BACKGROUND & AIMS: :Anti-endothelial antibodies (AEA) have been described in patients with rheumatoid arthritis (RA) complicated by vasculitis. In this study we made use of an ELISA and immunoblot technique (IBT) to further characterize AEA of the IgG class in serum of patients with rheumatoid vasculitis (RV) and to investigate the relationship between the presence of IgG-AEA and vasculitis. IgG-AEA as measured by ELISA or IBT could be detected in the serum from 20 of the 23 (87%) RV patients, in 2 out of 13 (15%) patients with RA and in one of 15 healthy donors. The IBT revealed reactivity of IgG-AEA against a total of 12 bands of endothelial antigens ranging in size from 16 to 68 kD. IgG-AEA as measured by ELISA and IBT in serum samples of patients followed longitudinally were present more frequently and in higher titres in patients with active RV as compared to patients with vasculitis in remission. A significant correlation was found between the presence of clinical signs of vasculitis and serum IgG-AEA reactivity against an endothelial membrane antigen of 44 kD. These data show that the pattern of IgG-AEA reactivity in the serum of RV patients is heterogeneous and suggest that IgG-AEA against one particular antigen is involved in the pathogenesis of RV.

背景与目标： 抗内皮抗体 (AEA) 已被描述用于类风湿关节炎 (RA) 并发血管炎的患者。在这项研究中，我们使用ELISA和免疫印迹技术 (IBT) 进一步表征类风湿血管炎 (RV) 患者血清中IgG类的AEA，并研究IgG-AEA的存在与血管炎之间的关系。通过ELISA或IBT测量的IgG-AEA可以在23名 (87% 名) RV患者中的20名，13名 (15% 名) RA患者中的2名以及15名健康供体中的一名的血清中检测到。IBT显示IgG-AEA对总共12条大小为16至68 kD的内皮抗原带具有反应性。与血管炎缓解期患者相比，通过ELISA和IBT在纵向随访的患者血清样品中测量的IgG-AEA更频繁，并且在活动性RV患者中滴度更高。发现血管炎的临床体征与血清IgG-AEA对44 kd的内皮膜抗原的反应性之间存在显着相关性。这些数据表明，RV患者血清中IgG-AEA反应性模式是异质的，并表明针对一种特定抗原的IgG-AEA参与了RV的发病机理。

BACKGROUND & AIMS: :Cardiovascular disease continues to be the foremost cause of morbidity and mortality in dialysis patients. Compared with the general population, dialysis patients suffer from an accelerated disease course that is, at least in part, resistant to conventional therapy. While there are a myriad of potential explanations for this resistance, derangements in lipid metabolism probably play an important role. Here, we discuss the significance of altered lipid metabolism in uremia, such as oxidative lipoprotein modification and the pathophysiology of adipose tissue; limitations of conventional approaches to dyslipidemia such as statin therapy and traditional lipid profiles; and areas of investigation with potential for new therapy, such as reverse cholesterol transport.

背景与目标： 心血管疾病仍然是透析患者发病和死亡的首要原因。与普通人群相比，透析患者的病程加速，至少部分对常规疗法具有抵抗力。尽管对这种抵抗力有多种潜在的解释，但脂质代谢的紊乱可能起着重要作用。在这里，我们讨论了尿毒症中脂质代谢改变的重要性，例如氧化脂蛋白修饰和脂肪组织的病理生理学; 血脂异常的常规方法 (例如他汀类药物治疗和传统脂质分布) 的局限性; 以及具有新疗法潜力的研究领域，例如胆固醇反向转运。

