MPO-ANCA相关性血管炎患者中性粒细胞外捕网与滤泡辅助T细胞间关系的探讨

目的 探讨抗中性粒细胞胞质髓过氧化物酶抗体相关性血管炎(MPO-AAV)患者中性粒细胞外捕网(NET)与滤泡辅助T细胞(Tfh)间关系及意义.方法 选择初诊未治疗的MPO-AAV患者和健康对照者各35例,流式细胞术(FCM)检测所有受试者外周血Tfh占CD4+T细胞分数(Tfh％)、表达 ICOS 的 Tfh 占 CD4+T 细胞分数(ICOS+Tfh％)及Tfh表达ICOS的平均强度(MFI);酶联免疫吸附试验(ELISA)法检测外周血MPO-ANCA、NET及IL-23水平,收集每例受试者的临床资料,评估每例患者病情活动度(BVAS-V3).结果 与健康对照组比较,MPO-AAV组外周血 Tfh％、ICOS+Tfh％、Tfh 的 MFI、NET 及 IL-23水平均高于对照组[分别为(25.7±3.9)％vs(20.7±5.3)％,P＜0.001;(1.9±1.0)％vs(0.8±0.4)％,P＜0.001;(59.5±10.3)vs(48.7±6.4)(MFI),P＜0.001;(0.6±0.2)vs(0.2±0.1)(吸光度),P＜0.001;(0.753 5±0.201 9)vs(0.237 5±0.087 0)(pg/L),P＜0.001].双变量相关性分析提示MPO-ANCA水平分别与Tfh％及Tfh的MFI呈正相关(分别为r= 0.737,P＜0.001;r = 0.628,P＜0.001),但在多变量线性回归分析显示MPO-ANCA仅与Tfh％相关(P＜0.001).IL-23分别与Tfh％、Tfh的MFI及NET水平呈正相关(分别为:r = 0.475,P = 0.004;r=0.359,P = 0.034;r =0.806,P＜0.001).虽然双变量相关性分析提示Tfh％分别与外周血中NET及IL-23水平呈正相关(分别为:r= 0.714,P＜0.001;r=0.480,P =0.004),但多变量线性回归分析显示Tfh％仅与NET水平呈正相关(P＜0.001),即NET是影响Tfh％的独立因素.同时,结果显示NET与肾损害间存在相关性(r = 0.390,P= 0.021).结论 NET可能通过激活髓样树突状细胞提升Tfh％,以辅助B细胞产生特异性自身抗体 MPO-ANCA 参与 MPO-AAV 发病.     

重症监护室医护人员对潮湿相关性皮肤损伤的知信行水平调查

目的：调查浙江温州地区三甲医院重症监护室医护人员对潮湿相关性皮肤损伤（MASD）的知信行现状,为提高监护室医护人员对MASD知信行水平提出切实可行的建议。方法：采用方便抽样法抽取三家三甲医院160名医护人员作为研究对象,通过一般资料调查表及MASD知信行调查问卷对其进行调查。结果：本研究共发放160份问卷,回收有效问卷共151份,有效回收率为94.38%。医护人员关于MASD知识、态度及行为的得分分别为（43.03±8.38）分、 （23.64±3.24）分和（13.98±3.16）分;不同工龄、职称、受教育程度医护人员知信行得分差异有统计学意义（P ＜0.05）。结论： 重症监护室医护人员对MASD的态度较积极,知识水平偏低,行为尚欠缺。其中医师对于皮肤问题的重视程度较低,医护人员的合作意识欠缺,对此需开展针对性培训,提高医护人员相关理论知识及合作行为能力,规范MASD的预防及处理方法。     

Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in HIV-infected patients

Summary

Eighty-one percent of human immunodeficiency virus (HIV)-infected patients had one or more of seven evaluated causes of secondary osteoporosis, and this rate increases with age. The type and number of causes were associated with a lower bone mineral density (BMD), and with an increased rate of osteopenia/osteoporosis, regardless of age and body mass index.

Introduction

The objective of this study was to determine whether factors of secondary osteoporosis were associated with lower BMD in HIV.

Methods

This was a cross-sectional study of 285 HIV-infected patients (25 % females) evaluating the impact of seven different factors of reduced BMD: hyperthyroidism, diabetes, chronic viral hepatitis, chronic kidney disease (CKD), hypovitaminosis D, secondary hyperparathyroidism, and hypogonadism. Dual-energy X-ray absorptiometry scan of the femoral neck was obtained at the clinical visit.

Results

Mean age was 45.7 years; osteopenia and osteoporosis were diagnosed in 38 and 6 %, respectively. Overall, 230 patients (81 %) had secondary factors; 107 (38 %) had only 1 cause, 94 (33 %) had 2, and 28 (10 %) had 3 or more, predominantly vitamin D deficiency in 61 %, hepatitis C virus coinfection in 45 %, and secondary hyperparathyroidism in 27 %. The number of secondary factors was closely related to a lower BMD, which is statistically significant for patients having ≥2 causes (0.77 vs 0.73 g/cm², p?=?0.02). The rate of osteopenia ranged from 36 % without any cause to 57 % with three or more, osteoporosis from 0 to 19 %, and Z-score <?2 SD from 0 to 27 %, respectively. In a multivariate linear regression, adjusting by age, body mass index, and HIV-related factors, the number of secondary factors was independently associated with a lower BMD (ß coefficient ?0.134; p?=?0.02), mainly due to patients with hepatitis C virus (HCV) coinfection, secondary hyperparathyroidism, and CKD.

