慢性阻塞性肺疾病患者血气分析与血浆纤维蛋白原的相关性研究

目的：探讨慢性阻塞性肺疾病患者血浆纤维蛋白原（FIB）水平及与血气分析相关性。方法：对30例慢性阻塞性肺疾病患者治疗前后血气分析、血浆纤维蛋白原及30例对照组的血浆纤维蛋白原分别进行测定。结果：血浆纤维蛋白原水平在慢性阻塞性肺疾病加重期患者明显升高，与对照组相比有显著性差异；治疗后血浆纤维蛋白原明显下降，与对照组相比无显著性差异；血浆纤维蛋白原与动脉血氧分压（PaO2）呈负相关。血浆纤维蛋白原与动脉血二氧化碳分压（PaCO2）呈正相关。结论：慢性阻塞性肺疾病患者血浆纤维蛋白原增高，可导致血液高凝状态，并易导致肺小动脉血栓形成、低氧血症和高碳酸血症。临床应改善缺氧、通气及适当的抗凝治疗对控制病情有益。     

慢性阻塞肺病急性发作D-二聚体、纤维蛋白原的变化及意义

目的探讨慢性阻塞性肺病患者急性发作期D-二聚体、纤维蛋白原的变化及其临床意义。方法分别测定53例慢性阻塞性肺病急性发作期患者治疗前后以及45例对照组的D-二聚体、纤维蛋白原水平并加以分析。结果53例慢性阻塞性肺病急性发作期患者治疗前D-二聚体、纤维蛋白原水平较治疗后以及对照组有明显升高。结论慢性阻塞性肺病急性发作期患者D-二聚体、纤维蛋白原异常增高，可导致血液处于高凝状态，并容易导致肺小动脉血栓形成。     

急性白血病血浆D-二聚体检测的临床意义

D-二聚体是交联纤维蛋白的特异降解产物,是体内高凝状态和继发纤溶亢进的分子标志物之一。急性白血病患者常伴有凝血功能的改变而形成高凝状态或者出血,是造成死亡的重要原因。本文检测了31例急性白血病（AL）患者血浆D-二聚体水平,以探讨其在AL患者发病过程中的临床意义。     

重症慢性阻塞性肺病动脉血气与D-二聚体纤维蛋白原的相关性分析

目的：观察慢性阻塞性肺病（COPD）急性加重期合并呼吸衰竭患者动脉血气分析（PaO2、PaCO2）与D-二聚体、纤维蛋白原的相关性。方法对58例慢性阻塞性肺病急性加重期合并呼吸衰竭患者（观察组）进行临床检验,观察治疗前后PaO2、PaCO2及D-二聚体（D-D）、纤维蛋白原（FIB）水平和变化,并采集42例健康人群（对照组）进行临床对比。结果观察组治疗前、后及与对照组比较,D-二聚体、纤维蛋白原差异均有显著性（P〈0.05）,PaO2、PaCO2与D-二聚体、纤维蛋白原水平分别呈负相关及正相关。结论重症COPD患者急性加重期及好转期均存在不同程度高凝及纤溶亢进状态,早期使用抗凝剂可能对改善预后有益。     

肺癌患者血浆纤维蛋白原、D-二聚体水平与预后的相关性研究

目的:探讨肺癌患者血浆纤维蛋白原、D-二聚体水平与预后的相关性。方法:测定60例肺癌患者(肺癌组)及20例健康体检者(对照组)血浆纤维蛋白原、D-二聚体水平并进行对比分析。结果:肺癌组血浆纤维蛋白原、D-二聚体水平高于对照组(P<0.05),肺癌组血浆纤维蛋白原、D-二聚体水平与病理类型、肿瘤大小、TNM分期之间无明显关系。肺癌患者血浆纤维蛋白原、D-二聚体水平与生存期呈显著负相关。结论:肺癌患者血液处于高凝状态,血浆纤维蛋白原、D-二聚体水平与患者的预后密切相关。抗凝治疗对控制肺癌患者病情的发展及预后可能有重要的临床意义。     

