Postoperative changes in acute phase protein in patients with esophageal cancer]

Thirty-three patients with esophageal cancer were studied to assess the relationship between nutritional state and the acute phase protein responses. Blood samples taken preoperatively and days 1, 4, 7 and 14 after operation were analyzed for C-reactive protein, fibrinogen, alpha 1-antitrypsin, alpha 1-acid glycoprotein and haptoglobin. Significant Spearman's coefficients were found between percent of ideal body weight (IBW) and alpha 1-acid glycoprotein (r = -0.42), between prealbumin and alpha 1-anti-trypsin (r = -0.55), and between retinol-binding protein and alpha 1-antitrypsin (r = -0.51). Postoperatively, the levels of C-reactive protein, fibrinogen, alpha 1-anti-trypsin and alpha 1-acid glycoprotein were significantly lower in the poorly nourished group than in the other groups. The changes of acute phase proteins in the immediate postoperative period were affected by the preoperative nutritional state, and were less marked in the poorly nourished patients. Between two groups of patients in whom lymph node dissection was carried out in 2 or 3 areas, no significant differences were observed in the acute phase protein responses postoperatively. The measurement of acute phase proteins is very important in assessing the body defense capacity of the patient, but it should be noted that the changes may be affected by several factors including malnutrition.     

脑动脉瘤病人血浆弹性蛋白酶水平分析

目的　探讨血浆中多形核嗜中性白细胞（ Ｐ Ｍ Ｎ） 弹性蛋白酶与脑动脉瘤发病的相关性。方法　应用 Ｅ Ｌ Ｉ Ｓ Ａ 方法检测１９ 例脑动脉瘤病人（ 破裂组１３ 例,未破裂组６ 例） 及１７ 例非血管性颅内病变病人血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平。结果　脑动脉瘤组血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平明显高于对照组（ Ｐ ＝ ０ ．０４７） 。破裂组与未破裂组血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平差异无显著性（ Ｐ ＞ ０ ．０５） 。结论　血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平增高与脑动脉瘤发生之间存在相关性。     

Early changes of arginine vasopressin and angiotensin II in patients with acute cerebral injury

ＡＤｅｐａｒｔｍｅｎｔｏｆＥｍｅｒｇｅｎｃｙ ,ＳｉｒＲｕｎＲｕｎＳｈａｗＨｏｓｐｉｔａｌ,ＭｅｄｉｃａｌＣｏｌｌｅｇｅ ,ＺｈｅｊｉａｎｇＵｎｉｖｅｒｓｉｔｙ ,Ｈａｎｇｚｈｏｕ 310 0 16 ,Ｃｈｉｎａ(ＨｕａｎｇＷＤ ,ＷｕＳＤ ,ＪｉｎＺＦａｎｄＢａｏＤＧ)ＤｅｐａｒｔｍｅｎｔｏｆＥｍｅｒｇｅｎｃｙ ,ＦｉｒｓｔＡｆｆｌｉａｔｅｄＨｏｓｐｉｔａｌ,ＭｅｄｉｃａｌＣｏｌｌｅｇｅ ,ＺｈｅｊｉａｎｇＵｎｉｖｅｒｓｉｔｙ ,Ｈａｎｇｚｈｏｕ 310 0 0 3 ,Ｃｈｉｎａ(ＹａｎｇＹＭ)ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇ…     

Early changes of endothelin,nitric oxide and arginine—vasopressin in patients with acute cerebral injury

