Juvenile polyarteritis: results of a multicenter survey of 110 children

OBJECTIVE: To characterize pediatric patients who had been diagnosed with polyarteritis nodosa (PAN) through necrotizing vasculitis of the small and mid-size arteries or those with characteristic findings on angiograms data were collected. STUDY DESIGN: Pediatricians were asked to classify their patients into one of the four suggested groups for juvenile PAN. Twenty-one pediatric centers worldwide participated with 110 patients. RESULTS: The girl:boy ratio was 56:54, with a mean age of 9.05 +/- 3.57 years. The cases were classified as: 33 (30%) cutaneous PAN; 5 (4.6%) classic PAN associated with hepatitis B surface antigen (HBs Ag); 9 (8.1%) microscopic polyarteritis of adults associated with antineutrophil cytoplasmic antibodies (ANCA); and 63 (57.2%) systemic PAN. Cutaneous PAN was disease confined to the skin and musculoskeletal system. All patients with HBs Ag-associated classic PAN were diagnosed with renal angiograms. Antiviral treatment was administered in most cases. Microscopic PAN patients had pulmonary-renal disease, in combination or separately. ANCA was present in 87%, and 2 patients progressed to end-stage renal failure. Patients classified with systemic PAN had multiple system involvement, almost all had constitutional symptoms, and all had elevated acute phase reactants. Corticosteroids and cyclophosphamide were the first choices of immunosuppressive treatment. The overall mortality was 1.1%. CONCLUSIONS: There were remarkable differences among pediatric patients with PAN, with different clinical manifestations and overall better survival and lower relapse rates when compared with adults.     

Aneurysmal subarachnoid hemorrhage in a patient with Wegener’s granulomatosis

A 34-year-old Japanese man admitted to hospital with pneumonia had previously undergone surgery for paranasal sinusitis and also for the clipping of an aneurysm at the origin of the anterior choroidal artery after subarachnoid hemorrhage. Laboratory tests performed at the present admission showed renal insufficiency and serological findings of raised proteinase 3 antineutrophil cytoplasmic antibody level. A renal biopsy was performed that showed diffuse necrotizing glomerulonephritis with fibrocellular crescents. The diagnosis of Wegeners granulomatosis(WG) was confirmed on the basis of the clinical picture, laboratory findings, and biopsies of renal tissues. The disease responded to prednisolone and cyclophosphamide. The association of WG with a ruptured intracranial aneurysm is rare and has not previously been confirmed.     

Resveratrol, a polyphenol found in grapes, suppresses oxidative damage and stimulates apoptosis during early colonic inflammation in rats

Oxidative stress, neutrophil infiltration, proinflammatory cytokines and eicosanoid generation are clearly involved in the pathogenesis of intestinal bowel disease. Resveratrol, a polyphenolic compound found in grapes and wine, has been shown to have anti-inflammatory, antioxidant, antitumour and immunomodulatory activities, however, its effects on experimental colitis remain unknown. We have investigated the effects of resveratrol on the colon injury caused by intracolonic instillation of trinitrobenzenesulphonic acid (TNBS) in rats. We determined the production of prostaglandin (PG)E(2) and PGD(2) in colon mucosa and the expression of cyclo-oxygenases (COX)-1 and -2 immunohistochemically. The inflammatory response was assessed by histology and myeloperoxidase activity, as an index of neutrophil infiltration. Interleukin-1 beta production, histological and histochemical analysis of the lesions were also carried out. Finally, since resveratrol has been found to modulate apoptosis we intended to elucidate its effects on colonic mucosa under early acute inflammatory conditions. Resveratrol (5-10mg/kg/day) significantly reduced the degree of colonic injury, the index of neutrophil infiltration and the levels of the cytokine. Resveratrol did not revert the increased PGE(2) levels but produced a significant fall in the PGD(2) concentration. Compared with inflamed colon, no changes in staining for COX-1 were observed in colon of resveratrol and TNBS-treated rats. In contrast, COX-2 expression was decreased. Furthermore, resveratrol enhanced apoptosis compared with already high level induced by TNBS. In conclusion, resveratrol reduces the damage in experimentally induced colitis, alleviates the oxidative events and stimulates apoptosis.     

川芎嗪对局灶性脑缺血后MPO活性及白细胞介素-6含量的影响

目的探讨川芎嗪对大鼠局灶性脑缺血后脑组织髓过氧化物酶（MPO）活性及IL-6含量的影响。方法采用线栓法制备大鼠局灶性脑缺血模型。将SD大鼠随机分为假手术组、模型组、川芎嗪组,并施以相应处理。分光光度法检测各组大鼠脑组织MPO活性,酶联免疫吸附法检测各组大鼠脑组织IL-6含量的变化。结果与假手术组相比,模型组脑组织MPO活性显著升高;与模型组相比,川芎嗪组脑组织MPO活性降低。假手术组脑组织中未检测出IL-6;模型组IL-6含量升高明显;川芎嗪组IL-6含量较模型组升高。结论川芎嗪可增加抗炎症细胞因子IL-6的含量,从而降低脑组织MPO活性,减轻局灶性脑缺血后的炎症反应,这可能是川芎嗪治疗缺血性脑血管病的机理之一。     

