多器官功能障碍评分系统:3个评分标准预测多器官功能障碍综合征结局关联性和准确性的比较与评估

目的研究高原急性呼吸窘迫综合征(HARDS)/多器官功能障碍综合征(MODS)各项诊断指标参数的变化特点,比较3个MODS评分标准预测结局的准确性。方法统一按通用的MODS诊断标准将540例ARDS/MODS患者按海拔高度分为平原对照组(CG,<430m,n=113)、中度高原1组(H1G,1517m,n=314)、中度高原2组(H2G,2261～2400m,n=78)和高原组(HG,2808～3400m,n=35)。4组分别用平原地区ARDS/MODS评分诊断标准(庐山会议评分标准和Marshall评分标准)以及兰州修订的HARDS/MODS评分标准(兰州标准),建立3个标准的数据统计模型,分别绘制受试者运行特征性曲线(ROC曲线),计算约登指数(Yoden)和最佳界值,验证3个标准在不同海拔高度预测ARDS/MODS结局的准确性;用向前逐步回归模式对影响MODS结局的多因素进行分析。结果用庐山、Marshall和兰州标准检验平原和高原不同海拔高度MODS总分的ROC曲线下面积,预测结局的敏感度、特异度及其最佳界值,结果显示,随海拔梯度上升,兰州标准明显优于庐山和Marshall标准,多元Logistic回归分析也以兰州标准的影响因素最大。结论1通用的ARDS/MODS诊断标准中某些参数界值可能不适合中度高原以上地区,建立HARDS/MODS标准是必要的,兰州标准随海拔梯度升高有进一步提高预测准确性的趋势。2海拔高度大于1500m以上地区     

急性移植物抗宿主病病人血清IL-2、IL-8、IL-10及TNF-α水平变化的研究

为了探讨细胞因子IL-2、TNF—α、IL-10、IL-8在异基因造血干细胞移植后aGVHD发病中的作用，观察33例Allo-HSCT患者aGVHD的发病情况。aGVHD的诊断主要依据临床表现，部分病例还依据皮肤、肠粘膜活检的病理学变化。移植前后定期采集患者血清，采用放射免疫法检测细胞因子IL-2、TNF—α、IL-10、IL-8的浓度的变化。结果发现，异基因造血干细胞移植后33例患者均获得造血功能重建，13例发生aGVHD，其中8例Ⅰ度aGVHD，5例Ⅱ-Ⅳ度aGVHD。IL-2、TNF—α水平在aGVHD阳性组明显高于aGVHD阴性组，而IL-10的水平在aGVHD阳性组明显低于aGVHD阴性组，IL-8水平的变化无统计学意义。结论：细胞因子IL-2、TNF—α在临床aGVHD的发病中起重要的正向调节作用，定期检测患者血清的IL-2、TNF—α水平有助于预测aGVHD的发生。     

金石穿胶囊对致石豚鼠胆汁主要成分的影响

目的 :研究金石穿对致石豚鼠胆汁中几种主要化学成分的影响 ,以确定其防治胆石症的疗效。方法 :随机将 6 0只实验豚鼠分为正常组、模型对照组、胆石通组、金石穿组 ,用致石饲料诱发豚鼠胆囊结石模型 ,喂养一段时间后处死豚鼠 ,取胆汁 ,测定其胆汁中胆红素 (Bi L)、胆固醇 (Cho)、钙离子 (Ca2 )的含量。结果 :金石穿组胆汁中Cho、Bi L、Ca2 浓度均降低。结论 :金石穿能有效降低致石豚鼠成石率 ,具有明显的防治胆石症的作用     