Conclusions

A high prevalence of secondary causes of osteoporosis is observed in HIV-infected patients, and its type and cumulative number determine a lower BMD, after adjusting by age and body mass index.     

Mapping the brain pathways of declarative verbal memory: Evidence from white matter lesions in the living human brain

Understanding the contribution of the brain white matter pathways to declarative verbal memory processes has been hindered by the lack of an adequate model in humans. An attractive and underexplored approach to study white matter region functionality in the living human brain is through the use of non-aprioristic models which specifically search disrupted white matter pathways. For this purpose, we employed voxel-based lesion–function mapping to correlate white matter lesions on the magnetic resonance images of 46 multiple sclerosis patients with their performance on declarative verbal memory storage and retrieval. White matter correlating with storage was in the temporal lobe–particularly lateral to the hippocampus and in the anterior temporal stem–, in the thalamic region and in the anterior limb of the internal capsule, all on the left hemisphere, and also in the right anterior temporal stem. The same volumes were relevant for retrieval, but to them were added temporo-parieto-frontal paramedian bundles, particularly the cingulum and the fronto-occipital fasciculus. These 3D maps indicate the white matter regions most critically involved in declarative verbal memory in humans.     

Myofascial trigger points, neck mobility and forward head posture in unilateral migraine

This paper describes the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles between unilateral migraine subjects and healthy controls, and the differences in the presence of TrPs between the symptomatic side and the non-symptomatic side in migraine subjects. In addition, we assess the differences in the presence of both forward head posture (FHP) and active neck mobility between migraine subjects and healthy controls and the relationship between FHP and neck mobility. Twenty subjects with unilateral migraine without side-shift and 20 matched controls participated. TrPs were identified when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band and reproduction of the referred pain typical of each TrP. Side-view pictures were taken in both sitting and standing positions to measure the cranio-vertebral angle. A cervical goniometer was employed to measure neck mobility. Migraine subjects showed a significantly greater number of active TrPs (P<0.001), but not latent TrPs, than healthy controls. Active TrPs were mostly located ipsilateral to migraine headaches (P<0.01). Migraine subjects showed a smaller cranio-vertebral angle than controls (P<0.001), thus presenting a greater FHP. Neck mobility in migraine subjects was less than in controls only for extension (P=0.02) and the total range of motion in flexion/extension (P=0.01). However, there was a positive correlation between the cranio-vertebral angle and neck mobility. Nociceptive inputs from TrPs in head and neck muscles may produce continuous afferent bombardment of the trigeminal nerve nucleus caudalis and, thence, activation of the trigeminovascular system. Active TrPs located ipsilateral to migraine headaches might be a contributing factor in the initiation or perpetuation of migraine.     

Recognition of Pain as Another Deficit in Young Males with High Callous-Unemotional Traits

Prior research on callous-unemotional (CU) traits supports a deficit in recognizing fear in faces and body postures. Difficulties recognising others’ emotions may impair the typical behavioural inhibition for violent behaviour. However, recent research has begun to examine other distress cues such as pain. The present study examined emotion recognition skills, including pain, of school-excluded boys aged 11–16 years (N = 50). Using dynamic faces and body poses, we examined the relation between emotion recognition and CU traits using the youth psychopathic traits inventory (YPI) and the inventory of CU traits. Violent delinquency was covaried in regression analyses. Although fearful facial and fearful bodily expressions were unrelated to CU traits, recognition of dynamic pain facial expressions was negatively related to CU traits using the YPI. The failure to replicate a fear and sad deficit are discussed in relation to previous research. Also, findings are discussed in support of a general empathy deficit for distress cues which may underlie the problem behaviour of young males with CU traits.     

Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.     

Glutamate Excitotoxicity Activates the MAPK/ERK Signaling Pathway and Induces the Survival of Rat Hippocampal Neurons In Vivo

Current knowledge concerning the molecular mechanisms of the cellular response to excitotoxic insults in neurodegenerative diseases is insufficient. Although glutamate (Glu) has been widely studied as the main excitatory neurotransmitter and principal excitotoxic agent, the neuroprotective response enacted by neurons is not yet completely understood. Some of the molecular participants have been revealed, but the signaling pathways involved in this protective response are just beginning to be identified. Here, we demonstrate in vivo that, in response to the cell damage and death induced by Glu excitotoxicity, neurons orchestrate a survival response through the extracellular signal-regulated kinase (ERK) signaling pathway by increasing ERK expression in the rat hippocampal (CA1) region, allowing increased neuronal survival. In addition, this protective response is specifically reversed by U0126, an ERK inhibitor, which promotes cell death only when it is administered together with Glu. Our findings demonstrate that the ERK signaling pathway has a neuroprotective role in the response to Glu-induced excitotoxicity in hippocampal neurons. Therefore, the ERK signaling pathway may be activated as a cellular response to excitotoxic injury to prevent damage and neural loss, representing a novel therapeutic target in the treatment of neurodegenerative diseases.