脑脊液相关指标在中枢神经系统感染中的应用分析

目的观察脑脊液降钙素原、C-反应蛋白、乳酸脱氢酶以及腺苷脱氨酶水平在成人化脓性脑膜炎和结核性脑膜炎中的特点,并探讨其应用价值。方法选取2015年1月-2017年5月于我院诊治的40例结核性脑膜炎和42例化脓性脑膜炎,以及44例同期非中枢性神经系统病变患者的临床资料进行回顾性分析,对患者脑脊液检查中降钙素原、C-反应蛋白、乳酸脱氢酶以及腺苷脱氨酶的水平进行比较分析,并通过ROC曲线对其应用价值进行分析。结果三组患者脑脊液PCT、CRP、LDH以及ADA水平均具有显著差异(P0.05),与对照组相比,化脑组、结脑组脑脊液PCT、CRP、LDH以及ADA水平均明显升高(P0.05),其中结脑组脑脊液PCT、CRP、LDH以及ADA水平均明显低于化脑组(P0.05);化脑组中AUC由大到小依次为CRP、LDH、ADA、PCT,其COV(敏感性,特异性)分别为0.75mg/L(100%,96%)、86.47U/L(100%,73%)、9.71U/L(100%,71%),PCT的AUC最低,且敏感性和特异性较差评价准确度不足;结脑组中AUC由大到小依次为ADA、PCT、CRP、LDH,其COV(敏感性,特异性)分别为6.76U/L(100%,86%)、0.54ng/ml(95%,77%)、1.51mg/L(95%,68%),LDH的AUC最低,且敏感性和特异性较差评价准确度不足。结论脑脊液PCT、CRP、LDH以及ADA的水平变化对化脓性脑膜炎和结核性脑膜炎的临床诊断和鉴别诊断具有一定的参考价值,可能为鉴别诊断两种细菌性脑膜炎的参考辅助指标。     

中枢神经系统感染患儿脑脊液血清神经元特异性烯醇化酶含量的临床意义

目的:探讨中枢神经系统感染(CNSI)患儿脑脊液(CSF)及血清中神经元特异性烯醇化酶(NSE)水平变化的临床意义。方法:选病毒性脑炎(病脑)32例,结核性脑膜炎(结脑)9例,化脓性脑膜炎(化脑)13例及20例同期住院的小儿普外科手术患儿作为对照组。用ELISA法检测他们CSF和血清中的NSE浓度。结果:病脑、结脑和化脑患儿CSF和血清中的NSE均明显高于对照组(P<0.01或P<0.05),其中以结脑的升高最明显,其次是病脑。结脑和病脑患儿CSF和血清中的NSE水平均高于化脑的(P<0.01或P<0.05)。急性期CNSI患儿CSF中的NSE浓度与血清中的NSE浓度呈正相关(r=0.83,P<0.01)。结论:CSF和血清中的NSE水平除可作为CSNI患儿脑实质损伤的指标之外,还可望作结脑和化脑或病脑和化脑间的鉴别依据之一。     

脑脊液sIL-2R、IL-8检测在小儿中枢神经系统感染鉴别诊断中的意义

目的探讨可溶性白细胞介素-2受体(sIL-2R)和白细胞介素-8(IL-8)在小儿不同病因中枢神经系统(CNS)感染急性期脑脊液(CSF)中的变化规律.方法采用双抗体夹心ELISA法检测了21例结核性脑膜炎结脑、15例化脓性脑膜炎(化脑)和20例病毒性脑膜炎患儿急性期CSF中sIL-2R和IL-8.结果结脑、化脑及病毒性脑膜炎急性期CSF中sIL-2R水平分别为(350±81.2)U/ml,(174.5±50.1)U/ml和(80.1±21.77)U/ml,均明显高于正常对照组(27.37±12.19)U/ml(P＜0.001);IL-8水平分别为(218.81±32.52)pg/ml、(360.8±69.38)pg/ml及(106.75±37.16)pg/ml,明显高于正常对照组(42.37±14.92)pg/ml(P＜0.01);结脑、化脑及病毒性脑膜炎急性期CSF中.结论sIL-2R在结脑的发病机制中起重要作用,其在CSF显著增高有助于结脑与病毒性脑膜炎、化脑的鉴别诊断;IL-8在化脑的发生发展中起重要作用,CSF中IL-8检测有助于化脑与病毒性脑膜炎、结脑的鉴别诊断.     