OBJECTIVE: To investigate the early changes and clinical significance of plasma endothelin (ET), nitric oxide (NO) and arginine-vasopressin (AVP) in patients with acute moderate or severe cerebral injury. METHODS: The early (at 24 hours after injury) plasma concentrations of ET, NO and AVP were measured with radioimmunoassay and Green technique in 48 cases of acute moderate (GCS8 in 21 cases) cerebral injury (Group A), in 42 cases of non-cerebral injury (Group B) and in 38 normal individuals (Group C), respectively. RESULTS: The early plasma concentrations of ET (109.73 ng/L+/-12.61 ng/L), NO (92.82 micromol/L+/-18.21 micromol/L ) and AVP (49.78 ng/L+/-14.29 ng/L) in Group A were higher than those in Group B (67.90 ng/L+/-11.33 ng/L, 52.66 micromol/L+/-12.82 micromol/L and 29.93 ng/L+/-12.11 ng/L, respectively, P<0.01) and Group C (50.65 ng/L+/-17.12 ng/L, 36.12 micromol/L+/-2.16 micromol/L and 5.18 ng/L+/-4.18 ng/L, respectively, P<0.001 ). The amounts of ET, NO and AVP in patients with severe cerebral injury were 116.18 ng/L+/-18.12 ng/L, 108.19 micromol/L+/-13.28 micromol/L and 58.13 ng/L+/-16.78 ng/L, respectively, which were significantly higher than that of the patients with moderate cerebral injury (92.33 ng/L+/-16.32 ng/L, 76.38 micromol/L+/-12.71 micromol/L and 36.18 ng/L+/-12.13 ng/L respectively, P<0.01 ). The early levels of ET, NO and AVP in Group A were negatively related to the GCS scales. The amounts of ET, NO and AVP were 126.23 ng/L+/-15.23 ng/L, 118.18 micromol/L+/-10.12 micromol/L and 63.49 ng/L+/-14.36 ng/L respectively in patients with subdural hematoma, which were significantly higher than those in patients with epidural hematoma (81.13 ng/L+/-12.37 ng/L, 68.02 micromol/L+/-13.18 micromol/L and 45.63 ng/L+/-12.41 ng/L respectively, P<0.01). The plasma concentrations of ET, NO and AVP in stable duration (at 336 hours after injury) in Group A and Group B were similar to those in Group C. CONCLUSIONS: ET, NO and AVP were related to the pathophysiological process that occurs in the early stage of acute cerebral injury and the values of ET, NO and AVP correlate positively with the clinical manifestations. The changes of plasma ET, NO and AVP can be regarded as important indices to assess the severity of acute cerebral injury.     

Early changes of arginine vasopressin and angiotensin Ⅱ in patients with acute cerebral injury

OBJECTIVE: To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT-II) in patients with acute moderate and severe cerebral injury. METHODS: The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non-cerebral injury and 30 healthy volunteers. RESULTS: The early plasma concentrations of AVP (50.23 ng/L +/- 15.31 ng/L) and AT-II (248.18 ng/L +/- 82.47 ng/L) in cerebral injury group were higher than those in non-cerebral injury group (AVP for 30.91 ng/L +/- 11.48 ng/L and AT-II for 120.67 ng/L +/- 42.49 ng/L, P<0.01). The early plasma concentrations of AVP and AT-II in cerebral injury group were also obviously higher than those of the volunteers (AVP for 5.16 ng/L +/- 4.23 ng/L and AT-II for 43.11 ng/L +/- 16.39 ng /L, P<0.001). At the same time, the early plasma level of AVP (58.90 ng/L +/- 18.12 ng/L) and AT-II (292.13 ng/L +/- 101.17 ng/ L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP for 36.68 ng/L +/- 12.16 ng/L and AT-II for 201.42 ng/L +/- 66.10 ng/L, P<0.01). The early level of AVP and AT-II was negatively related to the GCS scales in acute cerebral injury. The early plasma concentrations of AVP (45.98 ng/L +/- 13.48 ng/L) and AT-II (263. 28 ng/L +/- 80.23 ng/L) were lower in epidural hematoma group than those of subdural hematoma and cerebral injury group (AVP for 64.12 ng/L +/- 15.56 ng /L and AT-II for 319.82 ng/L +/- 108.11 ng/L, P<0. 01). CONCLUSIONS: AVP and AT-II may play an important role in pathophysiologic process in the secondary cerebral injury. The more severe the cerebral injury is, the higher the early level of AVP and AT-II will be. The early plasma level of AVP and AT-II may be one of the severity indexes of cerebral injury.     