BACKGROUND & AIMS: BACKGROUND:Complicated urinary tract infections (cUTI) are universal reasons for hospitalization, and highly likely to develop into sepsis or septic shock. Carbapenem antibiotics with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing different carbapenem antibiotics for cUTI. Network meta-analysis is a useful tool to compare multiple treatments when there is limited or no direct evidence available. OBJECTIVE:The aim of this study is to compare the efficacy and safety of different carbapenems with alternative antibiotics for the treatment of cUTI. METHODS:Pubmed, Medline, CENTRAL, and Embase were searched in November 2018. Studies of cUTI patients receiving carbapenem were included. We performed network meta-analysis to estimate the risk ratio (RR) and 95% credible interval (CrI) from both direct and indirect evidence; traditional meta-analysis was also performed. Primary outcomes were clinical and microbiological treatment success. RESULTS:A total of 19 studies and 7380 patients were included in the analysis. Doripenem (DOPM) was associated with lower clinical treatment success rates than other carbapenems. Although the efficacy of other carbapenems by RRs with 95% CrIs did not show statistical differences, the cumulative rank probability indicated that meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) had higher clinical and microbiological treatment success rates; imipenem/cilastatin (IC) and MV showed higher risk of adverse events (AEs). CONCLUSIONS:MV was associated with higher treatment success rates for cUTI, especially for cUTI caused by carbapenem-resistant uropathogens, but also with higher risk of AEs. Our findings suggest MV as a first-choice treatment of carbapenem-resistant cUTI. ETPM, BAPM, and meropenem (MEPM) is another reasonable choice for cUTI empiric therapy.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of cataract caused by uveitis. METHODS:This was a prospective, single-masked, randomised, controlled clinical trial. One hundred and six patients with uveitis-associated cataract underwent phacoemulsification with perfusion fluid temperature at 4 °C (treatment group) or 24 °C (control group). Anterior chamber inflammation grade, corneal endothelial cell count, corneal thickness, macular fovea thickness, and intraocular pressure (IOP) were observed on the 1st day and 7th day after operation. RESULTS:The aqueous flare score was 0.83 ± 0.76 in the 4 °C group, which was lower than that in the 24 °C group (1.51 ± 1.02, p = 0.006) on the first day after operation. The aqueous cells score was lower in the 4 °C group (0.17 ± 0.38) than that in the 24 °C group (0.62 ± 0.94, p = 0.025). The mean corneal thickness of incision in the 4 °C group (907.66 ± 85.37 μm) was thinner than that in the 24 °C group (963.75 ± 103.81 μm, p = 0.005). Corneal endothelial cells density, macular fovea thickness, or percentage of transiently increased IOP showed no difference between the two groups (p > 0.05). There was no significant difference in all the main outcome parameters between the two groups on the 7th day after operation (p > 0.05). CONCLUSIONS:Hypothermic perfusion in the phacoemulsification of uveitis-associated cataract is safe, and it can effectively inhibit anterior chamber inflammation and reduce the incisional corneal edema in the early postoperative stage. TRIAL REGISTRATION:The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/, Registration Number: ChiCTR1800016145).

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Prolonged grief disorder (PGD) and major depressive disorder (MDD) are common syndromes shaping bereaved caregivers' quality of life (QOL). However, distinctiveness of these syndromes warrants confirmation, and the temporal relationship of PGD and MDD symptoms has not been established. To fill these knowledge gaps, we conducted this longitudinal study. METHODS:PGD symptoms, depressive symptoms, and psychological QOL were measured over 398 caregivers' first 2 years of bereavement using the Prolonged Grief-13 (PG-13) scale, Center for Epidemiologic Studies-Depression (CES-D) scale, and Short Form-36 Health Survey mental health summary, respectively. To clarify the distinctiveness of PGD and MDD symptoms, we examined their associations with psychological QOL by incremental validity testing. Distinctiveness and temporal relationship of PGD and MDD symptoms were also examined using longitudinal, lower-level mediation analysis with a lagged approach. RESULTS:After the variance in psychological QOL was explained by CES-D scores (pseudo-R2 = 44.19%, P < .001), PG-13 scores significantly, incrementally increased the explained variance in psychological QOL (pseudo-R2 = 0.21%, P < .001), confirming the distinctiveness of PGD and MDD symptoms. CES-D scores mediated 40.7% of the time vs PG-13 score relationship, whereas PG-13 scores mediated 78.2% of the time vs CES-D score relationship with a better model fit, indicating that PG-13 scores assessed earlier mediated caregivers' current depressive status rather than vice versa. CONCLUSIONS:PGD and MDD are distinct constructs, and PGD precedes onset of MDD. Clinicians should distinguish between these two disorders and address bereaved caregivers' PGD to reduce PGD-associated distress and morbidity and to prevent MDD onset, thereby improving their QOL.

