支气管哮喘患者血清IL-25、ECP的表达及意义

[目的]监测支气管哮喘患者血清白细胞介素-25（IL-25）、嗜酸性粒细胞阳离子蛋白（ECP）的表达水平,探讨其水平变化及其在哮喘发病中的作用.[方法]收集支气管哮喘急性发作期患者30例（发作期组）、哮喘缓解期患者30例（缓解期组）、同期健康体检者30例（对照组）的静脉血标本,用双抗体夹心ELISA法检测并比较血清IL-25、ECP的水平.[结果]发作期组血清IL-25水平（51.91±9.05）ng/L显著高于缓解期组（28.09±6.96）ng/L及对照组（26.24±5.12）ng/L,其差异有统计学意义（P〈0.05）,缓解期组与对照组比较差异无统计学意义（P〉0.05）;哮喘急性发作期组血清ECP水平（18.95±8.97）μg/L,显著高于缓解期组（4.47±2.01） μg/L及对照组（2.01±1.47） μg/L,其差异有统计学意义（P〈0.05）,缓解期组与对照组比较差异有统计学意义（P〈0.05）;发作期组患者血清IL-25水平与ECP之间呈正相关（r=0.682,P〈0.01）.[结论]哮喘成人血清IL-25及ECP水平能反应哮喘气道炎症活动情况及严重程度,且两者在哮喘急性发作期存在正相关性.     

成人哮喘患者血清Periostin、Eotaxin、STAT3水平与气道高反应性的相关性研究

目的探讨成人哮喘患者血清骨膜蛋白(Periostin)、嗜酸性粒细胞趋化因子(Eotaxin)、信号转导及转录激活因子3(STAT3)蛋白水平与气道高反应性(AHR)的相关性。方法 2015年1-12月选取125例成人哮喘患者为哮喘组(其中急性期75例,缓解期50例),另选取同期收治的50例健康体检者为对照组,分别应用ELISA法测定哮喘组与对照组血清Periostin、Eotaxin、STAT3水平,采用支气管激发试验(BPT)测量患者第1秒用力呼气量(FEV1)下降20%时组织胺累计剂量(PD20),并根据PD20值评估哮喘患者AHR,分析哮喘患者血清Periostin、Eotaxin、STAT3与AHR的关系。结果哮喘急性期组血清Periostin、Eotaxin、STAT3水平高于哮喘缓解期组及对照组(P0.05),而哮喘缓解期组血清Periostin、Eotaxin、STAT3水平高于对照组(P0.05)。AHR中重度组血清Periostin、Eotaxin、STAT3显著高于AHR轻度及极轻度组(P0.05)。经Pearson相关因素分析可知,哮喘患者血清Periostin、Eotaxin、STAT3水平与PD20值均呈正相关关系(P0.05)。结论血清Periostin、Eotaxin、STAT3与哮喘患者AHR有密切关系,通过测定该类指标能有效评估哮喘患者预后及临床用药情况,具有一定的参考价值。     

血清尿酸、Eotaxin及Periostin表达特征与支气管哮喘急性发作的相关性分析

目的分析血清尿酸、嗜酸性粒细胞趋化因子(Eotaxin)及骨膜蛋白(Periostin)在支气管哮喘急性发病过程中的作用及相互关系。方法随机抽取2017年1月至2018年7月该院就诊且确诊的106例支气管哮喘患儿(哮喘组)和110例门诊体检的健康儿童(对照组)作为研究对象,用酶联免疫吸附测定法检测血清尿酸、Eotaxin、Periostin水平,各组间进行比较,同时测量哮喘组患儿肺功能,并进行比较。结果对照组儿童血清尿酸、Eotaxin及Periostin水平均低于哮喘组急性发作期和慢性持续期,且慢性持续期低于急性发作期,差异均有统计学意义(P<0.05)。哮喘组患儿急性发作期血清Eotaxin水平与血清尿酸、Periostin水平呈正相关(均P<0.05),慢性持续期血清Eotaxin水平与血清尿酸、Periostin水平呈正相关(均P<0.05)。急性发作期血清中尿酸、Eotaxin、Periostin水平与第1s用力呼气量(PEV1)、呼气流量峰值(PEF)呈负相关(均P<0.05);慢性持续期血清中尿酸、Eotaxin、Periostin水平与PEV1呈负相关(均P<0.05);慢性持续期血清中尿酸、Periostin水平与PEF呈负相关(P<0.05)。结论哮喘患儿血清中尿酸、Eotaxin、Periostin水平增高,且急性发作期高于慢性持续期,尿酸、Eotaxin、Periostin水平与肺功能水平呈负相关,可为评价支气管哮喘病情变化及治疗效果提供参考依据。     