急性胰腺炎患者的ECG改变

１９８０年７月至１９９３年７月．对２１４例ＡＰ进行了３０９次ＥＣＧ检查．其中男性９７例．女性１１７例，年龄１７～７７岁（平均４９．３岁）。结果正常６５例，异常１４９例。ＡＰ患者的ＥＣＧ异常改变发生率为６９．６％（１４９／２１４）．其中轻型为６４．７％（９９／１５３），重型为８２．０％（５０／６１）。ＡＰ患者的ＥＣＧ改变主要由“胰一心综合征”所致，表现为多种类型。结果表明：ＥＣＧ改变在ＡＰ的诊断、鉴别诊断、分类、预后估计及指导治疗等方面起一定作用。     

Serum sialic acid levels in patients with acute prostatitis or acute epididymitis

The serum sialic acid concentration in 17 male healthy adults, 11 patients with acute prostatitis and 12 patients with acute epididymitis was measured with a specific enzymatic assaykit. The concentration was studied in relation to erythrocyte sedimentation rate, total serum protein and its fraction, C-reactive protein, and white blood cell count. Blood samples were obtained from the patients immediately before antimicrobial chemotherapy and the subsequent 3, 5, 7, 14, and 28 days. The pretreatment sialic acid concentration in the patients was significantly greater than that in the control subjects (P greater than 0.001). The mean serum sialic acid concentration in the patients reached a maximum level 3 days after the beginning of the treatment, and then gradually decreased. There was a significant correlation between the daily change of the serum sialic acid level and those of the erythocyte sedimentation rate, alpha2-globulin, and alpha1-globulin. Serum sialic acid proved to be a useful biochemical marker in acute prostatitis and acute epididymitis.     

ECG changes in patients with acute ethanol intoxication

Objectives. To assess how ethanol in potential lethal serum concentrations affects features of the ECG that may be associated with cardiac arrhythmias. Design. We included 84 patients, who were hospitalised with assumed acute ethanol intoxication. In the emergency room resting ECG was recorded and blood was collected for serum osmolality measurement used as a proxy for ethanol level. Thirty-two also had ECG recorded at discharge. Twenty-seven hospitalised patients without known alcohol ingestion served as controls. ECG segment durations were compared with controls and related to intoxication level. Results. In subjects with moderately elevated to high serum osmolality, the P wave and QTc intervals were prolonged compared with sober subjects. P wave, PR, QRS and QTc intervals were longer when the subjects had high blood ethanol levels (at admission) than at discharge (p-values: 0.0001, 0.0002, 0.010 and < 0.0001 for P wave, PR, QRS and QTc intervals. n = 32). Conclusions. Ethanol at high to very high blood concentration causes several changes in the ECG that might be associated with increased risk of arrhythmias.     

ECG changes in patients with acute ethanol intoxication

OBJECTIVES: To assess how ethanol in potential lethal serum concentrations affects features of the ECG that may be associated with cardiac arrhythmias. DESIGN: We included 84 patients, who were hospitalised with assumed acute ethanol intoxication. In the emergency room resting ECG was recorded and blood was collected for serum osmolality measurement used as a proxy for ethanol level. Thirty-two also had ECG recorded at discharge. Twenty-seven hospitalised patients without known alcohol ingestion served as controls. ECG segment durations were compared with controls and related to intoxication level. RESULTS: In subjects with moderately elevated to high serum osmolality, the P wave and QTc intervals were prolonged compared with sober subjects. P wave, PR, QRS and QTc intervals were longer when the subjects had high blood ethanol levels (at admission) than at discharge (p-values: 0.0001, 0.0002, 0.010 and <0.0001 for P wave, PR, QRS and QTc intervals. n=32). CONCLUSIONS: Ethanol at high to very high blood concentration causes several changes in the ECG that might be associated with increased risk of arrhythmias.     

Serum haptoglobulin changes in patients with severe isolated head injury

Summary From a series of 74 patients with severe head injuries and massive brain lesions, we measured the changes in haptoglobulin in 33 cases.On average, the globulin was, after a short drop in the first two days, increased about three times towards the seventh day, and was still above normal after ten days. Seen together with the total alpha-2-globulin increase after head injury this rise seems mainly to be caused by the haptoglobulin changes. Haptoglobulin was found to be a good indicator of the extent of brain tissue damage. It cannot on its own be used for prediction of survival chances.     

