Alpha-1-antitrypsin content in the serum, alveolar macrophages, and alveolar lavage fluid of smoking and nonsmoking normal subjects.

The content of alpha-1-antitrypsin in the serum, alveolar lavage fluid, and alveolar macrophages of smokers and nonsmokers was studied. Bronchoalveolar lavage was used to obtain alveolar fluid and macrophages from normal volunteers, and alpha-1-antitrypsin and albumin were measured using the electroimmunodiffusion technique. The serum level of inhibitor was not different between the two groups, while the total lavage fliud content of alpha-1-antitrypsin was increased in the smokers. The level of alpha-1-antitrypsin was also significantly greater (P less than 0.001) in the alveolar macrophages of the smokers suggesting the possibility of chronically increased alveolar levels in the cigarette smoker as a possible protective mechanism against proteolysis.     

Effects of age and sex on hematologic and serum biochemical values of vervet monkeys (Chlorocebus aethiops sabaeus).

Hematologic and serum biochemical values are of great importance in assessing animal health. Normal reference ranges for vervet monkeys (Chlorocebus aethiops sabaeus) have seldom been reported, making it difficult for clinicians to interpret blood values. The purpose of this study was to determine what effects age and sex have on hematologic and serum biochemical values of vervet monkeys and to establish clinically relevant reference ranges for all life stages of each gender. Blood samples were collected from 140 healthy vervet monkeys of Caribbean origin consisting of 60 females and 80 males. Male and female data were displayed separately within six life-stage categories (yearlings, juveniles, adolescents, young adults, adults, and aged). The effects of sex and age on these values were examined statistically. Significant age-related factors included red blood cell count, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, alkaline phosphatase, albumin, total protein, globulin, direct bilirubin, blood urea nitrogen, creatinine, glucose, calcium, phosphorus, potassium, albumin/globulin ratio, blood urea nitrogen/creatinine ratio, and sodium/potassium ratio values. Significant sex-related values included red blood cell count, hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, neutrophil count, total bilirubin, direct bilirubin, creatinine, glucose, calcium, phosphorus, total carbon dioxide, chloride, potassium, and sodium/potassium ratio values.     

Smoking and serum alpha 1-antitrypsin in 1296 healthy men (author's transl)]

Serum alpha 1-antitrypsin (alpha 1AT) was measured by radial immunodiffusion in 1296 healthy men aged 18--50 years. Other biological criteria, including leukocyte count and alpha 2-globulins were measured and the subjects were given a detailed questionnaire on their smoking habits. Results showed a very strong positive relationship between smoking and serum alpha 1AT: the heavy smokers had a serum alpha 1AT 20% higher than the non-smokers, and among subjects who stopped smoking, the level returned rapidly to normal. There were also close interrelationships between serum alpha 1AT, smoking, leukocyte count and a alpha 2-globulins. A discussion of these results is presented.     

Continuous plasmafiltration in sepsis syndrome. Plasmafiltration in Sepsis Study Group.