D-二聚体测定在临床治疗中的应用进展

D-二聚体是交联纤维蛋白的特异性降解产物,它的存在表明体内有纤维蛋白的形成和溶解,它可作为反映高凝和纤溶亢进的分子标志物之一。D-二聚体反映着继发性纤溶的增强,是唯一反映凝血和纤溶的理想指标,在临床上已视为体内高凝状态和纤溶亢进的分子标志物,对高凝状态和血栓性疾病的诊断及预后判定有一定指导意义。监测血浆D-二聚体水平有助于患者血栓前状态的早期诊断,以期早期预防性治疗,对改善患者预后具有重要意义。因此,D-二聚体水平在血栓前状态及血栓形成性疾病的诊断、疗效观察、预后判断及病理研究中有着广泛的应用价值。现着重对D-二聚体的形成机理、方法学和其在临床应用作一综述。     

肺癌患者血中D-二聚体和纤维蛋白原水平的变化及其临床意义

目的 研究肺癌患者血中D-二聚体和纤维蛋白原水平的变化及其临床意义.方法 对肺癌患者63例、肺炎患者15例、健康人对照20例分别进行血浆D-二聚体和纤维蛋白原水平检测,运用SPSS软件进行统计学分析.结果 肺炎患者血浆D-二聚体、纤维蛋白原水平与对照组比较,差异无统计学意义(P>0.05).肺癌患者血中D-二聚体水平和纤维蛋白原水平均显著高于肺炎组和对照组,差异有统计学意义(P<0.01).结论 肺癌患者血液处于高凝状态,存在继发性纤溶亢进,血浆D-二聚体及纤维蛋白原水平联合检测可为区别诊断肺癌和肺炎提供有用的参考指标.     

肺结核患者D-二聚体及纤维蛋白原检测的临床意义

目的检测肺结核患者血浆D-二聚体、纤维蛋白原浓度变化,进一步探讨其临床意义。方法分别检测了142例肺结核患者和86例健康对照者血浆D-二聚体和纤维蛋白原水平,分析两组间的差异。结果肺结核组较健康对照组D-二聚体和纤维蛋白原水平显著升高（P〈0．05）。结论肺结核患者体内存在高凝状态,容易形成血栓性疾病,监测相关指标,预防血栓性并发症有重要临床意义。     

可疑DIC患者血浆D-二聚体和3P试验测定的比较

D-二聚体是交联纤维蛋白经纤溶酶水解后的一种特异性降解产物,凡伴有微血栓形成的许多疾病都可导致D-二聚体的增高,可作为弥漫性血管内凝血(DIC)及DIC前状态的诊断依据之一[1].血浆鱼精蛋白副凝试验(简称3PTest)检测纤维蛋白降解产物与纤维蛋白单体的复合物,纤维蛋白原在凝血酶作用下形成纤维蛋白单体,提示存在DIC可能[2].本研究对疑似DIC患者分别进行血浆D-二聚体水平和3P试验的测定,以比较两种方法在诊断疑似DIC和出血性疾病的意义.     

D-二聚体／FDP比值在急性与陈旧性脑梗死诊断中的意义

目的研究急性与陈旧性脑梗死时患者血浆凝血、纤溶活性的变化,探讨D-二聚体／FDP比值在急性与陈旧性脑梗死时的应用价值。方法比较40例急性脑死塞患者与40例陈旧性脑梗死患者血浆凝血、纤溶活性。检测血浆中的纤维蛋白原（Fbg）、D-二聚体（D-dimer）、纤维蛋白（原）降解产物（FDP）三个参数。对三个参数分别进行组合分析：评价不同组合在鉴别急性与陈旧性脑梗死时的应用价值。结果急性脑梗死组血浆D-二聚体／FDP比值明显高于陈旧性脑梗死组（P〈0．05）;而单独Fbg、FDP比较两组差别无显著性（P〉0．05）;两组单独D-dimer结果均与正常参考值有差别（P〈0．05）,但两组相比较,D-dimer值差别无显著性（P〉0．05）。结论急性脑梗死的发生存在血液高凝状态大于纤溶状态,D-二聚体／FDP比值可以作为诊断急性与陈旧性脑梗死的快速简便实验室指标。     