背景与目标：

BACKGROUND & AIMS: :We report a case of multiple aseptic splenic abscesses occurring in a woman with Crohn's disease for three years. All microbiological samples were negative. The diagnosis was suspected on abdominal echography and CT scan and confirmed on histologic examination of the splenectomy specimen. The evolution was marked by recurrence of fever and inflammatory syndrome, associated to transitory morphological abnormalities of the accessory spleen. Aseptic splenic abscesses recurrence was suspected. This case allows us to consider aseptic splenic abscesses as an extra-intestinal manifestation and not as a splenic localisation of Crohn's disease.

背景与目标： : 我们报告了一名患有克罗恩氏病的妇女三年发生的多发性无菌性脾脓肿的病例。所有微生物样本均为阴性。在腹部回声造影和ct扫描中怀疑诊断，并在脾切除术标本的组织学检查中证实。这种演变的特征是发热和炎症综合征的复发，与副脾的暂时性形态异常有关。怀疑无菌性脾脓肿复发。这种情况使我们能够将无菌性脾脓肿视为肠外表现，而不是克罗恩氏病的脾脏定位。

BACKGROUND & AIMS: PURPOSE:To report a case of presumed infective meningoencephalitis complicated by bilateral optic neuritis. METHODS:Interventional case report. RESULTS:A 7-year-old Pakistani girl presented with fever and multiple right-sided focal seizures. Despite empirical treatment with antibiotic, anti-viral and anti-tuberculous therapy for presumed infective meningoencephalitis, she further deteriorated, developing altered consciousness, hemiplegia and severe, bilateral optic neuritis. No infectious agent could be identified. Following the addition of high dose systemic corticosteroid therapy, her optic nerve function in both eyes began to recover. At 3-month follow-up, the hemiplegia had completely resolved, and visual acuity was 6/6 bilaterally with normal pupillary responses. CONCLUSIONS:This case demonstrates that meningoencephalitis of presumed infective origin may be complicated by acute, severe, bilateral optic neuritis, the latter often mediating profound visual loss. In the setting of rapidly deteriorating vision, aggressive corticosteroid treatment, with antimicrobial cover, albeit unproven, remains the mainstay of treatment.

背景与目标：

BACKGROUND & AIMS: :Primary Sjögren's syndrome (PSS) is an autoimmune disease of the exocrine glands that is presented with progressive ocular and oral dryness, parotid enlargement and often with systemic (extraglandular) manifestations. In patients with PSS the risk of development of non-Hodgkin's lymphoma (NHL) is 44-fold compared to healthy population. The risk is associated with certain characteristics of the disease's course: recurrent changes in the parotid glands, lymph node enlargement, skin vasculitis, peripheral neuropathy, anemia and lymphopenia. According to the morphologic and phenotypic characteristics, B-cell low-grade lymphomas prevail. This communication presents a 65-year-old woman with PSS who developed a follicular type B-cell NHL 21 years after the autoimmune disease had been diagnosed. The analysis of our case and the literature review summarize the characteristics of the course of PSS, histologic variants, and evolution and prognosis of NHL in this kind of patients.

背景与目标： : 原发性干燥综合征 (PSS) 是外分泌腺的一种自身免疫性疾病，表现为进行性眼和口腔干燥，腮腺肿大，通常具有全身 (腺外) 表现。与健康人群相比，PSS患者发生非霍奇金淋巴瘤 (NHL) 的风险是44倍。风险与疾病过程的某些特征有关: 腮腺的反复变化，淋巴结肿大，皮肤血管炎，周围神经病变，贫血和淋巴细胞减少。根据形态学和表型特征，以b细胞低度淋巴瘤为主。本通讯介绍了一名65岁的PSS妇女，该妇女在诊断出自身免疫性疾病21年后发展为滤泡型b细胞NHL。本例的分析和文献综述总结了此类患者PSS的病程特征，组织学变异以及NHL的演变和预后。

BACKGROUND & AIMS: :Although death has been frequently discussed in health communication, there has been a lack of research on coping with loss. Nevertheless, there are many websites and social network sites that offer suggestions to people as to how to cope with loss, including sites for support, sharing of experiences, and expressing grief. This article provides a theoretical understanding of grief by considering it as an emotional experience in terms of how it is expressed, its consequences, and the confrontation between the offline and online grief experience.

