrations (2.3+/-1.9 compared with 5.2+/-2.3 pg/ml; P <0.001). Patients with advanced CHF (NYHA class III and IV) had the lowest IL-10 plasma levels. Aspirin and statin therapy did not significantly influence serum levels of IL-10. The ratio of TNF-alpha to IL-10 was significantly higher in patients with advanced CHF (NYHA class III and IV, ratio 3.2+/-1.2 and 3.1+/-1.1 respectively, compared with control 0.4+/-0.2; P <0.01). Our present study demonstrates significantly decreased serum levels of IL-10 in patients with advanced CHF. Since IL-10 is known as a potent anti-inflammatory cytokine, its decrease in advanced CHF may favour the inflammatory milieu in CHF.     

Osteopathic manual therapy in heart failure patients: A randomized clinical trial

Background

Heart Failure (HF) patients usually present with increased arterial resistance and reduced blood pressure (BP) leading to an impaired functional capacity. Osteopathic Manual Therapy (OMT) focused on myofascial release techniques (MRT) and in the balancing of diaphragmatic tensions, has been shown to improve blood flow in individuals using the resistive index (RI). However, its effects in HF patients have not been examined.

Occupational therapy for inpatients with chronic schizophrenia: A pilot randomized controlled trial

Aim: People with schizophrenia tend to experience difficulties in social and cognitive function, self‐care, residual negative symptoms, high rates of unemployment, and social exclusion. Occupational therapy has contributed to the treatment and rehabilitation of people with severe mental health problems. Therefore, this study investigated the effects of occupational therapy on symptoms of patients with schizophrenia. Methods: This survey was an experimental study in which positive and negative symptoms of patients with schizophrenia were assessed with a scale for the assessment of positive and negative symptoms (SANS, SAPS, respectively). The study was conducted in Sina Hospital, Shahrekord, Iran. The samples consisted of patients with schizophrenia who were divided randomly into intervention and usual treatment groups (30 patients in each group). The occupational therapy was performed in the intervention group for 18 h/week for 6 months. SANS and SAPS were assessed at the beginning and after 6 months of treatment. Results: The groups were homogeneous in demographic variables, SANS and SAPS scores at baseline. The occupational therapy group showed significant improvement in the total score for the SANS and SAPS at 6 months (P < 0.001), but the control group did not show any significant improvement. Conclusion: The results of this study indicated that occupational therapy combined with medications can improve the symptoms of schizophrenia.     

A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure

Aims and objectives. To evaluate the effectiveness and cost‐effectiveness of a community nurse‐supported hospital discharge programme in preventing hospital re‐admissions, improving functional status and handicap of older patients with chronic heart failure. Design. Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re‐admission at six months. Secondary outcomes were number of unplanned re‐admissions, six‐minute walking distance, London Handicap Scale and public health care and personal care costs. Results. At sixth months, the re‐admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi‐square test). But the median number of re‐admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six‐minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion. Community nurse‐supported post‐discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re‐admissions. The cost benefits to public health care were not significant. Relevance to clinical practice. Older chronic heart failure patients are likely to benefit from post‐discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken.     

Comparison between febuxostat and allopurinol uric acid-lowering therapy in patients with chronic heart failure and hyperuricemia: a multicenter randomized controlled trial

ObjectiveHeart failure (HF) is a common and highly morbid cardiovascular disorder. Oxidative stress worsens HF, and uric acid (UA) is a useful oxidative stress marker. The novel anti-hyperuricemic drug febuxostat is a potent non-purine selective xanthine oxidase inhibitor. The present study examined the UA-lowering and prognostic effects of febuxostat in patients with HF compared with conventional allopurinol.MethodsThis multicenter, randomized trial included 263 patients with chronic HF who were randomly assigned to two groups and received allopurinol or febuxostat (UA >7.0 mg/dL). All patients were followed up for 3 years after enrollment.ResultsThere were no significant differences in baseline clinical characteristics between the two groups. The UA level was significantly decreased after 3 years of drug administration compared with the baseline in both groups. Urine levels of the oxidative stress marker 8-hydroxy-2′-deoxyguanosine were lower in the febuxostat group than in the allopurinol group (11.0 ± 9.6 vs. 22.9 ± 15.9 ng/mL), and the rate of patients free from hospitalization due to worsening HF tended to be higher in the febuxostat group than in the allopurinol group (89.0% vs. 83.0%).ConclusionsFebuxostat is potentially more effective than allopurinol for treating patients with chronic HF and hyperuricemia.This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (https://www.umin.ac.jp/ctr/; ID: 000009817).     

A randomized trial of rosiglitazone therapy in patients with inadequately controlled insulin-treated type 2 diabetes.

