Infectious Disease

3.1 Viral disease2007149 Study on platelet β3 integrin expression levels and their relationships with disease severity in patients with hemorrhagic fever with renal syndrome.GAO Maicang(高麦仓), et al. Dept Infect Dis, 1st Affili Hosp, Sch Med, Xi′an Jiaotong Univ , Xi′an 710061. Chin J Infect Dis 2007;25(3):152-153. Objective To investigate the relationship between the expression level of platelet membrane glycoprotein 133(GP Ⅲa, CD61) and the severity of disease in patients with hemorrhagic fever with renal syndrome(HFRS). Methods One hundred and four patients with HFRS and 30 healthy individuals were recruited. The percentage of CD61 positive platelets and the mean fluorescence intensities (MFI) of platelet membrane glycoprotein β3 were determined by flow cytometry (FCM). The 104 patients studied were divided into three groups based on their expression levels of platelet membrane glycoprotein β3 at oliguric phase. Clinical data and laboratory parameters in different groups were compared and analyzed. Results The expression levels of CD61 in patients with HFRS were significantly higher than those in control group, although no significant difference in the percentage of CD61 positive platelets between patients with HFRS and controls was detected. The MFI of CD61 expression in patients with HFRS at fever phase, oliguric phase and polyuric phase was 19. 75±2.57, 17.46±1.48 and 15. 55±0.60, respectively, which was significantly higher than that in control group (3. 20±0.12). The expression level of CD61 in patients with HFRS at oliguric phase was negatively correlated with platelet count and serum albumin(r=-0.637 and -0. 695. respectively) and positively correlated with white blood cell count, blood urea nitrogen, serum creatinine and alanine aminotransferase(r= 0.945, 0. 904, 0.956 and 0. 891, respectively). When the patients were compared according to the expression levels of CD61, it was indicated that the higher the expression level of CD61, the higher the incidence of uremia, hypoalbuminemia, abnormal liver function and leukocytosis was. Conclusion The expression levels of platelet membrane glycoprotein β3 in patients with HFRS vary in different clinical phases and are significantly correlated with the severity of the disease. It suggests that the expression levels of platelet β3 integrin dramatically increased in patients with HFRS, which may be an indicator for the severity of disease and be helpful for monitoring the state of the diseases and evaluating the severity of the disease.     

Infectious Disease

2020028 Impact of long-term antiviral therapy with Entecavir on renal function in elderly patients with chronic hepatitis B.LIANG Li(梁丽),et al.Liver Res Center,Beijing Friendship Hosp,Capital Med Univ,Beijing 100050.Chin J Geriatr 2019;38(11):1258-61.     

Infections Disease

3.1.Viral disease2005293 Hypothesis on generating and tracer gasstudy regarding transmission of severe acute respira-tory syndrome through ventilation system in a generalhospital HE Yao(何耀),et al.Instit Geriatr,ChinGeneral Hosp PLA,Beijing 100853.Chin J Epidemiol2005;26(1):33-35.     

Infectious Disease

2.1 Viral disease 2006009 Correlation analysis of type A influenza virus genetic variation characteristic with survival selective pressure ZHOU xiao -ming(周晓明 ) ,et al. Sch Pub Health,Fudan Univ. Shanghai 200032. China J Infect Dis 2005;23(4) :221 -224 Objective:To study the relationship betweer. type A influenza virus genetic variation with survival selective pressure to find possible vaccine conserved antigen target. Methods:Seven strains of same HA (Hemagglutinin) serotype, regional and isolation time closely related type A influenza virus were selected with full HA gene coding sequence , Blast2 program was used to calculate the param-     

Autoimmune Disease

2007159 Acute kidney injury of systemic sclerosis: scleroderma renal crisis and crescentic glomerulonephritis. LIU Dongyan(刘冬妍), et al. Dept Nephrol, PUMC Hosp, CAMS & PUMC, Beijin 100730. Chin J Nephrol 2007;23(4):209-203. Objective To explore the clinicopathological characteristics of acute kidney injury (AKI) of systemic sclerosis (SSc). Methods A retrospective study was performed on 11 SSc patients with AKI. The clinical data were analyzed and the patients were divided into antineutrophil cytoplasmic antibodies (ANCA) negative group(n=9) and ANCA positive(n=2) group. Results In the ANCA negative group, 2 cases were without malignant hypertension, 1 was acute tubular necrosis(ATN) caused by herbs, 6 were scleroderma renal crisis(SRC), including 4 with renal biopsy, indicating hypertrophic arterial media, edema, thickened intima, onion-skin lesion in interlobular arteries and afferent arterioles, as well as ischemic lesion in glomeruli. In the MPO-ANCA positive group, 1 was crescentic glomerulonephritis. Malignant hypertension was not noticed. All patients were given steroid, 8 of them received CTX in addition. Nine patients received dialysis, and 8 cases progressed to permanent hemodialysis. Six cases with SRC were given high dose ACEI and / or ARB. Six patients resulted in early death. Conclusion Scleroderma renal crisis and ANCA associated vasculitis may cause AKI in SSc patients. Patients with positive ANCA differ from those with negative ANCA in terms of clinical manifestation, pathology and treatment. Survival and prognosis of SSc patient were bad. High dose corticosteroids increases the risk of scleroderma renal crisis, so it is thereby recommended that the dose above 15 rog/day should be avoided if possible.     