OBJECTIVE: To assess the effect of plasmafiltration (PF) on biochemical markers of inflammation, cytokines, organ dysfunction, and 14-day mortality in human sepsis. DESIGN: Multicenter, prospective, randomized, controlled clinical trial. SETTING: Seven university-affiliated intensive care units. PATIENTS: Thirty patients (22 adults, eight children) with new (<24 hrs) clinical evidence of infection and sepsis syndrome were enrolled. Fourteen of 30 (nine adults, five children) were randomized to PF. INTERVENTIONS: All patients received protocol-driven supportive intensive care, and those randomized to PF received continuous plasma exchange for 34 hrs using a hollow-fiber plasma filter. MEASUREMENTS AND MAIN RESULTS: Illness severity and risk of death were calculated with the Pediatric Risk of Mortality (children) and the Acute Physiology and Chronic Health Evaluation II (adults) scales. Plasma samples (0, 6, 24, and 48 hrs) were assayed for acute-phase proteins (albumin, globulin, C-reactive protein, alpha1-antitrypsin, haptoglobin), inflammatory mediators (complement fragment C3, thromboxane B2), and cytokines (interleukin-6, granulocyte colony-stimulating factor, leukemia inhibitory factor). Sieving coefficients were estimated from filtrate concentrations at 3 hrs. The two groups were matched for incidence of septic shock (13 of 14 vs. 11 of 16), refractory shock (three of 14 vs. six of 16), bacteremia (six of 14 vs. five of 16), severity of illness, and calculated risk of death (0.68 vs. 0.64). There was no difference in mortality. Eight of 14 PF patients (57%) and eight of 16 controls (50%) survived for 14 days (p = .73, Fisher's exact test). Multiple logistic regression revealed age (odds ratio, 16.4:1; 95% confidence interval, 2.12-infinity) and shock (10.6:1; 1.32-infinity) as significant predictors of death; plasmafiltration was associated with a nonsignificant reduction in the risk of death (odds ratio, 1.78:1; 95% confidence interval, 0.20-18.1). The mean (SD) number of organs failing in the first 7 days in the PF group was 2.57 (0.94) vs. 2.94 (0.85) in controls (p = .37, Mann-Whitney U test). Both groups had similarly elevated plasma concentrations of all inflammatory mediators except complement fragment C3 at study entry. Leukemia inhibitory factor was detectable in four patients only. PF did not influence mean concentrations of interleukin-6, granulocyte colony-stimulating factor, thromboxane B2, total white cell count, neutrophil count, or platelet count, but it was associated with significant reductions of alpha1-antitrypsin, haptoglobin, C-reactive protein, and complement fragment C3 in the first 6 hrs (p < .05). The sieving coefficients for all inflammatory mediators approached unity. CONCLUSIONS: PF caused a significant attenuation of the acute-phase response in sepsis. There was no significant difference in mortality, but there was a trend toward fewer organs failing in the PF group that suggests that this procedure might be beneficial.     

A new immunoassay of human antibodies to chemical carcinogens

The study was undertaken to optimize the well known immunoassay of antibodies to chemical carcinogens, designed by J. Chagnaud et al., and examine the specific features of the generation of antibodies (Ab) to benzo[a]pyrene (BP) in patients with lung cancer. Ninety-two serum samples from healthy males and 80 samples from patients with lung cancer were studied. Increased efficiency was achieved by the use of bovine serum albumin instead of thyreoglobulin in the synthesis of carrier protein conjugates with BP. Better reproducibility was accomplished, by using the control serum sample with the known content of IgM, IgG, and IgA Ab to BP. Analysis of the study serum samples has established that in healthy male smokers, the count of IgA Ab was twice greater than that in non-smokers. The patients with lung cancer were found to higher levels of IgG and IgA Ab to BP (in both smokers and non-smokers) than healthy individuals. It is proposed to use the stated method to study a role of A to chemical carcinogens in the pathogenesis of malignancies.     

Quantitative immunological determination of 12 plasma proteins excreted in human urine collected before and after exercise

Urine was collected from 6 healthy male adults at rest and from 20 male adults after a marathon race (25 miles). The concentrated urines were quantitatively analyzed, by single radial immunodiffusion, for their content in 12 different plasma proteins: tryptophan-rich prealbumin, albumin, alpha(1)-acid glycoprotein, alpha(1)-antitrypsin, ceruloplasmin, haptoglobin, Gc-globulin, transferrin, hemopexin, beta(2)-glycoprotein I, gammaA-globulin, and gammaG-globulin.Albumin, gammaA-globulin, and gammaG-globulin represent the major part of the plasma proteins detected in normal urine excreted by humans at rest (12, 0.5, and 2.5 mg respectively, out of a total excretion of 17.5 mg of plasma proteins per 24 hr). The other plasma proteins were excreted at a lower rate (< 0.4 mg/24 hr). The relative content of tryptophan-rich prealbumin, alpha(1)-antitrypsin, Gc-globulin, transferrin, and gammaG-globulin was lower in normal urine than in normal serum, whereas that of alpha(1)-acid glycoprotein, beta(2)-glycoprotein I, and gammaA-globulin was higher. The ratio of gammaG-globulin to gammaA-globulin was 4.9:1. When plotted on a logarithmic scale, no direct relationship between the molecular weight of a protein and the value of its renal clearance could be observed.Strenuous exercise increased (up to 50-fold) the excretion of plasma proteins which represent 82% of the total proteins found in urine, instead of 57% in urine collected from humans at rest. There was particularly a significant rise of tryptophan-rich albumin, albumin, alpha(1)-acid glycoprotein, transferrin, gammaA-globulin, and gammaG-globulin (0.26, 127, 11.8, 3.3, 1.2, and 2.0 mug respectively, out of a total excretion of 167 mug of plasma proteins per min). The ratio of gammaG-globulin to gammaA-globulin was 16:1. After exercise, the renal clearance of proteins increased from 2 to 40 times, but, as for the urine of normal subjects at rest, no direct relationship between molecular weight and renal clearance could be observed.     