支气管哮喘患者血清IL-4、IL-10、IL-17和IFN-γ水平测定及其临床意义

目的测定支气管哮喘患者血清白细胞介素-4(IL-4)、IL-10、IL-17和干扰素-γ(IFN-γ)水平,并探究其临床意义。方法选取2016年10月至2017年3月该院接诊的40例支气管哮喘患者作为哮喘组,并根据病情分为缓解期组和急性发作组。选择同期在该院接受体检的健康人40例作为对照组。检测两组血清IL-4、IL-10、IL-17和IFN-γ水平,并进行统计学分析。结果哮喘组IL-4、IL-17水平显著高于对照组[(47.03±8.42)pg/mL vs.(15.82±3.30)pg/mL,(102.40±26.20)ng/L vs.(43.20±7.40)ng/L],IL-10、IFN-γ水平显著低于对照组[(84.20±4.38)ng/L vs.(98.83±5.23)ng/L,(94.36±23.67)ng/L vs.(110.70±30.02)ng/L],差异均有统计学意义(P0.05);缓解期组血清IL-4、IL-17水平均显著低于急性发作组[(19.16±3.92)pg/mL vs.(38.82±5.14)pg/mL,(51.32±8.31)ng/L vs.(82.08±9.20)ng/L],IL-10、IFN-γ水平均显著高于急性发作组[(71.46±4.28)ng/L vs.(48.07±4.12)ng/L,(63.27±6.26)ng/L vs.(31.98±4.13)ng/L],差异均有统计学意义(P0.05)。结论血清IL-4、IL-10、IL-17水平和IFN-γ浓度与支气管哮喘存在密切的联系,对其浓度进行检测可判断患者的病情变化,为临床治疗提供有效的依据。     

呼出气一氧化氮对哮喘-COPD重叠综合征的诊疗价值

目的 探讨呼出气一氧化氮(FeNO)检测对哮喘-COPD重叠综合征(ACOS)的诊疗意义.方法 连续收集2013年9月至2014年6月在暨南大学第二临床医学院就诊的老年ACOS、哮喘、COPD及慢性咳嗽患者共195例,对所有患者均进行胸部影像学、FeNO、肺通气功能及支气管舒张功能检测,分析四组患者间FeNO、FEV1/pred％、FEV1/FVC的差异,以及各组内FeNO与FEV1/pred％、FEV1/FVC的相关性.结果 ACOS组和哮喘组患者的FeNO值均显著高于COPD组及对照组[(30.9±27.8),(34.5 ±29.4) vs.(17.3±9.9,16.1±8.6),P均＜0.05],ACOS组和COPD组的肺通气功能则显著低于哮喘组及对照组[FEV1/pred％,(52.9±8.4,53.5±9.6)vs.(81.1±5.9,85.7±7.1),P均＜0.05; FEV1/FVC,(51.9±7.2,50.7±7.1)vs.(79.2±4.8,81.0±5.9),P＜0.05];除对照组中FeNO与FEV1/pred％呈正相关外,其余各组内FeNO值与FEV1/pred％及FEV1/FVC值之间均无显著相关性[ACOS组,r=0.115,-0.007 (P =0.464,0.963);哮喘组,r=0.038,0.045(P=0.772,0.733);COpD组,r=0.097,0.010 (P =0.498,0.944);对照组,r=0.315,0.091 (P=0.045,0.571)].结论 FeNO与肺通气功能联合应用有助于ACOS与其他慢性阻塞性气道疾病的鉴别诊断;对于FeNO显著升高的老年COPD患者应注意有无ACOS可能,治疗上可使用吸人性糖皮质激素以降低气道炎症.     