慢性鼻窦炎与眼的并发症

目的 耳鼻喉科医生应提高对眼症状的高度重视，尤其是慢性鼻窦炎时，注意视力的检查，达到正确诊断，及时治疗，防止漏诊延误治疗而形成严重的眼后遗症。方法 从解剖学角度剖析鼻窦与眼睛的关系，对慢性鼻窦炎也能引起眼并发症进行阐述说明。结合所遇2例慢性上颌窦炎合并眼症状病例及回顾性参考文献阐述慢性鼻窦炎可形成眼的并发症。结果 慢性鼻窦炎可引起眼视力低下、眼球运动障碍等并发症。结论 慢性上颌窦炎形成患侧眼并发症的几率虽低，但亦有散见，不容忽视。一旦发生眼部症状应立即手术。保守治疗仍以青霉素为首选。对青霉素耐药者，使用阿奇霉素治疗效果良好。     

Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: Results of the German Headache Consortium study

The objective of this study was to evaluate the association between low and frequent low back pain and chronic migraine (CM) and chronic tension-type headache (CTTH) in a large, German population-based sample. Headaches were diagnosed according to International Classification of Headache Disorders-2 criteria and categorized according to frequency (episodic 1–14 days/month or chronic ?15 days/month) and headache type (migraine or TTH). We defined frequent low back pain as self-reported low back pain on ?15 days/month. We calculated odds ratios and 95% confidence intervals (CI) using logistic regression analyses, adjusting for sociodemographic covariates. There were 5605 respondents who reported headache in the previous year, of whom 255 (4.5%) had Chronic Headache. Migraine was diagnosed in 2933 respondents, of whom 182 (6.2%) had CM. TTH was diagnosed in 1253 respondents, of whom 50 (4.0%) had CTTH. Among 9944 respondents, 6030 reported low back pain, of whom 1267 (21.0%) reported frequent low back pain. In adjusted models, the odds of having frequent low back pain were between 2.1 (95% CI 1.7-2.6) and 2.7 (95% CI 2.3-3.2) times higher in all episodic headache subtypes when compared to No Headache. The odds of having frequent low back pain were between 13.7 (95% CI 7.4-25.3) and 18.3 (95% CI 11.9-28.0) times higher in all chronic headache subtypes when compared to No Headache. Low and frequent low back pain was associated with CM and CTTH. Multiple explanations may contribute to the association of headache and back pain, including the notion that the neurobiology of chronic headache, independent of primary headache type, not only involves the trigeminal pain pathway, but is also a part of abnormal general pain processing.     

慢性偏头痛和慢性紧张型头痛临床特征分析

目的:分析比较慢性偏头痛(CM)和慢性紧张型头痛(CTTH)的临床特征.方法:回顾性研究66例CM和CTTH的人口学特征及临床特征.结果:CM 46例,CTTH 20例.单因素分析显示CM组与CTTH组患者间的发病年龄,病程均有显著性差异(P＜0.05);CM组头痛程度多为中到重度,过度服用止痛药物的情况在CM组也更常见(P＜0.001);两组患者的性别和年龄没有差异.结论:CM患者的发病年龄早于CTTH患者,同时CM患者的头痛严重程度以及止痛药物过度使用情况均高于CTTH患者,CM患者应该与CTTH患者区别对待.在临床工作中,全面评估慢性头痛的临床特征,明确头痛的严重程度,正确诊断慢性头痛的类型,可以有效提高CDH患者的预后.     

