Evaluation of the diagnostic value of serum and tissue apoptotic cytokeratin-18 in patients with chronic hepatitis C

Background and study aimsHepatitis C virus (HCV) is considered the most common aetiology of chronic liver disease (CLD) in Egypt. The disease severity ranges from mild illness to cirrhosis and hepatocellular carcinoma. A role for apoptosis in liver damage caused by HCV chronic infection has been suggested. Cytokeratin 18 (CK-18) is the major intermediate filament protein in the liver and is a known caspase substrate in hepatocyte apoptosis. Therefore, we analysed the serum and tissue levels of CK-18 in patients with chronic HCV infection to evaluate its role in hepatocyte apoptosis. We also correlated CK-18 expression with the severity of hepatic pathology.Patients and methodsThis study examined 80 Egyptian patients with liver disease. There were 69 patients with chronic hepatitis C and 11 patients with hepatitis C-induced cirrhotic changes. Fifteen healthy controls were also included in the study. The levels of CK-18 fragment were quantified in paired serum and liver biopsy samples.ResultsThe serum and tissue CK-18 levels were reduced in chronic HCV patients compared to early cirrhosis patients. This result indicates that serum levels of CK-18 and the hepatic expression of CK-18 might play an important role in disease progression. The serum and tissue levels of CK-18 were significantly increased and directly correlated with inflammation severity, stage of fibrosis, and ALT levels in the chronic HCV group and the cirrhotic liver group. There was no significant difference in viral load between patient cohorts.ConclusionThe serum level and the hepatic expression of CK-18 are related to disease activity and are directly correlated with METAVIR scoring. This result suggests that serum CK-18 levels may be useful for monitoring disease activity in chronic HCV and liver cirrhosis patients.     

The Impact of Interleukin 28b Gene Polymorphism on the Virological Response to Combined Pegylated Interferon and Ribavirin Therapy in Chronic HCV Genotype 4 Infected Egyptian Patients Using Data Mining Analysis

Background: Chronic HCV represents one of the common causes of chronic liver disease worldwide with Egypt having the highest prevalence, namely genotype 4. Interleukin IL-28B gene polymorphism has been shown to relate to HCV treatment response, mainly in genotype1.Objectives: We aim to evaluate the predictive power of the rs12979860 IL28B SNP and its protein for treatment response in genotype 4 Egyptian patients by regression analysis and decision tree analysis.Patients and Methods: The study included 263 chronic HCV Egyptian patients receiving peg-interferon and ribavirin therapy. Patients were classified into 3 groups; non responders (83patients), relapsers (76patients) and sustained virological responders (104 patients). Serum IL 28 B was performed, DNA was extracted and analyzed by direct sequencing of the SNP rs 12979860 of IL28B gene.Results: CT, CC and TT represented 56 %, 25 % and 19% of the patients, respectively. Absence of C allele (TT genotype) was significantly correlated with the early failure of response while CC was associated with sustained virological response. The decision tree showed that baseline alpha fetoprotein (AFP ≤ 2.68 ng/ml) was the variable of initial split (the strongest predictor of response) confirmed by regression analysis. Patients with TT genotype had the highest probability of failure of response.Conclusions: Absence of the C allele was significantly associated with failure of response. The presence of C allele was associated with a favorable outcome. AFP is a strong baseline predictor of HCV treatment response. A decision tree model is useful for predicting the probability of response to therapy.     

二维斑点追踪纵向应变评价不同部位右心室起搏患者心脏收缩同步性

目的利用二维斑点追踪超声纵向应变比较不同部位右心室起搏对左心室收缩不同步性的影响。方法有双腔起搏器植入指征的无器质性心脏病变患者共60例,按1:1随机数表法随机分为两组,根据分组结果分别将右心室电极植入右心室流出道间隔部(right ventricular outflow tract septum,RVOTs)及右心室心尖(right ventricular apex,RVA)。术后起搏器程控并保证心室完全起搏后,进行二维斑点超声成像分析,记录左心室收缩时纵向应变达峰时间的最大差(LS-TD)。结果 RVA组左心室收缩时纵向应变最大差大于RVOT组,差异有统计学意义[(161.6±43.9)ms vs.(74.3±13.7)ms,P<0.001]。结论二维斑点追踪超声纵向应变结果显示RVOT起搏时的左心室收缩同步性优于RVA起搏。     

抗肺炎衣原体蛋白酶样活性因子单克隆抗体在冠状动脉硬化患者肺炎衣原体感染诊断中的初步应用

目的 制备抗肺炎衣原体蛋白酶样活性因子重组蛋白的单克隆抗体,检测冠状动脉硬化患者的外周血单核细胞和冠状动脉瘤斑块中肺炎衣原体特异性抗原.方法 以肺炎衣原体蛋白酶样活性因子重组蛋白免疫小鼠,与SP2/0细胞融合后,采用间接ELISA和Western blot筛选阳性杂交瘤细胞,经亚克隆建株;小鼠体内诱生腹水法制备单克隆抗体,用硫酸铵沉淀法对腹水中的单克隆抗体进行纯化,测定其亚类和效价;检测肺炎衣原体标准株以鉴定其特异性.建立间接ELISA方法检测冠状动脉硬化患者外周血单核细胞和冠状动脉瘤斑块标本中的肺炎衣原体抗原.结果 获得4株稳定分泌抗蛋白酶样活性因子重组蛋白的杂交瘤细胞株,分别命名为3F8、7B9、8C4和11B5,其效价分别为1∶28000、1∶16000、1∶38000和1∶12000;经亚类鉴定,3F8和7B9杂交瘤细胞分泌的单克隆抗体为IgG2b,其它2株均为IgG1.以制备的单克隆抗体建立间接ELISA检测肺炎衣原体抗原,与经典PCR方法的检测结果比较,检出率具有较高的一致性.结论 成功获得了抗肺炎衣原体蛋白酶样活性因子重组蛋白的特异性单克隆抗体,能特异地识别天然肺炎衣原体蛋白酶样活性因子抗原,有望应用于冠状动脉硬化患者肺炎衣原体感染的抗原诊断.     

软坚护肝片的急性毒性及一般药理学研究

目的 观察软坚护肝片对实验动物的急性毒性及中枢神经系统、心血管系统和呼吸系统的影响.方法 小鼠20只,按最大给药量法给予软坚护肝片(19.84 g/kg),2次/d,14 d后观察急性毒性反应;不同剂量软坚护肝片(0.31、0.62、1.24 g/kg)分别给予各组小鼠灌胃给药,观察小鼠自主活动和运动协调能力;不同给药剂量软坚护肝片(0.31、0.62、1.24 g/kg)分别给予各组麻醉大鼠十二指肠给药,观察大鼠的收缩压、舒张压、平均动脉压、心率、呼吸频率、呼吸幅度.结果 软坚护肝片19.84 g/kg灌胃给药14 d后,小鼠无毒性反应.软坚护肝片各剂量组对小鼠自主活动和运动协调能力无明显影响(P＞0.05);对麻醉大鼠血压、平均动脉压、心率、呼吸频率、呼吸幅度均无明显影响(P＞0.05).结论 软坚护肝片对实验动物心血管系统、呼吸系统、自主神经系统均无明显影响.     

Experimental model of varicocele

The purpose of this investigation was to create a varicocele model in animals and to study the subsequent alterations in testicular physiology. The study comprised 22 dogs divided into 2 groups: test and control. In the test group (17 dogs), excision of a longitudinal strip of the fasciomuscular tube of the spermatic cord was done on one side only. In the control group (5 dogs), the spermatic cord was exposed without interference with the tube. Testicular temperature was measured, and biopsies from the 2 testicles and semen specimens were examined. Re-examination for variceal changes was performed in 3 dogs at the 4th postoperative week; in 3 dogs at the 6th, and in 16 dogs (11 test and 5 control) at the 8th postoperative week. Sections from spermatic cord and testicle were examined microscopically. Serum levels of testosterone follicle-stimulating hormone, luteinizing hormone and prolactin were assayed preoperatively and at the time of re-examination. Manifest varicocele was detected in 16 of 17 detubated dogs. It was huge in all dogs re-examined after 8 weeks. Semen showed decreased sperm count in all test animals except 1. The animals with induced varicocele had higher testicular temperature than the controls. Microscopically, the detubated spermatic cords have shown variceal changes and the testicle degenerative changes in all the test animals. Similar changes were encountered in the contralateral testicle in the animals re-examined at 8th week. Radioimmunoassay showed a significant decrease of serum testosterone and increase of prolactin postoperatively. Follicle-stimulating hormone and luteinizing hormone showed no significant change from the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)     

南京市社区人群高尿酸血症与痛风的流行病学调查

目的　调查南京市社区 2 0 a以上居民高尿酸血症与痛风的流行情况。方法　采用分层整群抽样的方法 ,在南京市玄武区、栖霞区调查了 7888名居民的高尿酸血症与痛风的患病情况。结果　正常人群男性血尿酸平均 ( 342 .3± 87.3)μmol/ L、女性平均 ( 2 5 2 .2± 77.8)μmol/ L ;高尿酸血症患病率为 13.3% ,男性 17.6 %、女性 9.3% ;高尿酸者男性血尿酸平均 ( 4 75 .8± 5 3.8)μm ol/ L ,女性平均 ( 4 13.9± 5 5 .7)μmol/ L。男、女平均患病年龄分别为 5 3.8a、5 4 .0 a;痛风患病率为 1.33% ,男性 1.98% ,女性 0 .72 %。高尿酸中痛风的患病率为 3.1%。结论　南京市社区人群高尿酸血症及痛风患病率均高于国内其它地区的调查结果 ,且患病年龄有提前的趋势 ,表明高尿酸血症及痛风患病率仍在继续升高 ,应引起人们的关注     

对Diasys R/S2003尿沉渣工作站健康人参考值范围的调查

目的 :确定使用美国DiasysR/S2 0 0 3(Diasys)型尿沉渣定量分析工作站测量尿沉渣的参考值范围。方法 :用Diasys型尿沉渣定量分析工作站随机对 932例健康人尿沉渣进行定量分析。结果 :尿液标本经离心浓缩5 0倍后 ,尿液中红细胞 95 %可信上限男性为 5个 / μl,女性为 7个 / μl;白细胞为男性 7个 / μl,女性 1 0个 / μl,男女间有显著性差异 (P <0 0 5 )。结论 :尿液红细胞、白细胞与性别有关。该健康人参考值的确立 ,为尿液检验标准化的推广和临床应用提供了依据     

建立糖尿病专科护士培训基地的实践与体会

随着医学领域科技发展和疾病谱的改变,护理工作在维护和促进人群健康中的重要性越来越显著,因而对护士的专业素质提出了更高的要求。江苏省按照《中国护理事业发展规划纲要(2005-2010)》中的要求,结合本省特点,建立糖尿病专业(科)护士培训基地。坚持以岗位需求为导向,理论学习与临床技能实践相结合,大力开展糖尿病护理的规范化培训工作,有效地推动了全省糖尿病护理知识和技能的普及,促进了护理队伍向专业化、学术化、资质化的发展。