支气管哮喘患者治疗前后血清IL-2和IL-8水平的动态变化

目的探讨支气管哮喘患者血清白细胞介素-2(IL-2)和白细胞介素-8(IL-8)水平的动态变化和检测的临床意义。方法对30例患者经中药治疗前后及26名正常对照者,采用酶联免疫吸附试验(ELISA)检测血清中上述2种细胞因子的含量。结果血清IL-2水平在急性发作期患者为(9.2±3.2)ng/m l,明显低于正常对照组[(22.8±11.5)ng/m l,P<0.01],缓解期增至(19.9±5.4)ng/m l,与正常对照组差异无显著性(P>0.05);血清IL-8水平在急性发作期患者为(1 055±506)ng/m l,明显高于正常对照组[(196±72)ng/m l,P<0.01],缓解期降至(214±119)ng/m l,与正常对照组差异无显著性(P>0.05)。结论动态测定IL-2、IL-8是判断支气管哮喘病情变化的有益指标。     

慢性阻塞性肺疾病患者血清IL-8及TNF-α的意义

目的　探讨白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)在慢性阻塞性肺疾病(COPD)发病机理中的作用。方法　采30例COPD急性发作期及缓解期患者血清,应用放射免疫法和液相竞争法分别测血清IL-8及TNF-α水平。结果　COPD患者急性发作期IL-8及TNF-α水平分别为:(1 .9608±2.0304)ng/L、(4 .6170±2 .2745)ng/L;缓解期IL-8及TNF-α水平分别为(1 6648±1 6786)ng/L、(3 8916±2 0820)ng/L;正常对照组IL-8及TNF-α水平分别为:(0. 3738±0 .1448)ng/L,(0 .7056±0. 5223)ng/L,急性发作期和缓解期IL-8 及TNF-α水平明显高于正常对照组(P<0 01),且急性发作期IL-8 及TNF-α水平又高于缓解期(P<0. 05)。结论　IL-8、TNF-α共同参与COPD气道炎症的形成,在COPD形成过程中可能起重要作用。     

白细胞介素-8、白三烯B4与慢性阻塞性肺疾病气道炎症的关系

目的 探讨慢性阻塞性肺疾病(COPD)患者白细胞介素-8(IL-8)及白细胞三烯B4(LTB4)水平的变化及在发病中的作用.方法 采用酶联免疫吸附法(ELISA)测定30例COPD患者急性加重期和缓解期及20例健康成人的血清及痰液中IL-8及LTB4含量.结果 COPD患者急性加重期血清及痰液中IL-8含量分别为(181.41±18.49)ng/L和(74.03±20.64)ng/L,高于缓解期[(152.33±17.48)ng/L和(42.30±14.99)ng/L,均P＜0.05],缓解期显著高于健康对照组(52.75±13.79)ng/L和(17.15±5.36)ng/L,均P＜0.05);COPD患者急性加重期痰液LTB4含量[(2300.91±496.01)ng/L],显著高于缓解期[(1884.14±651.37)ng/L,P＜0.05],COPD患者急性加重期血清LTB4含量[(2044.12±309.43)ng/L]与缓解期及对照组比较差异均无统计学意义[(1941.30±301.62)、(1880.77±302.11)ng/L,均P＞0.05].结论 IL-8与LTB4共同参与了COPD气道炎症反应的过程.     

哮喘患者血浆可溶性细胞间粘附分子的变化及意义

目的为了进一步探讨支气管哮喘的发病机理。方法采用双抗体夹心酶联免疫吸附（ELISA）法,检测了30例支气管哮喘发作期、20例缓解期患者以及20例健康对照者血浆中可溶性细胞间粘附分子（sICA－1）水平和IgE水平。结果急性发作期、缓解期支气管哮喘患者的sICAM－1和IgE分别为282.7±79.5（ng/L）、205.6±64.7（ng/L）和359.1±107.8、236.2±64.5（IU／ml）较健康对照者（163.2±54.9ng/L及92.5±26.3IU／ml）显著升高（P＜0．05）。缓解期哮喘患者sICAM-1和IgE较急性发作期明显下降。结论血液中sICAM-1与IgE一道参与了支气管哮喘的发病过程,因此,检测sICAM－1水平对急性发作期支气管哮喘存在与否具有重要意义。     

哮喘患者外周血IL-5及Eotaxin水平的变化及意义

目的探讨支气管哮喘患者外周血白细胞介素5(IL-5),嗜酸性粒细胞趋化蛋白(Eotaxin)水平变化的临床意义.方法采用ELISA法测定43例哮喘患者其外周血IL-5,Eotaxin的含量.结果哮喘发作组IL-5水平较缓解组、正常对照组明显升高(P＜0.05),而后两者之间无显著差异;哮喘发作组Eotaxin的水平明显高于缓解组及正常组(P＜0.05),而后两者之间无显著差异.IL-5水平和Eotaxin存在正相关.结论哮喘患者外周血IL-5,Eotaxin水平能反应哮喘气道炎症活动情况及疾病严重程度,两者存在正相关.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.