Infectious Disease

2005443 Detection and genotyping of Treponemapallidum by a nested PCR.ZHENG Heping(郑和平),et al.Guangdong Skin Dis & STIs Contr Prey Center,Guangzhou 510500.Chin J Dermatol 2005;38(9):546-548.Objective:To develop a nested PCR for the detectionof early syphilis and genotyping of Treponema pallidum     

Legionnaires’ Disease

Infection with Legionella spp. is an important cause of serious community- and hospital-acquired pneumonia, occurring sporadically and in outbreaks. Outbreaks of Legionnaires’ disease have recently received considerable media attention, and some factors indicate that the problem will increase in future. Infection with Legionella spp. ranks among the three most common causes of severe pneumonia in the community setting, and is isolated in 1–40% of cases of hospital-acquired pneumonia. Underdiagnosis and underreporting are high. Only 2–10% of estimated cases are reported. Detection of a single case should not be considered an isolated sporadic event, but rather indicative of unrecognized cases.There are no clinical features unique to Legionnaires’ disease; however, suspicion should be raised by epidemiologic information commensurate with the diagnosis and the presence of headache, confusion, hyponatremia, elevated creatine kinase and/or severe pneumonia. An arterial oxygen partial pressure <60mm Hg on presentation and progression of pulmonary infiltrates despite appropriate antibacterial therapy should always alert clinicians to this cause.Macrolides, fluoroquinolones and rifampin (rifampicin) are the most widely used drugs in treatment. Fluoroquinolones or azithromycin are the treatment of choice in immunosuppressed patients and those with severe pneumonia. Incorporation of the legionella urinary antigen test in emergency departments in hospitals and progressive improvement in this test will, in the near future, permit appropriate diagnosis and treatment of this frequent, sometimes severe, illness.     

Assessment of Endothelial Function in Alzheimer's Disease: Is Alzheimer's Disease a Vascular Disease?

OBJECTIVES: To compare endothelial function of people with Alzheimer's disease (AD) with that of people without. DESIGN: Case-control study. SETTING: Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS: Twenty-five patients with AD who were free of vascular risk factors and 24 healthy elderly controls were enrolled. Exclusion criteria were diabetes mellitus, hypertension, dyslipidemia, evident stroke, smoking, documented coronary artery disease, history of myocardial infarction, heart failure, acute or chronic infection, malignancy, peripheral artery disease, renal disease, rheumatologic diseases, alcohol abuse, and certain drugs that may affect endothelial function. Both groups underwent comprehensive geriatric assessment and neuropsychiatric assessment. MEASUREMENTS: Endothelial function was evaluated according to flow-mediated dilation (FMD) from the brachial artery. RESULTS: Mean age +/- standard deviation was 78 +/- 5.9 in the group with AD (11 female and 14 male) and 72.1 +/- 5.8 in the control group (9 female and 11 male). Multiple linear regression analysis revealed that FMD was significantly lower in patients with AD (median 3.45, range 0-7) than controls (median 8.41, range 1-14) (P < .001), independent of age. It was also found that FMD values were inversely correlated with the stage of the disease as determined according to the Clinical Dementia Rating scale (r=-0.603, P < .001). CONCLUSION: Endothelial function is impaired in patients with AD. Endothelial function was worse in patients with severe AD. These findings provide evidence that vascular factors have a role in the pathogenesis of AD.     

Whipple’s Disease: A Rare Disease Revisited

Since the original postmortem diagnosis of “intestinal lipodystrophy” by Dr. George H. Whipple in 1907, the complexities of Whipple’s disease have been elucidated through case reports. Universally fatal prior to the advent of antibiotics, Tropheryma whipplei is increasingly recognized as an organism that can be treated only if the clinician seeks to identify it. Whipple’s disease is primarily a gastrointestinal disease manifesting as a malabsorption syndrome, and is detected through endoscopy and intestinal biopsy. Nongastrointestinal manifestations of the disease, although less common, are reported and have aided in its recognition as a multiorgan disease entity. Because of its rarity, treatment recommendations are currently based on observational studies and on one recent prospective study, which outlined induction therapy followed by several months of suppressive maintenance therapy to prevent relapse, which is often characterized by neurologic symptoms.     

Unsuspected Coeliac Disease in Chronic ‘Cryptogenic’ Liver Disease

Lindgren S, Sjöberg K, Eriksson S. Unsuspected coeliac disease in chronic 'cryptogenic' liver disease. Scand J Gastroenterol 1994;29:661-664

Background: Earlier reports have suggested that a relationship exists between chronic liver disease and coeliac disease (CD). Gliadin antibodies (GA) have been used to screen for CD.

