肝豆状核变性所致精神障碍患者的综合护理干预

目的：探讨肝豆状核变性所致精神障碍患者的护理干预效果。方法对36例肝豆状核变性所致精神障碍患者在进行驱铜及抗精神病药物治疗的同时,予以综合护理干预。结果本组患者接受治疗及综合护理干预后,躯体症状均得到缓解,精神症状得到不同程度的控制。结论肝豆状核变性所致精神障碍患者在常规驱铜及抗精神病药物治疗的基础上,予以综合护理干预,能显著改善患者的临床症状,提高生活质量。     

The epidemiology of non-alcoholic steatohepatitis (NASH) in the United States between 2010-2020: a population-based study

Introduction and objectivesNon-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD) that can progress to liver cirrhosis, liver failure and hepatocellular carcinoma. It is the second leading cause of liver transplant in the US. We aim to investigate the prevalence, demographics and risk factors NASH patients in the US.Patients and methodsWe used a large database (Explorys IBM) that aggregates electronic health records from 26 nationwide healthcare systems. We identified adults with NASH between 2010-2020. Demographics including age, gender and race were collected. NASH risk factors including Diabetes Millets (DM), Hyperlipidemia (HLD), Hypertension (HTN) and Obesity were also collected. Cochran-Armitage test was used to assess the statistical significance of year-by-year trend. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) of risk factors.ResultsNASH annual prevalence rate increased from 1.51% in 2010 to 2.79% in 2020 (p < 0.0001). The proportion of patients with NASH by gender was 54.1% female vs 45.9% male (OR 1.04 [0.91-1.11]). Caucasian had higher odds of NASH than non-Caucasian (OR 1.42 [1.31-1.54]). NASH is strongly associated with DM and obesity (OR 18.61 [17.35-19.94]) and (OR 20.97 [17.87-23.21]), respectively. Other components of metabolic syndrome were associated with NASH to a lesser degree; HTN (OR 3.24 [3.20-3.28]) and HLD (OR 4.93 [4.85-4.01]).ConclusionThe prevalence of NASH has significantly increased in the US in the last decade. This is likely related to the increased prevalence of risk factors as well as increased awareness of the disease.     

对98例肝豆状核变性患者眼角膜K－F环的观察

目的：探讨肝豆状核变性患者角膜Ｋ－Ｆ环的定量分级，以反映疾病的严重程度。方法：通过裂隙灯角膜显微镜观察患者角膜后的铜质沉着情况，将其分级，并与体征和客观检查相对照。结果：全组病例均检出阳性Ｋ－Ｆ环，双眼角膜Ｋ－Ｆ环呈明显的一致性。结论：Ｋ－Ｆ环对本病的诊断具有决定意义，Ｋ－Ｆ环的分级情况与本病的严重程度呈正相关。     

Latex-allergic patients sensitized to the major allergen hevein and hevein-like domains of class I chitinases show no increased frequency of latex-associated plant food allergy

Allergies to certain fruits such as banana, avocado, chestnut and kiwi are described in 30-70% of latex-allergic patients. This association is attributed to the cross-reactivity between the major latex allergen hevein and hevein-like domains (HLDs) from fruit class I chitinases. We aimed to assess the extent of cross-reactivity between hevein and HLDs using sera from latex-allergic patients with and without plant food allergy. Hevein and HLDs of latex, banana, and avocado chitinases were expressed in Escherichia coli as fusion proteins with the maltose-binding protein and purified by affinity chromatography. IgE binding to these proteins was studied in sera from 59 latex-allergic patients and 20 banana-allergic patients without latex allergy by ELISA and ELISA inhibition. Additionally, 16,408 allergic patients’ sera were tested for IgE binding to hevein, latex chitinase, and wheat germ agglutinin using an allergen microarray. Hevein-specific IgE was detected in 34/59 (58%) latex-allergic patients’ sera. HLDs of latex, banana, and avocado chitinases were recognized by 21 (36%), 20 (34%), and 9 (15%) sera, respectively. In contrast, only one of 20 banana-allergic patients without latex allergy was sensitized to chitinase HLDs. In most tested latex-allergic patients’ sera, IgE binding to hevein was only partially reduced by preincubation with HLDs. Among hevein-sensitized, latex-allergic patients, the percentage of plant food allergy (15/34 = 44%) was equal to latex-allergic patients without hevein sensitization (11/25 = 44%). In the general allergic population, 230 of 16,408 sera (1.4%) reacted to hevein and/or a hevein-like allergen. Of these, 128 sera showed an isolated sensitization to hevein, whereas only 17 bound to latex chitinase or wheat germ agglutinin without hevein sensitization. In conclusion, the IgE response to HLDs is elicited by hevein as sensitizing allergen in most cases. Despite considerable cross-reactivity between these allergens, no correlation between latex-associated plant food allergy and sensitization to hevein or HLDs was found.     