OBJECTIVE: To determine the efficacy and safety of rosiglitazone (RSG) when added to insulin in the treatment of type 2 diabetic patients who are inadequately controlled on insulin monotherapy. RESEARCH DESIGN AND METHODS: After 8 weeks of insulin standardization and placebo (PBO) run-in, 319 type 2 diabetic patients with mean baseline HbA(1c) > or = 7.5% (8.9 +/- 1.1 to 9.1 +/- 1.3) on twice-daily insulin therapy (total daily dose > or = 30 U) were randomized to 26 weeks of additional treatment with RSG (4 or 8 mg daily) or PBO. Insulin dose could be down- titrated only for safety reasons. The primary end point was reduction of HbA(1c) from baseline. RESULTS: RSG 4 and 8 mg daily significantly improved glycemic control, which was unchanged on PBO. By intent-to-treat analysis, treatment with RSG 8 mg plus insulin resulted in a mean reduction from baseline in HbA(1c) of 1.2% (P < 0.0001), despite a 12% mean reduction of insulin dosage. Over 50% of subjects treated daily with RSG 8 mg plus insulin had a reduction of HbA(1c) > or = 1.0%. Neither total:HDL cholesterol nor LDL:HDL cholesterol ratios significantly changed with RSG treatment. Serious adverse events did not differ among groups. CONCLUSIONS: The addition of RSG to insulin treatment results in significant improvement in glycemic control and is generally well tolerated.     

Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial

BackgroundChronic insomnia is associated with disabling symptoms and decrements in functional performance. It may contribute to the development of heart failure (HF) and incident mortality. In our previous work, cognitive-behavioral therapy for insomnia (CBT-I), compared to HF self-management education, provided as an attention control condition, was feasible, acceptable, and had large effects on insomnia and fatigue among HF patients.ObjectivesThe purpose of this randomized controlled trial (RCT) is to evaluate the sustained effects of group CBT-I compared with HF self-management education (attention control) on insomnia severity, sleep characteristics, daytime symptoms, symptom clusters, functional performance, and health care utilization among patients with stable HF. We will estimate the cost-effectiveness of CBT-I and explore the effects of CBT-I on event-free survival (EFS).MethodsTwo hundred participants will be randomized in clusters to a single center parallel group (CBT-I vs. attention control) RCT. Wrist actigraphy and self-report will elicit insomnia, sleep characteristics, symptoms, and functional performance. We will use the psychomotor vigilance test to evaluate sleep loss effects and the Six Minute Walk Test to evaluate effects on daytime function. Medical record review and interviews will elicit health care utilization and EFS. Statistical methods will include general linear mixed models and latent transition analysis. Stochastic cost-effectiveness analysis with a competing risk approach will be employed to conduct the cost-effectiveness analysis.DiscussionThe results will be generalizable to HF patients with chronic comorbid insomnia and pave the way for future research focused on the dissemination and translation of CBT-I into HF settings.     

Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: A 1-year randomized controlled trial

OBJECTIVE; Weight loss improves glycemic control, lipid profiles, and blood pressure in patients with type 2 diabetes. However, successful long-term weight loss is difficult for these patients, particularly those treated with insulin. The aim of this study was to assess the effect of orlistat, a gastrointestinal lipase inhibitor, on weight loss, glycemic control, and cardiovascular risk factors in overweight or obese insulin-treated type 2 diabetic patients. RESEARCH DESIGN AND METHODS: This study was a 1-year multicenter, randomized, double-blind, placebo-controlled trial of orlistat (120 mg three times a day) or placebo combined with a reduced-calorie diet in overweight or obese adults (BMI 28-40 kg/m(2)) with type 2 diabetes treated with insulin alone or combined with oral agents, but with suboptimal metabolic control (HbA(1c) 7.5-12.0%). Outcome measurements included changes in body weight, glycemic control, blood pressure, and serum lipids. RESULTS; After 1 year, the orlistat group lost significantly more weight (-3.89 +/- 0.3% of baseline body weight, means +/- SE) than the placebo group (-1.27 +/- 0.3%, P < 0.001). Orlistat treatment, compared with placebo, produced greater decreases in HbA(1c) (-0.62 +/- 0.08 vs. -0.27 +/- 0.08%, P = 0.002), fasting serum glucose (-1.63 +/- 0.3 vs. -1.08 +/- 0.3 mmol/l, P = 0.02), and the required doses of insulin and other diabetic medications. Orlistat also produced greater improvements than placebo in serum total cholesterol (P = 0.0002) and LDL cholesterol concentrations (P = 0.001) and LDL/HDL ratio (P = 0.01). CONCLUSIONS; Orlistat therapy produces clinically significant weight loss, with improvements in glycemic control and cardiovascular disease risk factors, in overweight or obese patients with type 2 diabetes who have suboptimal metabolic control with insulin therapy.