TREC/KREC Levels and T and B Lymphocyte Subpopulations in COVID-19 Patients at Different Stages of the Disease

Background: T and B cell-mediated immunity can be assessed using T cell receptor excision circle (TREC) and Kappa-deleting recombination excision circle (KREC) analysis, respectively, and successful implementation of this method requires evaluation of the correlation between the TREC frequencies and T cell subsets as well as KREC levels and B lymphocyte subsets. The aim of the present study was to evaluate the correlation between the TREC/KREC concentrations and T/B lymphocyte subsets at different stages of COVID-19. Methods: We examined 33 patients in the acute stage of COVID-19 (including 8 patients with poor outcomes) and 33 COVID-19 survivors. TREC/KREC concentrations were measured using quantitative real-time PCR. T/B lymphocyte subsets were determined using flow cytometry. Results: Blood TREC and KREC levels were found to be significantly lower in the acute stage of COVID-19 compared to control values. Moreover, a zero blood TREC level was a predictor of a poor disease outcome. Reductions in CD3⁺CD4⁺CD45RO⁻CD62L⁻ and CD3⁺CD8⁺CD45RO⁻CD62L⁻ T cell counts (as well as in the main fractions of B1 and B2 B cells) indicated a favorable outcome in COVID-19 patients in the acute stage of the disease. Decreased CD3⁺CD4⁺CD45RO⁻CD62L⁺ and CD3⁺CD8⁺CD45RO⁻CD62L⁺ T cell frequencies and increased CD3⁺CD8⁺CD45RO⁻CD62L⁻ cell counts were found to indicate a poor outcome in patients with acute COVID-19. These patients were also found to have increased B1 cell counts while demonstrating no changes in B2 cell counts. The levels of effector T cell subsets an naïve B cells were normal in COVID-19 survivors. The most pronounced correlations between TREC/KREC levels and T/B cell subsets counts were observed in COVID-19 survivors: there were positive correlations with naïve T and B lymphocytes and negative correlations with central and effector memory T cell subsets. Conclusions: The assessment of correlations between TREC and T cell subsets as well as KREC levels and B cell subset counts in patients with acute COVID-19 and COVID-19 survivors has shown that blood concentrations of TREC and KREC are sensitive indicators of the stage of antigen-independent differentiation of adaptive immunity cells. The results of the TREC and KREC analysis correlated with the stages of COVID-19 and differed depending on the outcome of COVID-19.     

紫衫醇联合顺铂、5-氟尿嘧啶小剂量治疗高龄晚期食管癌的临床观察

目的观察小剂量DDP、5-Fu联合紫杉醇治疗高龄晚期食管癌病人近期疗效及不良反应。方法48例晚期食管癌高龄病人,皆应用紫衫醇联合DDP、5-Fu小剂量化疗,每周紫杉醇30mg/d,DDP5mg/d,5-Fu250mg/d,d1～d5/周。连续4周,观察疗效及不良反应。结果完全缓解2例,部分缓解14例,总有效率（CR＋PR）33.3%。毒性反应主要为骨髓抑制、消化道反应、口腔黏膜反应及肌肉关节痛、脱发,反应轻微,可耐受。结论紫衫醇联合DDP、5-Fu小剂量化疗方案治疗晚期食管癌有高效低毒的特点,适宜用于年老体弱的晚期食管癌病人。     

Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions.

BACKGROUND: Treatment with trisodium citrate provides an effective means of regional anticoagulation during continuous renal replacement therapy (CRRT). We evaluated the efficacy, safety and cost of a regional citrate anticoagulation protocol using commercial solutions in 17 critically ill patients treated with continuous venovenous haemodiafiltration (CVVHDF). We performed a total of 22 sessions. METHODS: We delivered an A.C.D-A(541(R)) solution containing 112.9 mmol/l disodium citrate (3.22%) at a median rate of 260 (190-280) ml/h via the pre-filter port of a COBE PRISMA with an AN-69 dialyser, while adjusting the rate to maintain post-filtered ionized calcium (iCa(2+)) between 0.25 and 0.4 mmol/l. Plasma iCa(2+) was maintained at >1.1 mmol/l by infusion of calcium chloride at a median rate of 1.70 (1.36-2.27) mmol/h. The dialysate was easily modified according to the acid-base status of each patient. Both replacement and dialysate solutions were delivered at 1200 ml/h. Each session was scheduled for 48 h and biological parameters were assessed every 6 h. RESULTS: The mean dialyser survival was 39 +/- 11 h (median 41.5 h; range 13-48 h). We observed dialyser clotting in four cases (18%). There were no bleeding events or modifications of coagulation parameters. The citrate solution, replacement solution and dialysate were obtained as commercial products. Both the replacement and dialysate solutions contained calcium. The extra cost of this technique was 25 euro;/day as compared to anticoagulation with heparin. CONCLUSIONS: We designed an efficient method of regional citrate anticoagulation for CVVHDF by using commercial solutions. The monitoring of patients was as intensive as during heparin anticoagulation for CRRT. Because of the higher cost of this method, it should be proposed only for patients with high bleeding risk.     