北京地区儿童肾功能生化项目参考区间调查

目的调查北京地区健康儿童肾功能常规生化检测项目参考区间,建立儿童肾功能生化指标评价标准。方法采用Olympus2700全自动生化分析仪对548例3～14岁北京地区健康体检儿童血清进行尿素、肌酐、尿酸、胱抑素C、总蛋白和清蛋白项目的检测。应用SPSS软件对资料进行年龄、性别分组的正态性检验和比较,依据近期发布的卫生行业标准WS／T402-2012建立以上项目北京地区儿童参考区间。结果03～14岁男孩尿素参考区间为4．21±1．02mmol／L,女孩为3．91±1．67mmol／L。②儿童肌酐测定值存在年龄、性别差异,其中3～6岁儿童参考区间为35．43±7．80μmol／L;7～14岁男孩为44．37土12．21μmol／L,女孩为42．58±10．45μmol／L。③3～6岁儿童尿酸、总蛋白和清蛋白的参考区间分别为277．04±110．49μmol／L,69．34±6．78g／L和44．24±3．68g／L,7～14岁儿童尿酸、总蛋白和清蛋白的参考区间分别为305．24±120．52μmol／L,73．21士7．76g／L和45．22±3．86g／L。④3～14岁儿童胱抑素C测定值不存在年龄、性别差异,其参考区间为0．51～1．12mg／L。结论儿童肾功能常规生化检测项目的参考区间与成人存在差异,儿童医院实验室应建立使用儿童参考区间。儿童肾功能常规生化检测项目参考区间的建立要考虑年龄、性别差异。     

Screening for cystic fibrosis by analysis of meconium for albumin and protease inhibitors

A qualitative method of detecting elevated meconium protein concentration was compared with a method of determining meconium albumin concentration by electroimmunoassay since elevated meconium protein levels can indicate pancreatic insufficiency caused by cystic fibrosis. Between 5 and 10 per 1000 healthy infants passed meconium specimens that gave a false positive reaction with the Boehringer Mannheim test strip and contained a greater than expected concentration of albumin. It was possible to exclude pancreatic insufficiency in all of these children by determining the ratio, albumin: α₁-antitrypsin in meconium and subsequent faecal specimens, since it was found that values of this ratio in excess of 2.0 suggested pancreatic insufficiency of the type associated with cystic fibrosis. Three of 14 neonates with subsequently proven cystic fibrosis yielded meconium specimens giving negative test strip results and low albumin concentrations. In two of these patients, the ratio, albumin: α₁-antitrypsin in the meconium was within normal limits but, within two months of birth, the albumin: α₁ -antitrypsin ratio in the faeces of both children was greater than 3.0 suggesting that pancreatic insufficiency had developed.     

Alpha1-antitrypsin phenotypes in chronic active liver disease and primary biliary cirrhosis.

Alpha1-antitrypsin concentrations and phenotypes were determined in groups of patients with chronic active liver disease and primary biliary cirrhosis. The concentrations of alpha1-antitrypsin were above normal values in both groups; the patients with primary biliary cirrhosis had higher concentrations than those with chronic active liver disease. The prevalence of common phenotypes in these two groups did not differ from that in a sample of healthy blood donors from this institution of from a large Norwegian sample. We interpret our data as disputing the view that alpha1-antitrypsin phenotypes, other than Z. significantly predispose adults to hepatic cirrhosis.     

