Nerve growth factor and Trk high affinity receptor (TrkA) gene expression in inflammatory bowel disease

BACKGROUND: Nerve growth factor (NGF), a target derived factor for survival and maintenance of peripheral and central neurones, has been implicated in several chronic inflammatory processes. AIMS: To analyse the concomitant presence of NGF and its high affinity receptor TrkA in patients undergoing surgery for Crohn's disease (CD) and ulcerative colitis (UC). PATIENTS: CD tissues were obtained from 33 patients and UC tissue samples from 12 patients undergoing surgery. Normal intestinal tissue samples were obtained from 30 individuals through an organ donor programme. METHODS: Expression of NGF and TrkA was studied by northern blot analysis. Using in situ hybridisation and immunohistochemistry, the respective mRNA moieties and proteins were localised. Western blot analysis was used to confirm the specificity of NGF and TrkA antibodies. RESULTS: In CD, NGF mRNA was increased in 60% (2.4-fold; p<0.01) and TrkA mRNA in 54% (1.3-fold; p<0.05) of samples. In UC, NGF mRNA expression was enhanced in 58% (2.4-fold; p<0.01) and TrkA mRNA expression in 50% (1.5-fold; p<0.05) of samples. In situ hybridisation showed that NGF and TrkA mRNA were often concomitantly present in polymorphonuclear-like cells of the lamina propria, in mast cells, and in a few ganglia of Auerbach's plexus and Meissner's plexus. Immunohistochemistry revealed that lamina propria cells and inflammatory cells (mainly mast cells) were NGF and TrkA immunopositive. NGF was also present in Meissner's plexus (especially in CD) and TrkA in enteric glia surrounding intestinal ganglia. CONCLUSIONS: The concomitant enhanced expression of NGF and its receptor suggests activation of this pathway in chronic inflammation in CD and UC. The presence of NGF and TrkA in both neural and non-neural structures in CD and UC supports the hypothesis that neuroimmune interactions occur and are activated in both disorders.     

Three-Dimensional Echocardiography for Quantitative Analysis of Left-Ventricular Aneurysm

Background: Quantitative analysis of left-ventricular (LV) aneurysms after myocardial infarction is prognostically relevant and assists in planning surgery. Three-dimensional (3D) echocardiography facilitates clear visualization of cardiac anatomy and accurate assessment of functional parameters. The aim of the present study was to determine the ability of 3D echocardiography to quantify LV aneurysms. Methods: Ten patients with a known LV-aneurysm after myocardial infarction underwent 3D echocardiography and cardiac magnetic resonance (CMR) imaging at 1.5 Tesla within 3 days. For 3D echocardiography, a multiplanar transesophageal examination was performed with full LV coverage and the 3D dataset was analyzed offline. The LV-aneurysm was defined by a wall thickness <5 mm. The following quantitative parameters were determined: left ventricular end-diastolic and end-systolic volumes, LV myocardial mass (LV-mass) and mass of the LV-aneurysm. LV ejection fraction and percentage of aneurysm mass (%-aneurysm) were calculated. Results: LV volumes and ejection fraction showed a strong correlation between 3D echocardiography and CMR (r = 0.94–0.97; P < 0.01). Importantly, the mass and percentage of mass of the LV-aneurysm demonstrated a high correlation as well (r = 0.94 and r = 0.86, respectively; P < 0.01). For all parameters, the calculated bias between both methods was found to be minimal (0.8–7.6%). Conclusions: Three-dimensional echocardiography proved to be a reliable tool for quantitative analysis of LV volumes, ejection fraction and aneurysm size in patients with prior myocardial infarction. In addition, 3D visualization of the complex cardiac anatomy in patients with LV-aneurysm may assist surgical procedure planning. (Echocardiography 2010;27:64-68)     

Acute appendicitis in the setting of Clostridium difficile colitis: case report and review of the literature

A 72-year-old man was hospitalized for exacerbation of chronic obstructive pulmonary disease and was treated with oral prednisone and 7 days of moxifloxacin. Five days after completing the antibiotic course, he developed watery diarrhea and diffuse, crampy abdominal pain. On presentation he was afebrile, and abdominal examination revealed diffuse tenderness without peritoneal signs. Stool tested positive for Clostridium difficile toxin A by enzyme-linked immunosorbent assay. Despite starting oral metronidazole, the patient developed a fever of 101.2 degrees F 36 hours after his initial episode of diarrhea, 12 hours after admission. His abdominal pain intensified and became localized to the right and left lower quadrants. Computed tomography scan revealed both a thickened cecal wall and an edematous appendix with ileocecal stranding consistent with appendicitis. Appendectomy was performed, and the appendix was found to be suppurative in appearance and nonperforated. The cecum had mild edema and erythema, whereas the colon and rectum were grossly unaffected. Pathology examination revealed exudative material in the appendiceal lumen and a diffuse transmural inflammatory cell infiltrate. The patient had an uneventful recovery and continued to improve on oral metronidazole. Although Clostridium difficile colitis and appendicitis are each very common independently, C. difficile as an etiology of appendicitis is exceedingly rare. A review of the literature revealed 2 prior cases. We speculate that this association is underdiagnosed, because milder cases might respond to antibiotic therapy alone, and severe cases might involve the entire colon and require total colectomy. In each scenario, the involvement of the appendix might be overlooked.     