中西医结合治疗妇产科手术后粘连性肠梗阻42例

目的：探讨采用中西医结合的方法，治疗妇产科术后患者粘连性肠梗阻，减少再次手术的机会。方法：对42例妇产科术后发生粘连性梗阻患者，进行中西医结合保守治疗，取得了较好的疗效。与53例未进行中西医结合的患者进行比较，治疗疗效存在差异（P＜0．01）。结果：中西医结合对妇产科术后患者出现的粘连性肠梗阻疗效较好，通过治疗，患者可经保守达到治愈的目的。结论：我们采用的传统治疗方法加中药腹外敷治疗妇产科术后粘连性肠梗阻，为一可行的治疗方法。     

七氟醚、丙泊酚麻醉对结肠癌根治术患者围手术期血液流变学的影响

目的研究丙泊酚与七氟醚麻醉对结肠癌根治术患者围手术期血液流变学的影响。方法从2014年11月至2015年11月到我院接受治疗的结肠癌根治术患者抽取110例作为研究对象,并严格按照随机原则将其分为行丙泊酚麻醉组与行七氟醚麻醉组,均为55例。比较两组患者麻醉前、麻醉后30 min、麻醉后90 min血浆黏度、细胞变形指数、红细胞聚集指数、血浆纤维蛋白原及全血黏度(高切、中切、低切)情况。结果麻醉后,两组患者三个时间点各项指标差异较小(P0.05)。与麻醉前相比,两组患者行麻醉后血浆黏度、全血高切黏度、全血中切黏度、全血低切黏度与血浆纤维蛋白原、红细胞变形指数与红细胞聚集指数皆明显下降(P0.05)。结论将丙泊酚与七氟醚麻醉运用于结肠癌根治术患者,均可明显降低血液黏度,有助于防止血栓形成的相关并发症。     

The effect of flurbiprofen and tiaprofenic acid on serum cytokine levels of patients with osteoarthrosis

39 patients with active knee osteoarthrosis, chosen according to ACR criteria, were assigned to receive flurbiprofen (n 12, 2 &#50 100 mg), tiaprofenic acid (n 14, 2 &#50 300 mg) and placebo (n 13) in a 3-week, placebo-controlled study. All patients completed the study, and both medications were found to be effective: improvement occurred in the clinical signs. These drugs reduced the TNF- &#102 levels. Flurbiprofen especially affected the IL-6 levels. Our findings indicate that NSAIDs may be effective in the etiopathogenesis of osteoarthrosis.     

血清铁蛋白与糖尿病肾病相关性的探讨

目的对2型糖尿病患者进行血清铁蛋白浓度和糖尿病肾病相关性探讨。方法89例住院治疗中的2型糖尿病患者分为肾功能正常组（58例）和肾功能异常组（31例）,分别采集血和尿标本,使用化学发光法、放射免疫法等方法测定血清铁蛋白2、4 h尿微量白蛋白排泄量等项目,并进行统计学分析处理。结果肾功能正常组的血清铁蛋白浓度和24 h尿微量白蛋白排泄量分别是226.21±126.65 ng/ml和10.09±7.17 mg/day,肾功能异常组分别是355.09±254.16 ng/ml和160.64±166.85 mg/day,两者比较有显著性差异（P〈0.05,P〈0.01）;线性回归分析提示血清铁蛋白浓度和24 h尿微量白蛋白排泄量成正相关（r=0.223）,有显著性差异（P〈0.05）。结论血清铁蛋白浓度可作为糖尿病肾病的指标。     

自我效能感与糖尿病患者血糖控制情况的研究

目的探讨糖尿病患者自我效能感对糖尿病控制情况的影响。方法选择我院80例门诊糖尿病患者分为两组,观察组给予临床路径干预,评测两组患者自我效能感和糖尿病控制情况。结果观察组自我效能感、空腹血糖、餐后血糖和糖化血红蛋白控制方面都优于对照组。结论患者自我效能感的提高,改善了患者的糖尿病控制情况,满足了患者的健康需求。     

高龄股骨转子间骨折的内固定手术疗效分析

目的　探讨髋部滑槽加压螺钉 (DHS/DCS ,dynamichipscew/dynamiccondylarscrew)手术治疗高龄股骨转子间骨折的疗效。方法　回顾性分析 2 0 0 0年 5月至 2 0 0 3年 4月间采用DHS/DCS治疗 70岁以上老年股骨转子间骨折 35例 ,平均年龄 82 .1岁 (71～ 10 0岁 ) ,就其生物特性、操作要点、围手术期及小转子骨折处理作一分析。结果　所有病人均获随访 ,平均随访时间 16月 (5～ 4 0个月 )。 4例死于心脑血管意外 ,3例发生髋内翻 ,髋关节功能评价优良率 90 .3% (占 2 8/ 31)。结论　DHS/DCS是治疗老年股骨转子间骨折较理想的方法。     

Effects of Exercise Training on Restless Legs Syndrome,Depression, Sleep Quality,and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis

Context

Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain.