塞来昔布治疗骨关节炎的随机对照试验

目的：比较塞来昔布、萘普生以及安慰剂在治疗膝关节骨关节炎时的疗效、安全性、方法：１００３名有症状的膝关节骨关节炎患者随机接受塞米昔布５０,１００,２００ｍｇ,ｂｉｄ;萘普生５００ｍｇ,ｂｉｄ或安慰剂１２周。患者在停用既往ＮＳＡＩＤ药或止痛治疗后２－７ｄ以及服用受试药物治疗后２,６,１２周,根据标准疗效判定方法进行评估。结果：塞来昔布在改善骨关节炎的症状和体征上有显著效果。在治疗后的２ｄ内疼痛明显缓     

Intermediate lymphocytic lymphoma: immunophenotypic and cytogenetic findings

A detailed immunohistologic and cytogenetic analysis of 12 cases of intermediate lymphocytic lymphoma was performed. The characteristic immunophenotype of intermediate lymphocytic lymphoma was: surface IgM and IgD+, BA1+, B1+, BA2-, B2-, B4+, Leu 14+, Leu 1+, HLA-DR+, and common acute lymphocytic leukemia associated (CALLA) antigen negative. Clonal chromosome abnormalities were identified in ten cases, with structural or numerical abnormalities of chromosomes 11 or 12 in nine cases. Five cases had structural abnormalities involving the long arm of chromosome 11; three of these had translocations with chromosome 14 at band q32. Three cases had trisomy 12, and one case had a translocation involving the long arm of chromosome 12. The tenth case had a translocation involving the long arms of chromosomes 7 and 9. These characteristic immunophenotypic and cytogenetic findings suggest a close lineage relationship between intermediate lymphocytic lymphoma and small lymphocytic (well differentiated) lymphoma/chronic lymphocytic leukemia. Their differing clinical, cytologic, and architectural features suggest, however, that intermediate lymphocytic lymphoma should be considered a separate category of lymphocytic lymphoma in the International Working Formulation.     

Plasma cytokine levels and monocyte activation in patients with obstructive jaundice

Some monocytic cytokines are important immune regulators. We have investigated cytokine production by monocytes and the blood levels of IL-1β, IL-6, TNFα, and TGFβ, in patients with obstructive jaundice. The supernatant from LPS stimulated monocytes from jaundiced patients released significantly increased quantities of TNFα by both bioassay and radioimmunoassay (RIA) (12.4 ± 2.5 fmol/mL and 32.6 ± 8.3 fmol/mL, respectively, for jaundice, compared with 1.6 ± 0.3 fmol/mL and 2.4 ± 0.5 fmol/mL respectively for controls, and also of IL-6 (54.8 ± 5.0 fmol/mL in jaundice compared with 35.6 ± 5.0 fmol/mL for controls). The production of IL-1β and TGFβ by stimulated monocytes was unchanged. Jaundiced patients had significantly higher plasma TGFβ, but TNFα and IL-1β were below the limits of detection. The highest monocyte TNFα and IL-6 levels were seen in malignant disease patients, especially those with a poor immediate prognosis. We conclude that the production of some cytokines by monocytes is up-regulated in patients with obstructive jaundice.     

Comparison of the Utrecht Scale for Evaluation of Rehabilitation-Participation With the ICF Measure of Participation and Activities Screener and the WHO Disability Assessment Schedule II in Persons With Spinal Cord Injury

Objective

To validate the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) in persons with spinal cord injury (SCI) using 2 International Classification of Functioning, Disability and Health (ICF)-based instruments: the ICF Measure of Participation and Activities-Screener (IMPACT-S) and the World Health Organization Disability Assessment Schedule II (WHODAS II).

Design

Validation study. Score distributions, internal consistency, and concurrent and discriminant validity were evaluated.

Setting

The community.

Participants

Convenience sample of persons (N=157) with long-term SCI living in The Netherlands.

Interventions

Not applicable.

Main Outcome Measures

USER-Participation, IMPACT-S, and WHODAS II.

Results

No instruments showed floor effects, and 3 out of 6 WHODAS II domains showed ceiling effects. Most scores showed adequate internal consistency (α≥.70), except for the USER-Participation frequency scale (.51) and 2 WHODAS II domains (.58–.60). Spearman correlation coefficients between the segregate USER-Participation scales were <.60 (range, .39–.46), showing that they cover separate aspects of participation. Concurrent validity of the USER-Participation was shown because >75% (83.3%) of the 24 hypotheses (Spearman correlation coefficients above or below .60) with the other measurement instruments were confirmed. Concurrent validity between the IMPACT-S and WHODAS II was not shown (53.8% of 13 hypotheses confirmed). All scores except 4 WHODAS II domains showed significant differences in participation between persons with paraplegia and tetraplegia.

Conclusions

The USER-Participation showed generally satisfactory psychometric properties in Dutch persons with long-term SCI living in the community. The IMPACT-S showed the best psychometric properties, and the WHODAS II showed less favorable results. Future research on the USER-Participation should focus on validation in other languages and different diagnostic groups.     

Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine

ObjectiveTo compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine.MethodsWe analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone.ResultsAmong 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81–1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24–2.02) in the full model.ConclusionsAfter adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.     

莫达非尼治疗帕金森患者白天嗜睡的双盲安慰剂对照试验

研究背景: 过度白天嗜睡 (EDS)通常使得帕金森(PD)患者的病情更为复杂。EDS的病因是多因素的,多巴胺药物治疗可能会使之恶化。莫达非尼(modafinil)是一种促醒药物,被批准用于发作性嗜睡的治疗,但是却经常被用于各种嗜睡状态的治疗。     

Gel electrophoretic analysis of polypeptides from nucleocapsids of Marek's disease virus strains and herpesvirus of Turkey

Summary The polypeptides of nucleocapsids of Marek's disease virus (MDV) strains with different biological properties and of antigenically related herpesvirus of turkey (HVT) strains were analysed by one- and two-dimensional (1D and 2D, respectively) gel electrophoresis. Based on small differences in migration behaviour (size and charge) of a number of corresponding nucleocapsid polypeptides, the virus strains could be differentiated into three groups.The polypeptide pattern of group I, comprising the virulent MDV-strain K and the attenuated strains, HPRS-16/att and CVI988 37th passage, was composed of four major polypeptides (i.e. 140K, 50K, 40K and 33K daltons) and at least four minor polypeptides. The pattern of group II, comprising the naturally occuring non-oncogenic MDV-strains SB-1 and HPRS-24, contained one additional major polypeptide of 39K daltons. The nucleocapsid-specific 2D polypeptide patterns of the HVT strains HVT-Fc 126 and PB-THV₁, comprising group III, were distinguishable from each other on the basis of a small difference in size of one major 50K polypeptide.Results were further substantiated by coelectrophoresis experiments.With 6 Figures     

Carpal avascular necrosis: MR imaging

The authors evaluated the use of magnetic resonance (MR) imaging in diagnosis of avascular necrosis (AVN) of carpal bones by examining 21 patients with wrist pain and two healthy volunteers. MR images were compared with conventional radiographs in every case and with bone scintigrams in 18 cases. MR imaging was slightly less sensitive than bone scintigraphy in depicting AVN, but in patients who were imaged with long repetition time (TR)/long echo time (TE) sequences in addition to short TR/short TE sequences, MR imaging was found to be more specific. While the authors believe that bone scintigraphy remains the screening test of choice for patients with wrist pain and normal plain radiographs, MR imaging promises to add significant diagnostic information in cases in which bone scans are abnormal.