脑脊液乳酸和腺苷脱氨酶检测在小儿脑膜炎中的诊断价值

目的探讨脑脊液乳酸和腺苷脱氨酶检测在小儿脑膜炎临床鉴别诊断中的应用价值。方法采用酶显色法检测脑脊液乳酸（LA）水平,酶动力学法检测脑脊液中腺苷脱氨酶（ADA）活性。结果化脓性脑膜炎（化脑组）和结核性脑膜炎（结脑组）脑脊液LA水平和ADA活性明显高于病脑组和对照组,差异均有统计学意义（P〈0．001）;化脑组脑脊液LA水平高于结脑组,两者比较差异有统计学意义（P〈0．05）;结脑组与化脑组脑脊液ADA活性差异有统计学意义（P〈0．001）,且结脑组脑脊液ADA阳性率为83．33％（20／24）,而化脑组脑脊液ADA活性水平均在正常范围内。病毒性脑膜炎（病脑组）脑脊液LA水平和ADA活性与对照组相比,差异均无统计学意义（P〉0．05）。结论脑脊液LA水平和ADA活性的同时检测,有助于小儿脑膜炎的临床鉴别诊断。     

不同类型脑膜炎感染患儿脑脊液C反应蛋白与乳酸相关指标变化分析

目的:探讨不同类型脑膜炎感染患儿脑脊液(cerebrospinal fluid,CSF) C反应蛋白(CRP)与乳酸(LA)相关指标变化。方法:收集我院2015年1月-2016年7月72例脑膜炎感染患儿,将其设定为观察组,且收集同时间段内的非中枢神经系统疾病患儿35例,设定为对照组,通过连续监测酶法、终点比色法及免疫比浊法,对两组患儿脑脊液中的腺苷脱氨酶(ADA)、LA、CRP、乳酸脱氢酶(LDH)活性进行检测,且观察不同类型脑膜炎感染患儿的脑脊液ADA、LA、CRP、LDH指标变化情况。结果:观察组患儿的脑脊液ADA、LA、CRP、LDH水平与对照组比较均明显提高(P 0. 05);病毒性脑膜炎患儿ADA、LA、CRP、LDH水平与化脓性脑膜炎、结核性脑膜炎对比均明显下降(P 0. 05);化脓性脑膜炎、结核性脑膜炎患儿的ADA、CRP、LDH水平存在明显差异(P0. 05),但LA水平无明显差异(P 0. 05)。结论:不同类型脑膜炎感染患儿ADA、LA、CRP、LDH活性指标存在一定不同,采用ADA、LA、CRP、LDH的联合检测,可有效确诊不同类型的脑膜炎患儿,临床使用价值较高。     

脑脊液C反应蛋白和腺苷脱氨酶检测在小儿脑膜炎中的诊断价值探讨

目的探讨小儿脑脊液C反应蛋白和腺苷脱氨酶在结核性脑膜炎、化脓性脑膜炎和病毒性脑膜炎早期诊断中的临床意义。方法分别检测315例小儿脑膜炎患儿(包括结核性脑膜炎102例、化脓性脑膜炎108例、病毒性脑膜炎105例)及96例非脑膜炎外科手术患儿(对照组)脑脊液C反应蛋白和腺苷脱氨酶含量,并做比较。结果结核性脑膜炎组及化脓性脑膜炎组脑脊液C反应蛋白、腺苷脱氨酶含量明显高于对照组及病毒性脑膜炎组(P0.05),而病毒性脑膜炎组与对照组之间差异无统计学意义(P0.05)。化脓性脑膜炎组脑脊液C反应蛋白含量明显高于结核性脑膜炎组(P0.05),而腺苷脱氨酶含量则低于结核性脑膜炎组(P0.05)。化脓性脑膜炎组脑脊液C反应蛋白均为阳性,阳性率为100%;结核性脑膜炎组有63例阳性,阳性率为61.76%;病毒性脑膜炎组均为阴性。结论脑脊液C反应蛋白和腺苷脱氨酶对细菌性脑膜炎(化脓性脑膜炎和结核性脑膜炎)与病毒性脑膜炎的鉴别诊断有重要的参考价值。腺苷脱氨酶可能是诊断结核性脑膜炎的良好指标。     