Serum c-reactive protein in patients with serious trauma.

Daily serum c-reactive protein (CRP) concentration was monitored in 98 patients (26 female) admitted to the Major Injuries Unit (MIU) at Birmingham Accident Hospital following serious trauma. The mean (SD) increase in CRP concentration for 79 survivors and 19 non-survivors between days 1 and 2 after trauma were 69.5 (74.6) and 111.8 (59.0) mg/l/24 h, respectively (P = < 0.001). By day 4 after trauma the mean serum CRP concentrations for survivors and non-survivors were 150.9 (76.9) and 233.4 (100.8) mg/l (P < 0.001), respectively. Injury severity data were available for 50 patients. The mean (range) injury severity score was 25.2 (4-50), Glasgow coma scale 10.4 (3-15), revised trauma score 6.5 (3.39-7.8) and predicted survival 0.78 (0.02-0.99). Univariate regression analysis of serum CRP on days 1-5 after injury against revised trauma score and injury severity score, revealed an inverse correlation between day 1 serum CRP and Glasgow Coma Score (r = -0.306, P < 0.05), but no correlation with injury severity score or predicted survival on any of the study days. The lack of correlation between serum CRP and injury severity or predicted survival, and the strong association with actual survival, suggests that the acute inflammatory response to serious trauma and subsequent complications, is an important determinant of outcome.     

Serum hepatocyte growth factor levels in patients with renal diseases.

The serum levels of hepatocyte growth factor (HGF) were determined in patients with various renal diseases. In patients with acute-phase acute renal failure (ARF) and chronic tubulointerstitial nephritis (chronic TIN), the serum HGF levels were 0.55 +/- 0.24 and 0.44 +/- 0.37 ng/ml (mean +/- SD), respectively, and were significantly higher than that in the control group (0.12 +/- 0.12 ng/ml). The serum HGF level tended to be high also in patients with active-phase steroid-sensitive nephrotic syndrome (SSNS). The serum levels of HGF were not elevated in patients with IgA nephropathy (IgAN), Henoch-Sch?nlein purpura nephritis (HSPN), membranoproliferative glomerulonephritis (MPGN), poststreptococcal acute glomerulonephritis (PSAGN), unilateral renal atrophy, unilateral nephrectomy, or proximal tubular dysfunction. These observations suggest that glomerular disorders cause no apparent elevation of the serum HGF level, and that elevation of the serum HGF level may be associated with tubulointerstitial damage in renal diseases.     

Serum protein changes in post-traumatic (post-burn) patients by polyacrylamide disc gel electrophoresis

Ten patients with 20 per cent burns were studied for total serum proteins and differential serum protein by paper electrophoresis and polyacrylamide disc gel electrophoresis. The study was carried out for 3 weeks. Total serum protein and albumin levels showed gradual decline in all the patients. Differential serum protein showed decreased albumin on days 4, 12 and 22. Beta-globulin was increased on days 4 and 22, but decreased on day 12. The changes in the group specific protein were indefinite and inconclusive. In all the cases, gamma-globulin was slightly decreased on day 4, but gradually increased on days 12 and 22 post burn. Thickness and intensity of gamma-globulin bands were more marked in the patients with superficial burns as compared to deep burns.     