系统性红斑狼疮患者活动性发热特点及相关性分析

目的 探讨系统性红斑狼疮(SLE)患者活动性发热的临床特点并进行相关性分析.方法 由各参研单位根据统一方式收集病历资料,总结江苏省1999-2009年住院SLE患者的临床资料及治疗情况,分析发热与SLE的临床表现、免疫学指标、疾病活动及治疗情况间的关系.组间的计数资料比较采用x2检验,非正态分布的计量资料比较采用秩和检验,相关性分析采用Logistic回归分析.结果 1762例SLE患者纳入研究范围,其中活动性发热患者729例,非发热患者1033例,通过对照研究,发热组入院年龄、是否初治、光敏感、浆膜炎、神经精神系统累及、肝脾淋巴结肿大、血白细胞、血红蛋白、红细胞沉降率(ESR)、C反应蛋白(CRP)、丙氨酸转氨酶(ALT)、白蛋白、血清肌酐、补体C3、抗双链DNA (dsDNA)抗体、抗Sm抗体、SLE疾病活动指数(SLEDAI)评分、既往治疗与非发热组比较差异有统计学意义(尸＜0.05);Logistic回归分析显示血白细胞异常[比值比(OR)=1.396,95％可信区间(CI)1.114～1.711,P=0.004]、CRP (OR=1.005,95％CI 1.002～1.009,P=0.002)、ALT( OR=1.003,95％CI 1.001 ～1.005,P=0.005)、血清肌酐(OR=0.997,95％CI 0.995～0.999,P=0.007)、血红蛋白(OR=0.986,95％CI0.981～0.992,P=0.000)、入院年龄(OR=0.984,95％CI 0.974～0.993,P=0.001)及环磷酰胺应用比例(OR=0.557,95％CI 0.382～0.813,P=0.002)与SLE 患者发热相关.结论 发热是SLE常见的临床表现之一.血白细胞下降、CRP升高、肝功能异常、贫血、入院年龄轻为SLE患者出现发热症状的危险因素,而肾累及、环磷酰胺应用为保护因素.     

大黄抑制鼠疫耶尔森菌的基因芯片检测

目的 研究基因组芯片检测大黄抑制鼠疫耶尔森菌分子机制的方法 .方法 使用的鼠疫耶尔森菌全基因组芯片包含4005条鼠疫耶尔森菌基囚.应用液体稀释法测定大黄对鼠疫耶尔森菌的最小抑菌浓度(MIC),基因芯片表达谱实验中,大黄作用鼠疫耶尔森菌的浓度为10×MIC,作用时间为30 min,提取并纯化鼠疫耶尔森菌总RNA,反转录合成cDNA,用Cy3,Cy5染料标记后,与鼠疫耶尔森菌全基因组芯片杂交,通过芯片扫描仪获得表达谱分析结果 .应用实时定量PCR技术对芯片结果 进行验证.结果 大黄对鼠疫耶尔森菌的MIC为0.02500 kg/L.获得了大黄作用鼠疫耶尔森菌的基因芯片表达谱.大黄作用鼠疫菌的明显差异表达基凶共有498个,上渊基闪358个,下凋基因140个.结论 应用鼠疫耶尔森菌全基因组DNA芯片可以进行大黄抑制鼠疫耶尔森菌的分子作用机制研究.     

Endotoxin-induced suppression of erythropoiesis: the role of erythropoietin and a heme synthesis stimulating factor

The regulation of erythropoiesis is primarily controlled by erythropoietin (Ep). Recently, however, other factors that both stimulate and inhibit erythropoiesis have been reported. Using an in vitro liquid culture of bone marrow cells, a factor in normal mouse serum was demonstrated that markedly stimulated heme synthesis by marrow erythroid cells. In this study, the role of this heme synthesis stimulating factor (HSF) and Ep in the erythropoietic suppression caused by endotoxin administration to mice was examined. Although HSF levels did not alter appreciably after endotoxin injection, marrow erythroid cells from these animals became unresponsive to the factor. This could be reversed if Ep was added to the culture in vitro or if the hormone was injected into the mice 18 hr prior to harvesting the marrow. This marrow erythroid cell response is identical to that seen in animals in whom Ep levels are markedly reduced, such as that found in exhypoxic polycythemia, and suggest a decrease in the hormone following endotoxin administration. Additional studies demonstrated that when Ep was injected into mice 6 hr after endotoxin administration, an increase in femoral erythroid colony-forming units (CFU-E), proerythroblast number, and 59 Fe incorporation into femoral marrow cells could be demonstrated. These findings, together with the marrow erythroid cell response to the hormone, suggest that the mechanism for suppression of erythropoiesis after endotoxin injection is a reduction in the level of circulating Ep.     

Molar incisor hypomineralization: prevalence,severity and clinical consequences in Brazilian children

International Journal of Paediatric Dentistry 2010; 20: 426–434 Background. The prevalence of molar incisor hypomineralization (MIH) varies considerably around the world; however, few studies have examined MIH in South American countries. Objective. To evaluate the prevalence, severity, and clinical consequences of MIH in Brazilian children residing in rural and urban areas of the municipality of Botelhos, Minas Gerais, Brazil. Methods. Children aged 6 to 12 years (n = 918) with all four‐first permanent molars erupted had these teeth evaluated according to the European Academy of Paediatric Dentistry (EAPD) criteria. The examinations were conducted by two previously trained examiners, and the dental impact caused by MIH was evaluated with the Decayed, Missing and Filled Teeth (DMFT) index (WHO). Results. Molar incisor hypomineralization was present in 19.8% of the 918 children, with a higher prevalence in rural areas. The majority of the defects presented were demarcated opacities without post‐eruptive structural loss, which has been considered as mild defects. Children with MIH had higher DMFT values. Conclusion. Despite the high prevalence of MIH, the severity of the defects was mild. The results indicate a positive association between MIH and the presence of dental caries.     

腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后疗效比较中的系统评价

目的评价腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后的临床疗效。方法计算机检索Co-chrane Library、PubMed、Embase、SCI、CNKI、CBM、VIP、WANFANG DATA,纳入腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后疗效比较的随机对照试验,对纳入研究的方法学质量进行评价,用Cochrane协作网提供的RevMan 5.1软件对数据进行统计分析,并对统计结果进行系统评价。结果共纳入6个随机对照试验,共计1 885例患者。Meta分析结果显示:腹膜外切口单层缝合与常规分层缝合法在手术时间[MD=-17.09,95%CI(-19.32,-14.87)],术后切口感染率[RR=0.06,95%CI(0.03,0.12)],7 d内出院率[RR=1.17,95%CI(1.13,1.22)]方面差异均具有统计学意义,但两者在术后疼痛程度(需应用镇痛药物比率)[RR=1.05,95%CI(0.91,1.20)]方面的差异无统计学意义。结论目前研究表明,与常规分层缝合法相比,腹膜外切口单层缝合法能显著缩短化脓性或坏疽性阑尾炎患者的手术时间,降低术后切口感染率,提高7 d内出院率,但本研究纳入的样本量小且质量不高,因此,有必要开展更多高质量、多中心的随机盲法对照试验进一步予以证实其疗效。     

Psoriasis and diabetes: a population-based cross-sectional study

Background Previous reports have shown an association between psoriasis and the metabolic syndrome, but there are only a few studies on the association between psoriasis and diabetes. Objectives To study the association between psoriasis and diabetes. Methods A cross‐sectional study was performed utilizing the database of Clalit Health Services (CHS). Patients who were diagnosed with psoriasis were compared with CHS enrolees without psoriasis regarding the prevalence of diabetes. Patients with diabetes were identified using the CHS chronic diseases registry. Chi‐squared tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. Results The study included 16 851 patients with psoriasis and 74 987 subjects without psoriasis (control patients). The proportion of diabetes was significantly higher in patients above 35 years (P < 0.05). The age‐adjusted proportion of diabetes was significantly higher in psoriasis patients as compared to the control group [odds ratio (OR), 1.38, P < 0.05] and was similar in men and women (OR, 1.32, 1.45, respectively). A multivariate logistic regression model showed that psoriasis was significantly associated with diabetes, independently of age and gender (OR, 1.58, P < 0.001). Conclusions Our study supports previous reports of an association between psoriasis and diabetes. Dermatologists taking care of patients with psoriasis should be aware of this association and advise the patients to reduce additional risk factors such as smoking, hypertension or dyslipidemia.     

Comparison of patch test results among white Europeans and patients from the Indian subcontinent living within the same community

Background There are few studies comparing the incidence of allergic contact dermatitis among different racial groups living within the same community. Objectives The objectives of this study were to compare white European patients with Fitzpatrick's skin phototypes (FSP) I to IV and patients from Indian, Pakistan and Bangladesh with FSP V living within the same community. Referral rates for patch testing, incidence of contact allergies and differences in contact allergens found were assessed. Method All patients referred to the Contact Dermatitis Unit at Dewsbury and District Hospital between 2004 and 2006, inclusive, were included in the study. All patients were patch tested to the British Contact Dermatitis Society standard series, plus other series according to their clinical history, occupational history and clinical findings. Results Four hundred and thirty‐five consecutive patients from the patch testing clinic were included in the study. Fewer patients from the Indian subcontinent underwent patch testing (11.5%) than would have been expected for the size of the local population (18%). Fewer patients from the Indian subcontinent (44%) had one or more positive reactions compared with the white European patients (56%). No significant differences in the contact allergens responsible were detected between the two racial groups. Conclusion There is a lower incidence of positive patch test results among patients with racial origins from the Indian subcontinent compared with white Europeans. This modest difference could be explained by a lower average age within the study population, and increased or differing exposure to contact allergens rather than demonstration of variability in the susceptibility to develop contact sensitivities following equal exposure.