脑脊液CK—BBADA和IgM检测在小儿病毒性结核性和新型隐球菌性脑膜炎疾病中的应用

目的探讨脑脊液肌酸肌酶同功酶BB（CK—BB）、腺苷脱氨酶（ADA）和免疫球蛋白IgM水平在小儿病毒性脑膜炎、结核性脑膜炎和新型隐球菌性脑膜炎疾病中的变化和临床意义。方法选择小儿脑膜炎患者139例,分为病毒性脑膜炎组（病脑组）43例、结核性脑膜炎组（结脑组）45例和新型隐球菌型脑膜炎组（新脑组）41例;另选同期的健康体检儿童48例为健康对照组。利用罗氏MODuLARP800全自动生化分析仪检测各组脑脊液CK－BB、ADA和IgM水平。结果病脑、结脑和新脑组的脑脊液CK．BB水平分别与对照组比较,均明显升高（P均〈0．01）。病脑、结脑和新脑组的脑脊液ADA水平分别与对照组比较,结脑组ADA水平显著升高,差异有统计学意义（P〈0．01）,病脑和新脑组升高不显著。病脑、结脑和新脑组的脑脊液IgM水平分别与对照组比较,均明显升高（P均〈0．01）。结脑和新脑组的CK—BB水平明显高于病脑组（P均〈0．01）。结脑组的ADA水平明显高于病脑组和新脑组（t=-21．03,P〈0．01;t=-23．17,P〈0．01）。结脑和新脑组的IgM水平明显高于病脑组（P均〈0．01）。结论小儿脑脊液CK—BB、ADA和IgM水平可反映其中枢神经系统的感染状况,联合检小儿脑脊液三项生物指标水平有助于结核性脑膜炎、病毒性脑膜炎和新型隐球菌性脑膜炎的早期鉴别诊断。     

丙氨酰谷氨酰胺对急性肺损伤患者的保护作用及其机制初探

目的 观察丙氨酰谷氨酰胺(Ala-Gln)对急性肺损伤(ALI)患者的保护作用及其机制.方法 110例ALI患者随机分为对照组(50例)和Ala-Gln组(60例).对照组给予常规治疗,Ala-Gln组在常规治疗的基础上,加用Ala-Gln,疗程7天,分别观察两组间治疗前后血清谷氨酰胺(Gln)、热休克蛋白70(HSP70)水平、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及机械通气时间的差异.结果 Ala-Gln组治疗后血清HSP70、Gln水平明显增高,与治疗前比较差异有统计学意义,HSP70 (1.99±0.66) μg/L vs (1.34±0.68) μg/L( P＜0.01);Gln (386.15±68.60)μg/L vs (304.72±73.70) μg/L(P＜0.01).与对照组治疗后比较差异亦有统计学意义,Gln (386.15±68.60) μg/L vs (303.74±78.08) μg/L( P＜0.01);HSP70 (1.99±0.66) μg/L vs(1.35±0.48)μg/L(P＜0.01).Ala-Gln组治疗前后Gln浓度比与HSP70浓度比呈明显正相关(r=0.809,P＜0.01),对照组治疗前后血清Gln、HSP70水平差异无统计学意义,对照组治疗前后Gln浓度比与HSP70浓度比无明显相关性(r=0.147,P＞0.05).Ala-Gln组机械通气时间明显低于对照组,(162.20±96.33)小时vs (235.00±107.90)小时(P＜0.05).治疗后APACHEⅡ评分的改善明显优于对照组,(8.40±2.17)分vs (11.10±2.42)分(P＜0.05).结论 Ala-Gln治疗可显著提高ALI患者血清Gln、HSP70水平、缩短机械通气时间,改善APACHEⅡ评分,提示Ala-Gln对ALI患者具有保护作用,其机制可能与提高患者体内Gln、HSP70水平有关.     

