类风湿关节炎患者外周血B10细胞高表达核因子κB受体活化因子配体

目的: 检测类风湿关节炎(rheumatoid arthritis, RA)患者外周血B10细胞核因子κB受体活化因子配体(receptor activator of nuclear factor kappa B ligand, RANKL)的表达,并分析其与RA患者临床和实验室指标的关系,探讨B10细胞在RA发病中的作用及其免疫调节功能缺陷的潜在机制。方法: 选取RA患者25例(近半年未使用糖皮质激素、免疫抑制剂及生物制剂)和20名健康对照者(healthy controls, HC),利用流式细胞仪(flow cytometry, FCM)、聚合酶链式反应(polymerase chain reaction, PCR)检测RANKL在健康对照组和RA患者外周血B10细胞及非B10细胞中的表达,分析表达RANKL的B10 细胞比例与RA患者临床特征和实验室指标的相关性,体外刺激实验评价肿瘤坏死因子α(tumor necrosis factor α, TNF-α)和白细胞介素1β(interleukin 1β, IL-1β)对B10细胞表达RANKL的影响。数据分析采用独立样本t检验、Pearson和Spearman相关分析。结果: 健康人外周血B10细胞能表达低水平RANKL, RA患者外周血表达RANKL的B10细胞比例较健康对照组显著升高(3.65%±1.59% vs. 2.25%±0.68%, P<0.01)。RA患者表达RANKL的B10 细胞比例与关节压痛数、关节肿胀数及28-关节疾病活动度分值(disease activity score in 28 joints,DAS28)呈正相关(分别为r=0.479,P=0.035;r=0.519,P=0.008;r=0.526, P=0.019),与年龄、病程、红细胞沉降率(erythrocyte sedimentation rate, ESR)、C反应蛋白(C-reactive protein, CRP)、类风湿因子(rheumatoid factor, RF)及抗环瓜氨酸多肽抗体(anti-cyclic citrullinated peptide antibody, ACPA)无显著相关性。TNF-α能促进B10细胞高表达RANKL(P<0.01)。结论: RA患者外周血表达RANKL的B10细胞比例升高,与关节肿痛数及疾病活动度正相关,提示RA患者B10细胞免疫调节功能受损的同时可能参与了RA的发病及骨破坏。     

Programmability in DDD Pacing

Des pacemakers DDD fiables, non dangereux ayant de nom-breuses possibilités de programmation sont maintenant au point. Certains paramètres programmables tels que mode, voltage (courant), largeur d'impuision, sensitivité et périodes réfractaires, dans chaque chambre sont fondamentaux. La fréquence maximum limite de même que ies donnees lors des rythmes Ients et les intervalles AV sont également iniportants. Avec certains modèles, la possibilité de programmer Ja période de blanking s'est montrée très utile. La corrélation de toutes ces fonctions assure Je fonc-tionnement sans fautes de ces appareiJs.     

FACTOR ANALYSIS OF SEVEN MEASURES OF ASTIGMATISM

Seven measures and estimates of astigmatism from 70 eyes were factor analyzed to discover the common factors and variances, and in turn determined their successfulness in estimating subjective astigmatism. Results showed that the difference between the mean keratometer reading of –.59 and subjective finding of +.14 confirms the existence of about .50 to .75 D. of physiological astigmatism, that the five estimates of the subjective from the keratometer reading show mean values of about zero to –.25 D., indicating some success in reducing the –.59 D., that moderate correlation between each of the estimates and the subjective indicates poor approximation of the subjective, and that the only Factor extracted, which accounts for about 44% of the common variance, a kind of Astigmatism Estimation, with low-moderate correlation with the subjective and Sutcliffe, again indicates that these estimates of the subjective are quite poor.     

胰酶胶囊与多酶片对照治疗非胰腺疾病伴消化不良症状的疗效

目的:比较胰酶胶囊与多酶片治疗非胰腺疾病伴消化不良患者的疗效.方法:将116例随机分成两组,胰酶胶囊组56例,给予胰酶胶囊2粒,po,tid;多酶片组60例,给予多酶片5片,po,tid;两组疗程均为4周.服药后2,4周进行临床症状的积分评价.结果:胰酶胶囊组治疗4周后在腹痛、饱胀、胃肠胀气、腹泻等积分分别下降了(1.06±0.16),(1.40±0.25),(1.48±0.27),(1.16±0.18)分;多酶片组分别下降了(0.18±0.05),(0.43±0.09),(0.48±0.13),(0.21±0.04)分.两组比较差异均有非常显著性(P<0.01).治疗4周后胰酶胶囊组总有效率为93%,多酶片组为58%,两组间比较差异有非常显著性(P<0.01).结论:胰酶胶囊治疗非胰腺疾病伴消化不良的疗效优于多酶片.     

Comparison of morbidities in very low birthweight and normal birthweight infants during the first year of life in a developing country

Objective : To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; ± 2500 g) Malaysian infants during the first year of life.
Methodology : Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity.
Results : Compared with NBW infants ( n = 106), VLBW infants ( n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [Cl]: 1.1 to 354.3), wheezing (OR = 3.7, 95% Cl: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% Cl: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% Cl: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% Cl: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% Cl for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life.
Conclusions : Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neurodevelopmental morbidities.     

Evaluation of percutaneously inserted peripheral silicone catheters for parenteral nutrition in infants and children

Delivery of long term parenteral nutrition (PN) to small infants and children by peripheral vein effectively reduces: he risk of serious cather-related complications which may occur with central vein delivery, but provides the practical difficulties of repeated vein puncture, limited vein access and the problems of phlebitis and extravasation. This study evaluates the use of percutaneous peripheral indwelling fine silicone catheters, compared with conventional methods of delivery in 20 patients (median age 0.2 years) requiring PN for 521 patient-days (average, 26). These catheters compared favourably with other peripheral insertions in terms of mean indwelling time (12,6 ± 2.0 vs 1.3 ± 0.2 days, p<0.001), frequency of insertions required (7.9 vs 75 insertions per 100 patient-days) and local complications (2.6 episodes per 100 days — mild phlebitis only — vs 65 per 100 days). Fewer serious complications were encountered than with the centrally placed catheters, the major complication rate of 0.3 per 100 patient-days being due to a single possible episode of sepsis. We conclude that this technique offers significant practical advantages over conventional PN delivery for small infants and children, by reducing the frequency of venipuncture, prolonging vein life and vein access, reducing work load, and eliminating extravasation, with a minimum of serious complications.     

DOXORUBICIN AND HYPERPIGMENTATION

Sixty-four patients with advanced malignant disease underwent treatment with Doxorubicin alone or in combination with other drugs. Twenty-one percent developed hyperpigmentation. Four patients were noted to have total body pigmentation, a side effect which has not been recorded before.     

Malnutrition in children with chronic liver disease accepted for liver transplantation: Clinical profile and effect on outcome

The nutritional profiles of 37 children (aged 0.5-14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = -1.4 +/- 0.2) and stunted (mean s.d. height = -2.2 +/- 0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium--mean % expected for age = 58 +/- 5%, n = 15). Mean ad libitum nutrient intake was 63 +/- 5% of recommended daily intake (RDI). Those who died while waiting (n = 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight greater than -1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight less than -1.0) was 38% (P less than 0.003). Declining nutritional status during the waiting period also adversely affected outcome.(ABSTRACT TRUNCATED AT 250 WORDS)