3-T MRI detects inflammatory stenosis of the vertebral artery in giant cell arteritis

Giant cell arteritis (GCA) is a granulomatous vasculitis. Early diagnosis is important for the initiation of corticosteroid treatment because the arteritis can result in blindness. In most of the cases, the superficial cranial arteries are affected. However, extracranial involvement of various arteries is known. Here, we report a case of histologically proven GCA with an inflammatory stenosis of the right vertebral artery. For complete evaluation of the extension of the disease, an optimized protocol of high-resolution magnetic resonance imaging at 3 T in combination with contrast-enhanced magnetic resonance angiography was performed. This non-invasive method facilitates the differentiation of inflamed and healthy segments of small cranial arteries, may help to find appropriate sites for biopsy, and allows the assessment of affected extracranial vessels. In this patient case, even the cause of vertebral stenosis—inflammatory versus arteriosclerotic—could be elucidated.     

Combined effects of HMG-CoA-reductase inhibition and renin-angiotensin system blockade on experimental atherosclerosis

Therapeutic strategies to prevent atherosclerotic plaque progression and achieve plaque stabilization involve 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA)-reductase inhibitors (statins) and renin-angiotensin system (RAS)-blockade, but studies investigating the potentially additive effects of a combined treatment strategy are rare. We hypothesised that the adjunction of atorvastatin with telmisartan or ramipril might achieve additional effects on experimental atherosclerosis though statin-induced lipid-lowering is lacking. ApoE-/- mice were fed a high-fat diet for 12 weeks and randomized to either placebo (CON), atorvastatin (ATO), ramipril (RAM), telmisartan (TEL) or RAM+ATO and TEL+ATO (N=23 per group). RAS-blockade, but not ATO, reduced systolic blood pressure. None of the treatment regimens lowered systemic cholesterol levels or lipoprotein fractions. RAM, TEL and the combined therapy, but not ATO, significantly reduced aortic lipid deposition. All substances significantly reduced monocyte chemoattracting protein (MCP)-1 concentrations, macrophages and matrixmetalloproteinase (MMP)-9 content and enhanced plaque's content of tissue inhibitor of MMP (TIMP)-1, collagen and fibrous cap thickness, resulting in an overall decrease of advanced plaques (classified as types IV-VI). Additive effects of the adjunction were observed on MMP-9 gelatinolytic activity, interleukin (IL)-6 and IL-10 plasma levels. These results indicate that a combined treatment with RAS-blockade and statins may have additive effects on systemic cardiovascular risk markers even in the absence of lipid-reduction, although additional effects on atherosclerotic plaque progression and stability were not observed in this model.     

MCP-1在小型猪慢性阻塞性胰腺炎组织中的表达及其意义

目的 检测慢性阻塞性胰腺炎小型猪血单核细胞趋化蛋白-1(MCP-1)含量及胰腺组织MCP-1蛋白表达,探讨其在胰腺纤维化中的作用.方法 采用不全结扎主胰管方法建立小型猪慢性阻塞性胰腺炎模型,术后4、6、8 周分批处死动物.观察胰腺病理变化;胶原(VG)染色评估胰腺纤维化程度;ELISA法检测血MCP-1浓度;免疫组化法检测胰腺组织MCP-1、α-SMA、PDGF、TGF-β1和NF-κB表达.结果 造模成功14头(58.3%).术后4周起胰腺体尾部呈萎缩性改变,间质纤维组织增生,炎细胞浸润,第8周改变最明显.胰腺纤维化Ⅰ期5头(35.7%),Ⅱ期4头(28.6%),Ⅲ期5头(35.7%).术后4、6、8周造模成功组血MCP-1含量分别为(102.44±36.25)pg/m1、(97.84±28.67)pg/ml、(94.32±28.42)pg/ml,显著高于对照组的(10.42±5.86)pg/ml、(8.58±4.86)pg/ml、(8.22±4.58)pg/ml(P值均＜0.01).对照组胰腺无MCP-1蛋白表达,造模成功组胰腺组织内见MCP-1蛋白表达,且MCP-1表达与α-SMA、PDGF、TGF-β1和NF-κB表达呈正相关.结论 MCP-1在慢性阻塞性胰腺炎胰腺纤维化过程中起重要作用.     