The effect of sodium valproate on chronic daily headache and its subgroups

The objective of the study was to assess the efficacy and tolerability of sodium valproate (VPA) on chronic daily headache (CDH) in a prospective, double-blind, randomized, placebo-controlled trial. Seventy patients were included in the study. Twenty-nine had chronic migraine (CM) and 41 had chronic tension-type headache (CTTH). VPA and placebo were applied for 3 months to 40 and 30 patients, respectively. Visual analog scale (VAS) and pain frequency (PF) were used for evaluation. VPA decreased the maximum pain VAS levels (MaxVAS) and PF at the end of the study (P = 0.028 and P = 0.000, respectively), but did not change general pain VAS (GnVAS) levels (P = 0.198). In CM patients, the decreases in MaxVAS, GnVAS and PF parameters were more in VPA treated patients (P = 0.006, P = 0.03, and P = 0.000, respectively). VPA treatment caused more reduction in PF than placebo in the CTTH subgroup (P = 0.000). VPA is effective in the prophylactic treatment of CDH by reducing MaxVAS levels and PF. It was more effective in CM than in CTTH. This study was presented as a poster at “8th Headache Congress Of The European Headache Federation” in Valencia, Spain, between 26–29 April, 2006 and published as an abstract in The Journal of Headache and Pain, Vol 7, Suppl 1 S39 April 2006. An editorial commentary on this article can be found at .     

Pathogenesis and clinical features of chronic pulmonary aspergillosis – Is it possible to distinguish CNPA and CCPA clinically?

BackgroundThe pathogenesis of chronic pulmonary aspergillosis (CPA) including chronic necrotizing pulmonary aspergillosis (CNPA), chronic cavitary pulmonary aspergillosis (CCPA), and simple aspergilloma (SA) has been poorly investigated. We examined all types of CPA cases with histopathological evidence to clarify the differences in pathogenesis and clinical features.MethodWe searched for cases diagnosed as pulmonary aspergillosis by histopathological examination in Nagasaki University Hospital between 1964 and September 2010. All available clinical information including radiological findings were collected and analyzed.ResultWe found 7, 5, 8, and 7 cases of proven CNPA, probable CNPA, CCPA, and SA, respectively. The radiograph of proven and probable CNPA was initially infiltrates or nodules that progress to form cavities with or without aspergilloma, whereas the radiograph of CCPA showed pre-existed cavities and peri-cavitary infiltrates with or without aspergilloma. The patients with proven and probable CNPA exhibited not only respiratory symptoms but also systemic symptoms and malnutrition. Aspergillus fumigatus was the most frequently isolated Aspergillus species (n = 14), however, Aspergillus niger was the predominant isolated species in proven CNPA cases (n = 4).ConclusionOur data indicate that the cases with chronic infiltration, progressive cavitation, and subsequent aspergilloma formation should be diagnosed as CNPA, and the cases with pre-existed cavities showing peri-cavitary infiltrates with or without aspergilloma would mean CCPA. However, it may be difficult to distinguish the two subtypes if a series of adequate radiography films are not available. We propose the term “chronic progressive pulmonary aspergillosis (CPPA)” for the clinical syndrome including both CNPA and CCPA.     

Experience with onabotulinumtoxinA (BOTOX) in chronic refractory migraine: focus on severe attacks

The objective of this study is to analyse our experience in the treatment of refractory chronic migraine (CM) with onabotulinumtoxinA (BTA) and specifically in its effects over disabling attacks. Patients with CM and inadequate response or intolerance to oral preventatives were treated with pericranial injections of 100 U of TBA every 3 months. The dose was increased up to 200 U in case of no response. The patients kept a headache diary. In addition, we specifically asked on the effect of BTA on the frequency of disabling attacks, consumption of triptans and visits to Emergency for the treatment of severe attacks. This series comprises a total of 35 patients (3 males), aged 24-68 years. All except three met IHS criteria for analgesic overuse. The number of sessions with BTA ranged from 2 to 15 (median 4) and nine (26%) responded (reduction of >50% in headache days). However, the frequency of severe attacks was reduced to an average of 46%. Oral triptan consumption (29 patients) was reduced by 50% (from an average of 22 to 11 tablets/month). Those six patients who used subcutaneous sumatriptan reduced its consumption to a mean of 69% (from 4.5 to 1.5 injections per month). Emergency visits went from an average of 3 to 0.4 per trimester (-83%). Six patients complained of mild adverse events, transient local cervical pain being the most common. Although our data must be taken with caution as this is an open trial, in clinical practice treatment of refractory CM with BTA reduces the frequency of disabling attacks, the consumption of triptans and the need of visits to Emergency, which makes this treatment a profitable option both clinically and pharmacoeconomically.     