冠心病患者血浆中MPO水平与冠心病及其严重性的相互关系

目的:探讨冠心病患者血浆中MPO水平与冠心病及其严重性的相互关系。方法:选择以胸痛为主要症状的患者100例,根据冠状动脉造影结果,分为非冠心病对照组32例、稳定型心绞痛组37例、急性冠脉综合征组31例。所有患者均进行冠状动脉造影检查,测定血浆MPO水平,并测定血糖、血脂、血清等指标。结果:稳定性心绞痛组与正常对照组比较差异有统计学意义(P<0.05)。急性冠脉综合征组血浆MPO水平明显高于正常对照组,两组比较差异无统计学意义(P>0.05)。三组患者在FBS、HDL C、cTnⅠ指标方面比较差异无统计学意义(P>0.05)。稳定性心绞痛组和急性冠脉综合征组在TC、TG、LDL C、CK-MB、hs CRP指标方面与正常对照组比较差异有统计学意义(P<0.05)。血浆MPO水平随狭窄程度越重,指数越高,各组间比较差异有统计学意义(P<0.05)。结论:冠心病患者血浆中MPO水平与冠心病及其严重性有密切关系。     

电针腧穴“肠病方”对肠黏膜损伤大鼠MPO和IL-10表达的影响

目的:观察电针"肠病方"对大鼠急性肠黏膜损伤的治疗作用并探讨其可能机制。方法:清洁级SD大鼠30只,随机分为空白组、模型组和治疗组,每组10只。用6%冰乙酸制备大鼠急性肠黏膜损伤模型,造模成功后电针"肠病方",测定大鼠血清中髓过氧化物酶(MPO)和白细胞介素-10(IL-10)的含量。结果:与空白组比较,模型组MPO含量上升,IL-10含量下降;与模型组比较,治疗组MPO活性下降(P<0.05),IL-10含量上升(P<0.05)。结论:电针"肠病方"对大鼠急性肠黏膜损伤有明显的治疗作用,其机制可能与调节血清中MPO和IL-10含量有关。     

贫困地区医务人员远程医疗使用意愿及影响因素调查——以重庆市城口县为例

目的 了解重庆市城口县医务人员对远程医疗的使用意愿及影响因素,为贫困地区远程医疗服务工作的开展及远程医疗协作网络建设提供决策参考。方法 采用多阶段分层抽样,在已开展远程医疗服务的重庆市城口县医疗机构中抽取153名医务人员进行问卷调查。结果 该县有75.8%的医生认为了解远程医疗,使用意愿为71.2%,使用率为47.1%。单因素分析结果显示不同年龄、文化程度、职称、是否使用过远程医疗、对远程医疗了解情况、使用远程医疗方便程度、远程医疗对诊疗工作帮助程度、远程医疗对临床技能提升程度、降低患者医疗费用程度的使用意愿不同,差异具有统计学意义（P<0.05）;多因素logistic回归分析结果显示年龄、文化程度、使用远程医疗服务方便程度、远程医疗对诊疗工作帮助程度、降低患者医疗费用程度是医生远程医疗使用意愿的影响因素。结论 重庆市城口县医生远程医疗使用意愿有待提高,应加强远程医疗服务机制体制建设,提高医生远程医疗使用意愿。     

Recipient hypertonic saline infusion prevents cardiac allograft dysfunction

Objective

Hypertonic saline (HTS) has potent immune and vascular effects. We assessed recipient pretreatment with HTS on allograft function in a porcine model of heart transplantation and hypothesized that HTS infusion would limit endothelial and left ventricular (LV) dysfunction following transplantation.

补心气口服液联合尼可地尔治疗冠心病心绞痛的临床研究

目的探讨补心气口服液联合尼可地尔治疗冠心病心绞痛的临床疗效。方法选取2017年6月—2018年6月在邯郸市第二医院治疗的冠心病心绞痛患者94例,根据住院号分为对照组(47例)和治疗组(47例)。对照组患者口服尼可地尔片,10 mg/次,3次/d;治疗组在对照组基础上口服补心气口服液,10 mL/次,3次/d。两组患者均治疗3个月。观察两组患者临床疗效,同时比较治疗前后两组患者心电图改善情况、心绞痛发作次数和持续时间及血清学指标。结果治疗后,对照组患者临床和心电图有效率分别为80.85%和82.98%,均分别显著低于治疗组的95.74%和97.87%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者心绞痛发作次数、持续时间较治疗前均显著降低(P0.05),且治疗组心绞痛发作次数和持续时间比对照组降低更明显(P0.05)。治疗后,两组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)、髓过氧化物酶(MPO)和肌钙蛋白(CTnI)水平均显著降低(P0.05),且治疗后治疗组上述血清学指标水平明显低于对照组(P0.05)。结论补心气口服液联合尼可地尔治疗冠心病心绞痛能够明显改善患者心绞痛症状,降低机体炎症反应,降低心肌损害,具有一定的临床应用价值。