耳后进路夹层法与内植法鼓膜修补术疗效比较

【目的】探讨并比较耳后进路夹层法与内植法鼓膜修补术疗效。【方法】收集需行鼓膜修补术患者80例（92耳）,按手术方法分为夹层法组42例（46耳）与内植法组38例（46耳）。分别观察两组术后听力恢复情况、术前术后言语频率平均听阈、术后3个月鼓膜情况、术后6个月愈合率。【结果】术后听力恢复情况夹层法优于内植法（P ＜0．05）;夹层法术后言语频率平均听阈明显高于内植法（P ＜0．01）;术后随访3个月后两组引起再穿孔、鼓膜内陷的发生有统计学差异（ P ＜0．05）;术后6个月愈合率比较,夹层法优于内植法,两组有统计学差异（ P ＜0．05）。【结论】耳后进路夹层法与内植法鼓膜修补术短期疗效相当,但前者更有利于听力恢复,是治疗鼓膜穿孔的较为理想的方法。     

糖尿病人群中胰岛素和游离脂肪酸水平的相关性研究

目的探讨糖尿病人群中胰岛素和游离脂肪酸水平的相关性。方法选取2009年1月至2014年8月成都市第四人民医院就诊的2型糖尿病患者及同期门诊体检的健康人群,观察比较各人群各项生化指标。结果 2组人群生化特征比较,其中体质量指数、空腹血糖、餐后2h血糖、空腹血清胰岛素(FINS)、三酰甘油、高密度脂蛋白胆固醇、游离脂肪酸(FFA)、胰岛素敏感指数(IAI)差异有统计学意义(P0.05);糖尿病组中FINS与FFA呈正相关(r=0.678,P0.05),IAI与FFA呈负相关(r=-0.654,P0.05)。健康组FINS与FFA呈正相关,相关系数为0.447(P0.05)。结论糖尿病人群血清FFA升高,胰岛素分泌增加,IAI下降,而健康人群血清FFA升高与胰岛素分泌增加有关。     

甲氧西林耐药／敏感金黄色葡萄球菌基因分型和毒力基因检测

目的：分析耐甲氧西林金黄色葡萄球菌（金葡菌）（MRSA）和甲氧西林敏感金葡菌（MSSA）临床分离株基因分型及毒力基因分布特征是否存在差异,了解金葡菌耐药性演变与毒力变迁之间的相关性。方法采用脉冲场凝胶电泳（PFGE）方法和多位点序列分型（MLST）方法对呼和浩特地区住院患者中分离的30株 MRSA 和30株 MSSA 进行分子分型,同步采用聚合酶链反应（PCR）方法检测菌株毒力基因。结果60株金葡菌 PFGE 分型共分19个型,MSSA 菌株分布在 I 和 H 型等16个基因型中,而 MRSA 株主要集中分布在 K 和 M 2个基因型中。20株不同 PFGE 型菌株 MLST 分型结果显示,MRSA 株主要为 ST-239型;MSSA 株呈多样性分布特征,主要以 ST-5型、ST-7型、ST-15型为主。毒力基因在 MRSA 和 MSSA 中分布差异显著。MSSA 毒力基因整体携带率明显高于 MRSA（53．9％对40．0％,χ2＝32．7,P ＜0．01）。MRSA 株 sea、cna 和 cap 8基因携带率明显高于 MSSA 携带率（P ＜0．01）,而 sec、seg 、sei、sem、sen、seo、fnbB、ebpS、cap5基因携带率明显低于 MSSA（P＜0．05）。结论呼和浩特地区金葡菌临床分离株基因型呈现多样化分布特点,MRSA 主要以 ST-239型为主。MSSA 毒力基因携带率高,特定毒力因子在 MRSA 和 MSSA 株中呈现一定聚集分布特征,金葡菌特定耐药性的获得可能伴随特定毒力特征的变化。     

Late cytomegalovirus polyradiculopathy following haploidentical CD34+-selected hematopoietic stem cell transplantation

A 55-year-old man with acute myeloid leukemia in second relapse presented 4 months after haploidentical CD34+-selected hematopoietic stem cell transplantation (HSCT) with symmetric, progressive neurological deficits of the lower extremities. Although there was no molecular evidence for drug resistance in the cerebral-spinal fluid, antiviral combination therapy failed to control the rapidly progressing CMV polyradiculopathy (PRP) and encephalitis, which were confirmed by autopsy studies. Late CMV PRP as an unusual manifestation of CMV disease should be kept in mind in patients with suggestive neurological symptoms after HSCT.