Smoking accelerates absorption of inhaled neutrophil elastase inhibitor FK706

PURPOSE: We compared the pharmacokinetics of the inhaled novel neutrophil elastase inhibitor FK706 between healthy nonsmokers and smokers. METHODS: Six healthy nonsmokers and six smokers inhaled 50 to 400 mg FK706 in two different doses. Series of plasma concentrations of the SSS form of FK706 (pharmacologically active epimer) were analyzed model dependently and independently. Pharmacokinetic parameters obtained from each group were compared after standardization by doses. RESULTS: The plasma concentration-time curve of inhaled FK706 was apparently different between smokers and nonsmokers. The maximum plasma concentrations (Cmax) were significantly higher in the smokers than in the nonsmokers (smokers, 1.47 +/- 0.62 ng/mL/mg; nonsmokers, 0.49 +/- 0.14 ng/mL/mg [mean +/- SD; P < .01]). The time to reach Cmax (tmax) and elimination half-life (t1/2) were statistically smaller in the smokers compared with the tmax and elimination t1/2 in the nonsmokers (tmax in smokers, 0.44 +/- 0.27 hours; tmax in nonsmokers, 1.17 +/- 0.39 hours [P < .01]; t1/2 in smokers, 1.23 +/- 0.40 hours; t1/2 in nonsmokers, 2.73 +/- 0.57 hours [P < .01]). The area under the plasma concentration-time curve and plasma clearance were not significantly different between the two groups. Model-dependent pharmacokinetic analysis, assuming a flip-flop model, revealed that the absorption rate constant (ka) was about 10 times greater in smokers than the ka in nonsmokers. CONCLUSION: Significant increases of Cmax and ka and reductions of tmax and elimination t1/2 of the inhaled FK706 were observed in the healthy smokers, suggesting that the smoking habit accelerates the drug absorption after inhalation. These results suggest that we should pay attention to the drug-related adverse events caused by smoking, especially when the drug has a narrow therapeutic range.     

Normal values for quantitative parameters for evaluation of mucociliary clearance in lungs

Twenty-eight normal male subjects (13 nonsmokers and 15 smokers, 25 to 76 years of age) inhaled ultrasonically generated 99mTc-tagged human serum albumin aerosol (mass median diameter: 1.93 microns with geometric standard deviation of 1.52) and radioactivity from the thorax was measured continuously from anteriorly in 10 sec frame mode for 90 to 120 min to evaluate mucociliary clearance function in the lungs. Normal values for lung retention ratio (LRR), airway deposition ratio (ADR), airway retention ratio (ARR), airway clearance efficiency (ACE), alveolar deposition ratio (ALDR), and disappearance rate of radioactivity from the ciliated airways (DR) were presented. ALDR was significantly larger in nonsmokers than in smokers. LRR and ARR were significantly smaller and ACE, significantly larger in smokers at any time intervals than in nonsmokers, while ADR and DR were larger in smokers only in the initial 30 min following radioaerosol inhalation was completed. Thereafter there was little difference in ADR and DR between normal smokers and nonsmokers.     

部分胃肠外营养在早产儿、低体重儿的应用和护理

目的:观察部分胃肠外营养(PPN)对早产儿,特别是低出生体重儿的应用,探讨严格的护理措施对治疗的辅助意义。方法:选择本院2007年1月～2008年12月应用PPN辅助治疗早产儿48例,测量PPN输注前后的体重、血浆总蛋白、白蛋白、血糖、淋巴细胞总数、血尿素氮等的变化,严密观察应用PPN的并发症,并与2005年1月～2006年12月未应用PPN的早产儿、低出生体重儿42例疗效对比。结果:静脉营养支持组治愈40例,好转5例,死亡2例,自动出院1例;治疗后,患儿血浆总蛋白、白蛋白、血糖、淋巴细胞总数明显增加,血尿素氮明显降低(P0.01或P0.05),无明显并发症发生。静脉营养支持组患儿救治成功率明显高于对照组(P0.01)。结论:合理应用胃肠外营养,密切监测各项指标,早期发现并发症,及时处理,可提高早产儿、低出生体重儿的存活率,严格的护理操作有助于治疗的顺利进行。     