C reactive protein in patients with chronic renal diseases

Base-line serum levels of plasma C-reactive protein (CRP) are predictive of future myocardial infarction and sudden cardiac death in apparently healthy subjects, suggesting the hypothesis that chronic inflammation might be important in the pathogenesis of atherothrombosis. CRP production is mediated by several inflammatory mediators: interleukin 6 (IL-6) is currently felt to be the major cytokine influencing the acute phase response. CRP and other acute phase proteins are elevated in dialysis patients and cardiovascular diseases represent the single largest cause of mortality in chronic renal failure patients. Little information is available, however regarding CRP and IL-6 plasma levels in pre-dialysis renal failure. Plasma CRP was determined by a modification of the laser nephelometry technique; IL-6 by immunoassay (RD System); and fibrinogen, serum albumin, cholesterol, triglycerides, hematocrit, white blood cell count, erythrocytic sedimentation rate (ESR) and urinary protein levels by standard laboratory techniques. Results were obtained in 102 chronic pre-dialysis patients whose mean age was 53+/-5.8 years with a mean creatinine clearance (C(Cr)) of 52+/-37 mL/min). CRP was greater than 5 mg/L in 25% of the global population. CRP and IL-6 were 4.0+/-4.6 mg/L and 5.8+/-5.6 pg/mL, respectively and were not significantly correlated (r=0.11, p=n.s.). CRP and IL-6 were however related with renal function (CRP versus C(Cr) r=-0.40 p <0.001; IL- 6 versus C(Cr) r=-0.45; p <0.001). When patients were divided in two groups according to renal function, CRP resulted 7.4+/-6.3 mg/L in the group of patients with a C(Cr) lower than 20 mL/min (n=32) and 2.76+/-4.35 in the group of patients with a C(Cr) higher than 20 mL/min (n = 70) (p <0.0001). CRP and IL-6 were positively related with ESR (r=0.32 and 0.46 respectively). Serum albumin levels were not significantly different in the two groups of patients (3.2+/-0.4 versus 3.0+/-0.5 g/dL). CRP and serum albumin were not significantly related (r=0.17). CRP and IL-6 correlated positively with ESR (r=0.32 and 0.46 respectively). In pre-dialysis patients we have demonstrated an increase in both CRP and IL-6 that occurs as renal function decreases. These data provided evidence of the activation - even in the predialysis phase of renal failure - of mechanisms known to contribute to the enhanced cardiovascular morbidity and mortality of the uremic syndrome.     

急性脊髓损伤患者血清蛋白质组学研究

目的观察急性脊髓损伤(SCI)患者和健康人群血清差异表达蛋白,寻找急性SCI相关特异性代谢通路或蛋白标志物。方法 2013年7月—2014年12月,采集9例急性颈部SCI患者(病例组)和9例年龄、性别与病例组相匹配的健康受试者(对照组)的血液样本。记录病例组损伤时间、颈椎日本骨科学会(JOA)评分等基本信息。应用非标记相对定量蛋白质组学技术比较病例组与对照组血清蛋白质谱,采用Spearman相关分析寻找差异表达蛋白与患者年龄、损伤时间以及JOA评分的相关性。应用基因本体论(GO)分析、BiNGO富集分析和京都基因与基因组百科全书(KEGG)对差异表达蛋白进行生物信息学分析。结果共发现22个差异表达蛋白。与对照组相比,病例组11个蛋白表达上调(包括果糖-二磷酸醛缩酶、碳酸酐酶等),且与损伤时间和颈椎JOA评分呈正相关;11个蛋白表达下调(包括免疫球蛋白等),且与损伤时间和颈椎JOA评分呈负相关。生物信息学分析发现这些差异表达蛋白主要富集在果糖和甘露糖代谢通路、血小板激活代谢通路、黏附连接代谢通路和氮代谢通路。结论急性SCI患者和健康人群血清蛋白质谱存在差异,果糖-二磷酸醛缩酶、碳酸酐酶等有望成为急性SCI潜在的分子标志物。     

Electrocardiographic changes in cardiac patients with acute gallbladder disease

Acute cholecystitis or biliary colic may be associated with angina pectoris, arrhythmias, or nonspecific ST-T wave changes on the electrocardiogram. A vagally mediated cardio-biliary reflex is the presumed cause of these changes. Three cases of acute exacerbation of biliary tract disease in patients with known coronary artery disease associated with transient electrocardiographic changes and no concurrent cardiac complaints or abnormalities are reported. The signs and symptoms of gallbladder and heart disease may overlap, making diagnosis difficult. These patients underwent extensive workups of both their cardiac and biliary disease, which did not document any acute cardiac problem. In patients with known coronary artery disease and acute cholecystitis, the surgeon should not be discouraged from cholecystectomy merely because of a "questionable" electrocardiogram. Undue delay in treatment while awaiting the results of the cardiac screen may result in both cardiac and septic complications.