联合检测脑脊液相关免疫指标的临床评价

目的：研究脑脊液(CSF)中肿瘤坏死因子α(TNF-α)、铁蛋白(Ferritin)、β2微球蛋白(β2-MG)、C3、C4、α2巨球蛋白(α2-M)含量与小儿中枢神经系统(CNS)感染的关系，分析诊断3种不同类型脑膜炎的指标。方法：应用化学免疫发光法和速率散射比浊法分别检测37例病毒性脑炎(病脑)、12例化脓性脑膜炎(化脑)、11例结核性脑膜炎(结脑)患儿CSF中上述6项指标。结果：3组患儿CSF中6项指标均有不同程度升高，其中化脑组TNF-α含量最高，与其它两组比较差异有显著性(P<0．01)；其它5项指标都是结脑组最高；病脑组补体C3、C4、α2-M含量均低于仪器最低检出限。结论：联合检测补体C3、C4和TNF-α，可准确诊断3种不同类型脑膜炎。     

血清PCT、hs-CRP在成人脑膜炎诊断中的应用价值

目的检测成人化脓性脑膜炎、病毒性脑膜炎及结核性脑膜炎患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平,探讨其在脑膜炎鉴别诊断中的价值。方法收集该院神经内科脑膜炎患者141例(病脑组53例,结脑组51例,化脑组37例)为观察组,其他患者37例为对照组,比较各组血清PCT、hs-CRP水平及诊断价值。结果化脑组患者血清PCT、hs-CRP含量均明显高于病脑组、结脑组和对照组,差异均有统计学意义(P0.05);病脑组、结脑组与对照组患者血清PCT含量比较,差异无统计学意义(P0.05)。病脑组患者血清hs-CRP水平明显高于对照组,差异具有统计学意义(P0.05)。经受试者工作曲线(ROC)分析,血清PCT诊断化脓性脑膜炎的临床价值高于hs-CRP,两者联合诊断成人化脓性脑膜炎时灵敏度可达93.4%。结论血清PCT、hs-CRP作为化脓性脑膜炎与其他类型脑膜炎早期鉴别诊断的指标,有较好的应用价值。     

颅内感染患者脑脊液中磷脂酶A2活性的研究

目的　探讨常见颅内感染患者脑脊液中磷脂酶A2(PLA2)活性变化及其临床意义。方法　采用(     

常见中枢神经系统感染临床、CSF特征及鉴别诊断

目的分析常见中枢神经系统感染性疾病在临床表现及脑脊髓液（CSF）特征的异同点。方法回顾性总结296例中枢神经系统感染性疾病的临床表现及CSF表现。结果高热以病毒脑和化脑常见（62％和67％）,以头痛为首发症状者隐脑多见（60％）;抽搐多见于病毒脑（63％）;隐脑出现视力改变（40％）、听力下降（45％）、视神经乳头水肿（74％）及脑疝（41％）的比例明显高于其他组;54％的病毒脑出现肢体瘫痪;化脑外周血白细胞显著升高且以多核细胞为主（64％超过20×10^9／L）。CSF检查结果：隐脑的CSF压力升高最明显（91％大于3．96kPa）;化脑白细胞升高明显（76％大于400×10^6／L）;化脑（74％）和结脑（82％）氯化钠浓度下降;结脑蛋白质升高最显著（48％大于2g／L）。结论隐脑、结脑在临床及CSF变化上相似,CSF压力及蛋白质含量是鉴别的重要指标。化脑、病毒脑的临床诊断相对容易。     