Predictors of fatigue in healthy young adults: moderating effects of cigarette smoking and gender

Fatigue is a common complaint of patients seen in primary care. Factors that contribute to fatigue in a patient population include poor health status, psychological stress, poor nutrition, and pregnancy. Less well understood are factors that contribute to fatigue among healthy, nonpregnant individuals. Within the framework of the theory of unpleasant symptoms, 40 healthy young smoking and nonsmoking adults between the ages of 18 and 35 were evaluated to determine self-report level of fatigue and contributing physiological, psychological, and situational factors. Results indicate that while self-report of fatigue did not vary in this population based on gender, subjects who were moderate to heavy cigarette smokers were significantly more fatigued than were nonsmokers (F = 10.24, df = 1, 38, P < 0.01), with the effect being specific to male smokers. Self-report of fatigue did not correlate with body mass index, baseline inflammatory or immune status, or blood pressure. Positive psychological and situational predictors of fatigue included depression (r = 0.556, P < 0.001), state anxiety (r = 0.569, P < 0.001), sleep quality (r = -0.399, P < 0.05), and sleep quantity (r = -0.411, P < 0.05). These results suggest that psychological and situational factors are key contributors to fatigue in young adults and that smoking is a risk factor for fatigue in men.     

Determination of thiocyanate in plasma and saliva without deproteinisation and its validation as a smoking parameter

A simple photometric procedure was developed for the determination of thiocyanate (SCN-) in plasma and saliva without deproteinisation or dialysis. Fe(III) ions form a red coloured complex with SCN- with a maximum absorbance at 460 nm. Mercury(II) nitrate is used to run a sample blank. A manual and an automated version (COBAS BIO) of the method is described. The method is linear up to 5000 mumol/l SCN-. The CV of the between-run precision is 2.8-8% for the manual and 2.6-6.6% for the automated method. The SCN- plasma concentration was 21-134 mumol/l in nonsmokers and 44-260 mumol/l in smokers. In mixed saliva, the concentration is much higher than in plasma: 1.57-5.5 mumol/l in smokers and 0.79-3.9 mumol/l in nonsmokers. Plasma, but not oral fluid SCN-, is a valuable parameter for studying smoking habits in population surveys. However, its use is limited. In our experience only heavy smokers can be distinguished from nonsmokers.     

Multiple defects in arachidonate metabolism in alveolar macrophages from young asymptomatic smokers

This study was undertaken to localize and determine the relative importance of potential biochemical defects in the release and metabolism of arachidonic acid (AA) in alveolar macrophages (AMs) from asymptomatic smokers. Using high-performance liquid chromatography and radioimmunoassay, we compared the metabolism of both endogenously released and exogenously supplied AA in AMs and autologous peripheral blood monocytes (PBMs) from nine healthy nonsmokers and eight healthy smokers. AMs from both groups incorporated similar amounts of radiolabeled AA into cellular lipids. However, AMs from smokers released only about half as much radioactivity as free AA and its metabolites in response to ionophore A23187, when compared to cells from nonsmokers; this suggests that net phospholipase activity was decreased in smokers. In addition, AMs from smokers synthesized less of total cyclooxygenase and 5-lipoxygenase products than did cells from nonsmokers, both constitutively and in response to A23187 as well as the particulate agonist zymosan. Furthermore the metabolism of exogenous AA to both cyclooxygenase and 5-lipoxygenase products was reduced in smoker cells compared to nonsmoker cells. Inverse relationships between eicosanoid synthesis and intensity of smoking were observed. No differences between smoker and nonsmoker PBMs were found. These results show that the major defect in smoker AMs is at the phospholipase level, with additional defects being present at the levels of the cyclooxygenase and 5-lipoxygenase pathways. All these abnormalities are compartmentalized to the mononuclear phagocyte population of the lung.     