Methods: Using a micro-enzyme-linked immunosorbent procedure, we analysed sera from 327 consecutive patients with chronic liver disease for GA (IgA and IgG) and evaluated their clinical significance.

Results: GA were detected in 19 patients (6%), a prevalence six times greater than that found in healthy blood donors. In 9 of the 19 patients the liver disease had been classified as cryptogenic. The occurrence of GA was independent of the degree of hepatocellular impairment. A diagnosis of CD was confirmed in 5 of the 10 patients who underwent small-bowel biopsy.

Conclusions: Our findings suggest the prevalence of CD in patients with chronic liver disease to be at least 1.5%–that is, 15 times higher than in the general population. They also suggest that the possible presence of CD should be considered in cases of chronic 'cryptogenic' liver disease.     

Study of Coronary Artery Disease in Single Aortic Valvular Disease

Objectives To analyze the results of coronary angiographies (CAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p < 0.01 ). Conclusions Angina pe     

Colonic Crohn’s Disease Is Associated with Less Aggressive Disease Course Than Ileal or Ileocolonic Disease

Digestive Diseases and Sciences - The literature on disease characteristics of colonic Crohn’s disease (CD) is sparse, especially from Asia, where the burden of inflammatory bowel disease is...     

Impaired Sleep Quality in Crohn’s Disease Depends on Disease Activity

Background

Little is known concerning the relationship of disease activity and sleep disturbances in inflammatory bowel disease (IBD) and specifically in patients with Crohn’s disease.

Aim

This study examined the prevalence of poor sleep quality in patients with active and inactive Crohn’s disease compared with healthy controls.

Methods

Participants included 108 patients with Crohn’s disease attending the IBD clinic of a tertiary medical center in 2009–2010 and 36 healthy volunteers. All prospectively completed a demographic questionnaire and the Pittsburgh sleep quality index (PSQI). Patients with Crohn’s disease completed the Crohn’s disease activity index (CDAI) and were divided into two groups accordingly: inactive disease (CDAI ≤150) and active disease (CDAI >150). Data on disease duration, medications, complications, and treatment were collected from the medical files.

Results

Seventy-one patients had inactive Crohn’s disease and 37 had active disease. All three groups were similar in mean age, sex distribution, and body mass index. Mean duration of Crohn’s disease was 10.22 ± 8.6 years; 40 patients (37 %) had ileal disease, 16 (15 %) colonic disease, and 56 (50 %) ileo-colonic disease. Patients with active disease had a significantly higher mean ± SD global score on the PSQI (8.6 ± 2.4; indicating poorer sleep quality) than patients with inactive disease (4.6 ± 1.9) or control subjects (5.1 ± 1.7) (p < 0.0001 for both), with no significant difference between the inactive-disease and control groups. The correlation between the CDAI and PSQI scores was statistically significant (p < 0.001).

Conclusions

Impaired sleep quality is associated with active Crohn’s disease, but not inactive disease.     

Usefulness of C-Reactive Protein as a Disease Activity Marker in Crohn’s Disease according to the Location of Disease

Background/Aims

C-reactive protein (CRP) is a serologic activity marker in Crohn’s disease (CD), but it may be less useful in evaluating CD activity in ileal CD patients. We aimed to investigate the usefulness of CRP as a disease activity marker in CD according to disease location.

Methods

Korean CD patients in a single hospital were evaluated. Factors associated with elevated CRP concentration at the time of diagnosis of CD and the association between the physician’s prediction regarding upcoming surgery and the sites of the lesions directly related to surgery were analyzed.

Results

Of 435 CD patients, 25.7%, 6.9%, and 67.4% had ileal, colonic, and ileocolonic CD, respectively. Multivariate analysis revealed that an elevated erythrocyte sedimentation rate, reduced serum albumin, CD activity index (CDAI) >220, and ileocolonic/colonic location were associated with an elevated CRP level and that the CRP level was significantly correlated with the CDAI in all CD patients (γ=0.466, p<0.01). However, the correlation coefficient was dependent on the location, with values of 0.395, 0.456, and 0.527 in patients with an ileal, ileocolonic, and colonic disease location, respectively. Surgery for ileal lesions was less predictable than surgery for ileocolonic or colonic lesions during follow-up.

Conclusions

CRP is less useful as a disease activity marker in patients with ileal CD than those with ileocolonic or colonic CD.     

Celiac Disease: Does Hyposplenism Predispose to the Development of Malignant Disease?

Splenic size and function was assessed in eight patients with celiac disease and coexisting malignancy (six had small bowel lymphoma and two gastric adenocarcinoma). The size of the spleen was reduced in four of seven patients as seen at autopsy or radionucleotide scanning. Splenic function was studied using "pitted" erythrocyte counts, platelet counts, and Howell-Jolly bodies and was impaired in five of eight patients. Malignant disease developed in some celiacs with normal splenic size and function. Splenic function as measured by pitted erythrocyte counts was similar in the celiac patients with malignancy and appropriately matched nonmalignant celiacs. We conclude that hyposplenism in celiac disease does not influence the development of malignant disease.