Reduced Requests for Medical Rehabilitation Because of the SARS-CoV-2 Pandemic: A Difference-in-Differences Analysis

ObjectiveTo examine the extent to which medical rehabilitation requests decreased because of the pandemic in Germany.DesignData were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age people in Germany. Our data represented all medical rehabilitation requests in 2019 and 2020. These requests have to be approved to use a rehabilitation program. We used a difference-in-differences model to determine the reduction in rehabilitation requests attributable to the pandemic.SettingGeneral community.ParticipantsWe included 1,621,840 rehabilitation requests from working-age people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020 (N=3,013,482).InterventionMedical rehabilitation in inpatient or outpatient facilities.Main Outcome MeasuresNumber of medical rehabilitation requests.ResultsThe number of medical rehabilitation requests decreased by 14.5% because of the pandemic (incidence rate ratio, 0.855; 95% confidence interval, 0.851-0.859). The decline in requests was more pronounced among women and in Western Germany than among men and in Eastern Germany. The reduction in requests affected non-postacute rehabilitations more clearly than postacute rehabilitation services. After the pandemic declaration by the German Bundestag in March 2020, the reduction in requests was initially strongly associated with the regional incidence of infection. This association weakened in the following months.ConclusionsThe reduction in requests will have a significant effect on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.     

High prolactin levels as a worsening factor for migraine

Many factors should be considered when an episodic migraine worsens and becomes chronic. Prolactin (PRL) was linked to the origin of pain in patients with microprolactinomas who developed different types of headaches. Our team carried out studies on 27 patients with a background of episodic headaches that became chronic. The patients were evaluated by means of a general examination, a neurological examination and a hormonal profile. Of the 27 patients, 7 of them had an increased level of prolactinaemia. All the patients were women, ranging from 17 to 57 years of age. Four of them had a pure form of migraine without aura, whereas 3 patients had both migraines without aura and tension–type headaches. They suffered from headache for a period ranging from 3 to 32 years and their headache became chronic 4–12 months prior to the visit. Their headache did not change in type, but only in severity and frequency. Two patients had no symptoms referable to high PRL levels; 4 patients had irregular menses or amenorrhoea. One of these patients also suffered galactorrhoea and two of these patients had a microprolactinoma at MRI; one patient was using estroprogestinic drugs, so her menstrual alteration could not be considered. The patients were followed–up for a period of 6–16 months. Six patients responded favourably after being treated with cabergoline, although some had already tried other drugs, which, however, had no effect on their headache. One patient improved after ceasing to take estroprogestinic, in spite of increased levels of PRL. Therefore, on this basis, PRL levels should always be considered when headache worsens. It is an adjunctive worsening factor, which can be easily eliminated.     

IL-23／IL-17免疫调节与慢性牙周炎

慢性牙周炎病因复杂,对于其发病机制目前尚不是很明确。对于新近发现的与白细胞介素-23（IL-23）相关能分泌白细胞介素-17（IL-17）的CD4＋T细胞亚群即Th17细胞,或许能为我们提供新的思路。下面就慢性牙周炎的发病机制、研究现状、IL-23/IL-17与慢性牙周炎致病因子的关系及此免疫通路活化在慢性牙周炎致病过程中所起的作用作一综述。