Effect of the 252A>G polymorphism of the lymphotoxin-alpha gene on inflammatory markers of response to cigarette smoking in Korean healthy men

BACKGROUND: The systemic inflammatory response is heightened in smokers. We examined whether the established cardiovascular risk factor, smoking status, might interact with the lymphotoxin-alpha (LTA) gene 252A>G polymorphism in determining concentrations of TNF-alpha and eventually IL-6, adiponectin and CRP downstream in the inflammatory cascade. METHODS: We measured anthropometric parameters, serum lipid profile, glucose, TNF-alpha, IL-6, CRP, adiponectin and urinary excretion of 8-epi PGF2alpha as well as a genotyping for 252A>G polymorphism of LTA in 480 healthy Korean men. RESULTS: After adjustment for age, 208 smokers with an average consumption of 18+/-1 cigarettes/d had higher concentrations of TNF-alpha, IL-6, CRP and urinary excretion of 8-epi PGF2alpha than nonsmokers (n=272). Nonsmokers with G/G had higher TNF-alpha and 8-epi PGF2alpha concentrations than those with A/A or A/G. TNF-alpha concentrations were higher in smokers than nonsmokers of the same genotype. Smokers with G/G showed higher TNF-alpha concentration than those with A/A and had higher IL-6 and urinary 8-epi PGF2alpha concentrations than those with A/G or A/A. Furthermore, smokers carrying the G allele showed lower adiponectin concentrations than those with A/A. There are main effects of genotype and smoking, as well as the smoking-genotype interaction to TNF-alpha concentration. CONCLUSION: Our results suggest that the LTA 252A>G polymorphism may modulate the inflammatory effects and oxidative stress of smoking. The detrimental effect of smoking is most clearly seen in men with G/G, suggesting a genotype-specific interaction with smoking.     

Heart rate variability reproducibility during exercise

The use of heart rate variability (HRV) parameters during exercise is not supported by appropriate reliability studies. In 80 healthy adults, ECG was recorded during three 6 min bouts of exercise, separated by 6 min of unloaded cycling. Two bouts were at a moderate intensity while the final bout was at a heavy exercise intensity. This protocol was repeated under the same conditions on three occasions, with a controlled start time (pre-determined at the first visit). Standard time and frequency domain indices of HRV were derived. Reliability was assessed by Bland–Altman plots, 95% limits of agreement and intraclass correlation coefficients (ICC). The sample size required to detect a mean difference ≥30% of the between-subject standard deviation was also estimated. There was no systematic change between days. All HRV parameters demonstrated a high degree of reproducibility during baseline (ICC range: 0.58–0.75), moderate (ICC: 0.58–0.85) and heavy intensity exercise (ICC range: 0.40–0.76). The reproducibility was slightly diminished during heavy intensity exercise relative to both unloaded baseline cycling and moderate exercise. This study indicates that HRV parameters can be reliably determined during exercise, and it underlines the importance of standardizing exercise intensity with regard to fitness levels if HRV is to be reliably determined.     

Associations of atherosclerotic risk factors with oxidized low-density lipoprotein evaluated by LOX-1 ligand activity in healthy men

BackgroundThe aim of this study was to determine the relationships of risk factors for atherosclerosis with oxidized low-density lipoprotein (OxLDL) evaluated by a new enzyme immunoassay for measurement of LOX-1 (lectin-like OxLDL receptor) ligand.MethodsSubjects were 236 healthy men aged 33–62 years. LOX-1 ligand containing apoB (LAB) was measured by an enzyme-immunoassay using immobilized recombinant LOX-1 and anti-ApoB monoclonal antibody.ResultsIn simple regression analysis, log-converted LAB showed significant positive correlations with history of smoking, waist circumference, diastolic blood pressure, LDL cholesterol, log-converted triglycerides, uric acid and white blood cell count and showed a significant negative correlation with HDL cholesterol. In multiple regression analysis using history of smoking, history of drinking, waist circumference, diastolic blood pressure, HDL cholesterol, log-converted triglycerides and uric acid as explanatory variables, log-converted LAB showed significant correlations only with history of smoking and log-converted triglycerides. Log-converted LAB was significantly higher in heavy smokers (≥ 20 cigarettes per day) than in nonsmokers and light smokers (< 20 cigarettes per day), while no difference in log-converted LAB was found between nonsmokers and light smokers. Log-converted LAB was significantly higher in subjects with hypertriglyceridemia (≥ 150 mg/dl), large waist circumference (≥ 85 cm), high diastolic blood pressure (≥ 85 mm Hg), or metabolic syndrome defined by the NCEP-ATP III criteria than in subjects without each risk factor or metabolic syndrome.ConclusionsHypertriglyceridemia and smoking are determinants of LOX-1 ligand activity in healthy men and are thus thought to be crucial risk factors for initiation of atherosclerotic progression through generation of OxLDL.     

The reproducibility of multi-joint isokinetic and isometric assessments in a healthy and patient population

DESIGN: Test re-test reliability design. OBJECTIVE: To determine a reproducible protocol for lower limb simultaneous multi-joint assessments on a healthy group of subjects and a patient group with patellofemoral pain syndrome. BACKGROUND: Although single joint assessment with isokinetic dynamometers has been utilised for many years in knee rehabilitation, simultaneous multi-joint assessment has not attracted comparable attention. METHODS: Twenty healthy volunteers mean age 30.6 years and 16 patients with patellofemoral pain syndrome mean age 29.6 years performed isometric maximum voluntary contractions and concentric isokinetic contractions of the lower limb. Data were collected on three separate days for resultant extension/flexion peak torque, average power and total work which were analysed using intraclass correlation coefficients with a 95% level of confidence. RESULTS: In healthy subjects, intraclass correlation coefficients estimates were > or =0.75 for isokinetic peak torque and >0.83 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.82. In the patient group, intraclass correlation coefficients estimates were >0.82 for isokinetic peak torque and > or =0.75 for average power and total work. The intraclass correlation coefficients estimate for isometric peak torque extension was 0.89. Discarding the first session's data for both groups improved the intraclass correlation coefficients estimates for virtually all assessments. CONCLUSIONS: This study has demonstrated high reproducibility of lower limb multi-joint testing for peak torque, average power, and total work on healthy subjects and then has employed the protocol to demonstrate similarly high reliability on a patient group. It has also highlighted the need for a practice session before the data can be said to be reliable. RELEVANCE: Reliability studies often use healthy subject groups, which although useful, have limited relevance to patient populations. This study has not only gained comprehensive reproducibility data on multi-joint assessment in healthy subjects, it has also shown that multi-joint testing can be used safely and reliably in patients with patellofemoral pain syndrome. Clinicians may now be able to measure objectively lower limb function in this patient group both pre and post treatment.     

外周血NLR对IM患儿发生肝损伤风险的预测价值

目的探讨初诊传染性单核细胞增多症(IM)患儿外周血中性粒细胞与淋巴细胞比值(NLR)对其发生肝损伤风险的预测价值。方法选取70例住院IM患儿作为研究对象,患儿于入院当日采集空腹静脉血检测全血细胞计数,根据全血细胞计数结果计算得出NLR,并以中位数为临界值,将患儿分为高NLR组(NLR≥0.42)36例和低NLR组(NLR<0.42)34例。所有研究对象进行血清EB病毒(EBV)-DNA载量,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、总胆红素(TB)、直接胆红素(DB)和清蛋白水平检测。结果 2016-2018年EBV-DNA检出率分别为1.62%、3.49%、3.99%,呈逐年上升趋势,其中2018年6~15岁患儿检出率为2.18%,在各年龄组中最高。与低载量组患儿相比,中载量组和高载量组患儿NLR降低,LDH、HBDH表达水平升高,差异均有统计学意义(P<0.05);与低载量组相比,高载量组IM患儿清蛋白水平明显降低(P<0.05);两组ALT、AST、TB与DB表达水平差异无统计学意义(P>0.05)。与高NLR组比较,低NLR组ALT≥80U/L的患儿比例,ALT、AST、LDH和HBDH表达水平均明显升高,差异有统计学意义(P<0.05),TB、DB和清蛋白水平差异无统计学意义(P>0.05);IM患儿NLR与ALT、AST、LDH和HBDH表达水平均呈负相关(r=-0.586、-0.506、-0.577、-0.665,均P<0.05)。结论 IM患儿NLR越低,EBV-DNA载量越高,肝脏损伤越重。