颅脑疾病患者血清及脑脊液中心肌酶谱检测的意义

目的观察各种心肌酶在颅脑疾病患者血清及脑脊液中的变化,为临床颅脑疾病的鉴别诊断提供依据。方法采集结核性脑膜炎、病毒性脑膜炎、脑血管疾病、急性颅脑损伤和脑肿瘤患者的血清及脑脊液,检测其乳酸脱氢酶(LDH)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、羟丁酸脱氢酶(HBDH)、肌酸激酶(CK)和谷氨酰转移酶(GGT)值。结果 1)与健康对照组比较,各组脑脊液及血清中的心肌酶差异有统计学意义,均有不同程度升高(P0.05),其中以急性颅脑损伤组最高;2)结核性脑膜炎患者与病毒性脑膜炎患者比较,脑脊液中的GGT、LDH、HBDH、CK差异有统计学意义(P0.05)。结论同时检测脑脊液及血清中的心肌酶可用于鉴别诊断病毒性脑膜炎和结核性脑膜炎;脑脊液中心肌酶的测定可作为急性颅脑损伤的性质及预后的辅助诊断指标。     

Improved meal-related beta-cell function and insulin sensitivity by the dipeptidyl peptidase-IV inhibitor vildagliptin in metformin-treated patients with type 2 diabetes over 1 year

OBJECTIVE: To examine the effects of dipeptidyl peptidase-IV (DPP-4) inhibition on meal-related beta-cell function and insulin sensitivity over 52 weeks in type 2 diabetes. RESEARCH DESIGN AND METHODS: In a 12-week core study, placebo (n = 51) or vildagliptin (n = 56; 50 mg OD) was added to metformin treatment (1.5-3.0 mg/day). A 40-week extension followed in 71 patients. Meal tests were performed at 0, 12, 24, and 52 weeks; glucose, insulin, and C-peptide were evaluated. RESULTS: In subjects completing 52 weeks with participation in all meal tests (n = 57), HbA(1c) (A1C) decreased in the vildagliptin/metformin group (VM group, n = 31) but increased in the placebo/metformin group (PM group, n = 26; between-group difference -1.0 +/- 0.2%; P < 0.001; baseline of all subjects combined 7.7 +/- 0.1%). Also, fasting glucose decreased in the VM group but increased in the PM group (difference -0.9 +/- 0.3 mmol/l, P = 0.016; baseline 9.8 +/- 0.3 mmol/l). Insulin secretion (postmeal suprabasal area under the 0- to 30-min C-peptide curve divided by the 30-min increase in glucose) was increased in the VM group but was reduced in the PM group (difference +0.011 +/- 0.03 pmol/l 30 min/mmol/l, P = 0.018; baseline 0.036 +/- 0.02). Insulin sensitivity during meal ingestion (oral glucose insulin sensitivity) increased in the VM group but was not altered in the PM group (difference +27 +/- 4 ml x min(-1) x m(-2), P = 0.036; baseline 246 +/- 6). Insulin secretion related to insulin sensitivity (adaptation index) increased in the VM group but decreased in the PM group (difference +3.2 +/- 1.0, P = 0.040; baseline 9.1 +/- 0.5). The change in adaptation index correlated to the change in A1C (r = -0.39, P = 0.004). CONCLUSIONS: This study presents evidence that DPP-4 inhibition by vildagliptin when added to metformin in type 2 diabetes over 52 weeks improves beta-cell function along with improved postmeal insulin sensitivity.     

Cerebrospinal fluid alpha-1-antitrypsin alpha-1-antitrypsin-elastase complex levels in meningitis

Alpha-1-antitrypsin (A-1-AT) and A-1-AT-elastase complex levels in cerebrospinal fluid have been evaluated in 11 children with viral meningitis (VM), 14 with bacterial meningitis (BM), 10 with tuberculous meningitis (TBM) and 10 investigated for, but found not to have meningitis (NM). A-1-AT concentrations in the NM group were lower than in the BM group (P = 0.0002) and the TBM group (P = 0.0005) but did not differ from the concentrations in VM; those in the VM group were lower than in the BM group (P = 0.0001) and the TBM group (P = 0.003) but no difference was found between the BM and TBM groups. A-1-AT-elastase complex concentrations in CSF were lower in the NM group than the BM group (P = 0.0001) or the TBM group (P = 0.0089), however those in the BM group were significantly higher than in the TBM group (P = 0.0001). A significant correlation existed in CSF between the protein concentrations and neutrophil counts as well as the A-1-AT and A-1-AT-elastase complex concentrations.     