Non-anti-Galα1-3Gal antibody mechanisms are sufficient to cause hyperacute lung dysfunction in pulmonary xenotransplantation

BACKGROUND:Hyperacute lung dysfunction, which is always associated with pulmonary pig-to-primate xenotransplantation is not well understood. The mechanisms associated with its occurrence seem to differ from mechanisms involved in hyperacute xenograft rejection seen in porcine hearts or kidneys transplanted into primates. To determine the contribution of anti-Galα1-3Gal antibodies (αGAb) in such a process, we performed a set of orthotopic pig lung transplants into baboons depleted of αGAb and compared graft function and survival with those receiving only immunosuppression.STUDY DESIGN:Pigs expressing human membrane cofactor protein served as donors. All baboons received triple immunosuppressive therapy. Depletion of αGAb in the experimental group (n = 4) was done by way of immunoadsorption using immunoaffinity membranes. Controls (n = 4) did not undergo immunoadsorption. Orthotopic lung transplants were performed through a left thoracotomy. Main pulmonary artery blood flow and pressure, left pulmonary artery blood flow, and left atrial pressure were recorded.RESULTS:At 1 hour after reperfusion, pulmonary artery graft flows and pulmonary vascular resistances (PVR) were better in animals depleted of αGAb than in controls (605 ± 325.2 mL/min versus 230 ± 21 mL/min; 27.1 ± 41.3 mmHg/L/min versus 63 ± 1 mmHg/L/min). But at 3 hours after reperfusion average graft flows in baboons depleted of αGAb had decreased to 277.6 ± 302.2 mL/min and PVRs had increased 58.3 ± 42.0 mmHg/L/min. On the other hand, controls maintained stable flows and PVRs (223 ± 23 mL/min; 61 ± 3 mmHg/L/min). Survival was ultimately better in control baboons when compared with αGab depleted ones (12.2 ± 3.3 h versus 4.4 ± 3.2 h).CONCLUSION:Unlike heart and kidney xenograft transplants, hyperacute lung xenograft dysfunction seems to be mediated by factors other than αGAb.     

心理护理、人文关怀对肝豆状核变性患者心理状况影响

目的探讨心理护理及人文关怀对肝豆状核变性患者心理状况的影响。方法对30例肝豆状核变性患者采用症状自评量表(Scl-90)进行测查,进行干预后再次进行相应量表进行测查。结果实施心理护理及人文关怀对肝豆状核变性患者的心理状况有显著性改善,躯体化(p<0.01);以强迫、人际关系、抑郁、焦虑、敌对性、恐怖、偏执、阳性项目差异更为明显(p<0.001)。结论心理护理、人文关怀能提高肝豆状核变性患者的心理状况,促进HLD患者的全面康复。     

Hemolymph coagulation and phenoloxidase activity in Uca tangeri induced by Escherichia coli endotoxin

Uca tangeri is a marine fiddler crab found commonly in the West African coast and is often exposed to Gram-negative pathogens upon injury. The aim of this study was to document the patterns of endotoxin-induced protein coagulation and phenoloxidase (PO) activity in hemolymph fractions of Uca tangeri. Hemolymph from live crabs was obtained by carapace puncture, pooled. and then separated into plasma, hemocyte Lysate (HL), hemocyte lysate supernatant (HLS) and hemocyte lysate debris (HLD). The effect of Escherichia coli (O1111:B4) endotoxin and calcium ion (Ca²⁺) on protein coagulation in the presence/absence of endotoxin and the endotoxin dose-dependence of coagulation and PO activity were each studied in the plasma, HL, HLS and HLD. The results showed Ca²⁺ was required to induce coagulation, and was endotoxin concentration-dependent in the plasma. PO activity was highest in the HLS but PO specific activity was highest in HLD. PO activity remained relatively constant with increased LPS concentration in the range studied 0–10 EU/ml. From the data we conclude that endotoxin-induced protein coagulation occurs in the plasma alone and might be mediated by trans-glutaminases, while PO activity is localized inside hemocytes and cell membranes in Uca tangeri.