红细胞分布宽度在儿童过敏性紫癜中的临床价值

目的探讨红细胞分布宽度（RDW）在儿童过敏性紫癜（HSP）中的临床价值。 方法收集2013年1月至2018年5月在广西壮族自治区人民医院儿科住院的HSP患儿的资料,根据是否存在肾脏损害分为紫癜性肾炎（HSPN）组和过敏性紫癜无肾炎（HSPWN）组,同时设置同期健康儿童作为对照组。对HSP患儿和健康儿童,HSPN、HSPWN患儿与健康儿童,血红细胞（RBC）、血小板（PLT）的两组间比较采用两样本t检验,三组间比较采用one-Way ANOVA;年龄,血白细胞（WBC）、血红蛋白（Hb）、红细胞比容（Hct）、红细胞平均体积（MCV）、红细胞分布宽度变异系数（RDW-CV）、红细胞分布宽度标准差（RDW-SD）和血小板平均体积（MPV）的组间比较采用秩和检验;性别分布的组间比较采用χ²检验。任意两组间比较采用Kruskal-Wallis检验（视图中选择pairwise comparisons）。HSP患儿RDW-CV、RDW-SD与其他指标的相关性分析采用Spearman秩相关分析。 结果HSP患儿与健康儿童在性别,年龄,血MCV、PLT、MPV方面差异无统计学意义（P均>0.05）。HSP患儿血WBC,RDW-CV、RDW-SD水平较健康儿童显著增高,差异有统计学意义（Z=-6.838,P<0.001;Z=-5.437,P<0.001;Z=-4.681,P<0.001）;血RBC,Hb、Hct水平较健康儿童显著降低,差异有统计学意义（t=-2.701,P=0.008;Z=-4.396,P<0.001;Z=-4.043,P<0.001）。HSPN、HSPWN患儿与健康儿童在性别,年龄,血MCV、PLT、MPV方面差异无统计学意义（P均>0.05）。HSPN、HSPWN患儿与健康儿童比较,血WBC、RDW-CV、RDW-SD水平明显升高,差异有统计学意义（Z=46.760,P<0.001;Z=32.984,P<0.001;Z=28.343,P<0.001）;而血RBC、Hb、Hct水平明显降低,差异有统计学意义（t=4.375,P=0.014;Z=20.623,P<0.001;Z=18.256,P<0.001）。HSPN患儿与HSPWN患儿比较,血RDW-SD水平明显升高,差异有统计学意义（P<0.05）,其余指标差异无统计学意义（P均>0.05）。HSP患儿血RDW-CV与WBC、RBC和RDW-SD呈正相关（r=0.189,P=0.047;r=0.263,P=0.005;r=0.217,P=0.023）,与Hb、Hct、MCV呈负相关（r=-0.329,P<0.001;r=-0.194,P=0.042;r=-0.447,P<0.001）,未发现RDW-CV水平与CRP、Fib、D-二聚体和总胆固醇水平之间的相关性（r=0.029,0.021,-0.143,0.015,P均>0.05）。HSP患儿血RDW-SD水平与MCV、RDW-CV、总胆固醇水平之间呈正相关（r=0.434,P<0.001;r=0.217,P=0.023;r=0.360,P<0.001）,与RBC、D-二聚体水平呈负相关（r=-0.213,P=0.026;r=-0.301,P=0.003）,未发现RDW-SD与WBC、Hb、Hct、CRP、Fib水平之间的相关性（r=-0.027,0.060,0.139,-0.073,-0.195,P均>0.05）。 结论HSP患儿RDW水平升高,但RDW在评估HSP患儿能否进展为HSPN方面仍有待进一步研究。     

隐球菌性脑膜炎及病毒性脑炎患者脑脊液IL-6、IL-10和TNF-α含量检测及其临床意义

目的:探讨隐球菌性脑膜炎及病毒性脑炎患者脑脊液中白细胞介素-6(IL-6)、IL-10和肿瘤坏死因子-α(TNF-α)含量的变化及临床意义.方法:应用Luminex液相芯片技术对隐球菌性脑膜炎患者18例(隐脑组),病毒性脑炎患者20例(病脑组)及非中枢神经系统感染患者15例(对照组)脑脊液中IL-6、IL-10和TNF...     

Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise

Local metabolic changes are suggested to be involved in muscle pain development in humans. Nineteen women with chronic work-related trapezius myalgia (TM) and 20 healthy female controls (CON) were studied during baseline rest, 20 min repetitive low-force exercise, and 120 min recovery. Interstitial serotonin (5-HT), glutamate, lactate, pyruvate, and blood flow were determined by microdialysis in the trapezius muscle. Baseline pressure pain threshold (PPT) was lower (143+/-18 (TM) vs. 269+/-17 (CON)kPa) (mean+/-SEM), pain intensity (visual analogue scale, VAS) higher (33+/-5 vs. 2+/-1mm), muscle 5-HT higher (22.9+/-6.7 vs. 3.8+/-1.3 nmol/l), and glutamate higher (47+/-3 vs. 36+/-4 micromol/l) in TM than in CON (all P<0.05), whereas muscle blood flow was similar in groups. Furthermore, muscle pyruvate was higher (180+/-15 vs. 135+/-12 micromol/l) and lactate higher (4.4+/-0.3 vs. 3.1+/-0.3 mmol/l) in TM than in CON (P<0.001). In response to exercise, VAS and glutamate increased in both TM and CON (all P<0.05). In TM only, lactate and pyruvate increased significantly (P<0.02), whereas blood flow increased to similar levels in both groups. During the initial 20 min recovery period, blood flow remained increased in TM (P<0.005) whereas it decreased to baseline levels in CON. In conclusion, patients with chronic work-related TM have increased levels of muscle 5-HT and glutamate that were correlated to pain intensity (r=0.55, P<0.001) and PPT (r=-0.47, P<0.001), respectively. In addition, TM was associated with increased anaerobic metabolism, whereas a normal rise in blood flow was seen with exercise. These findings indicate that peripheral nociceptive processes are active in work-related TM.     

Prognostic factors for overall survival in prostate cancer patients with different site-specific visceral metastases: A study of 1358patients

BACKGROUND Distant metastasis,particularly visceral metastasis(VM),represents an important negative prognostic factor for prostate cancer(PCa)patients.However,due to the lower rate of occurrence of VM,studies on these patients are relatively rare.Consequently,studies focusing on prognostic factors associated with PCa patients with VM are highly desirable.AIM To investigate the prognostic factors for overall survival(OS)in PCa patients with lung,brain,and liver metastases,respectively,and evaluate the impact of site-specific and number-specific VM on OS.METHODS Data on PCa patients with VM were extracted from the Surveillance,Epidemiology,and End Results database between 2010 and 2015.Univariate and multivariate Cox regression analyses were used to analyze the association between clinicopathological characteristics and survival of patients with different site-specific VM.Kaplan-Meier analyses and Log-rank tests were performed to analyze the differences among the groups.RESULTS A total of 1358 PCa patients with site-specific VM were identified from 2010 to 2015.Older age(>70 years)(P<0.001),higher stage(T3/T4)(P=0.004),and higher Gleason score(>8)(P<0.001)were found to be significant independent prognostic factors associated with poor OS in PCa patients with lung metastases.Higher stage(T3/T4)(P=0.047)was noted to be the only independent risk factor affecting OS in PCa patients with brain metastases.Older age(>70 years)(P=0.010)and higher Gleason score(>8)(P=0.001)were associated with shorter OS in PCa patients with liver metastases.PCa patients with isolated lung metastases exhibited significantly better survival outcomes compared with PCa patients with other single sites of VM(P<0.001).PCa patients with a single site of VM exhibited a superior OS compared with PCa patients with multiple sites of VM(P<0.001).CONCLUSION This is the first Surveillance,Epidemiology,and End Results-based study to determine prognostic factors affecting OS in PCa patients with different sitespecific VM.Clinical assessments of these crucial prognostic factors become necessary before establishing a treatment strategy for these patients with metastatic PCa.