背景与目标： : 尽管在健康交流中经常讨论死亡，但缺乏应对损失的研究。然而，有许多网站和社交网站向人们提供如何应对损失的建议，包括支持、分享经验和表达悲伤的网站。本文通过将悲伤视为一种情感体验，从表达方式，后果以及离线和在线悲伤体验之间的对抗来提供对悲伤的理论理解。

BACKGROUND & AIMS: :Hirschsprung's disease (HD) is an intestinal malformation caused by the innate absence of ganglion cells in the neural plexus of the colorectal wall, and is most common in male infants. It is rare in adult, and is usually left-sided. Herein we reported based on the CARE guidelines a case of a 47-year-old adult female suffering from "right-sided" HD complicated by refractory hypertension and cough. The patient with a history of cesarean section and with digestive unfitness (abdominal pain, distention, and constipation) only since 20 years old had recurrence of HD after initial surgery due to the incomplete removal of the HD-affected bowel based on a diagnosis of "chronic ileus", leading to the relapse of the digestive symptoms and the emergence of some intractable circulatory and respiratory complications which could be hardly controlled by conservative treatment. During the long interval before coming to our department for help, she had been re-hospitalized for several times with various misdiagnoses and supplied merely with symptomatic treatment which could only achieve temporary symptomatic relief. At her admission to our department, the imaging examinations strongly indicated recurrent HD which was further supported by pathological examinations, and right hemi-colectomy was performed to remove the remnant aganglionic intestinal segment. Intraoperative and postoperative pathology supported the completeness of the definitive resection. Post-operation, the patient's bowel motility significantly improved, and interestingly, the complications disappeared. For adult patients with long-term constipation combined with cough and hypertension, rare diseases like HD which requires definite surgery and which could be "right-sided" should not be overlooked. It is vital to diagnose and cure HD patients in childhood. Through the comparison of the two surgeries, it is noteworthy that for diagnosed HD, sufficient removal of the non-functional intestine confirmed by intraoperative pathology is essential.

背景与目标： : Hirschsprung病 (HD) 是由于结肠直肠壁神经丛中神经节细胞先天缺失而引起的肠道畸形，最常见于男婴。在成人中很少见，通常为左侧。在此，我们根据护理指南报告了一例47岁的成年女性患有 “右侧” HD并伴有难治性高血压和咳嗽的病例。自20岁起才有剖宫产史且消化功能不健康 (腹痛，扩张和便秘) 的患者，由于诊断为 “慢性肠梗阻”，HD受影响的肠道未完全切除，因此在初次手术后复发了HD。导致消化系统症状复发，并出现一些顽固性循环和呼吸系统并发症，保守治疗难以控制。在来我们部门寻求帮助之前的很长一段时间内，她因各种误诊而再次住院了几次，仅提供对症治疗，只能暂时缓解症状。在她入院时，影像学检查强烈提示复发性HD，并得到病理检查的进一步支持，并进行了右半结肠切除术以去除残留的神经节肠段。术中和术后病理支持确定性切除的完整性。术后，患者的肠蠕动明显改善，有趣的是，并发症消失了。对于长期便秘合并咳嗽和高血压的成人患者，HD等罕见疾病需要明确手术且可能 “右侧” 的疾病不容忽视。诊断和治疗儿童时期的HD患者至关重要。通过两种手术的比较，值得注意的是，对于确诊的HD，术中病理证实的无功能肠的充分切除至关重要。

BACKGROUND & AIMS: BACKGROUND:Right ventricular (RV) dysfunction plays an important role in chronic heart failure (CHF). We evaluated the echocardiographic determinants of 1-year all-cause mortality in CHF patients with clinically relevant functional tricuspid regurgitation (TR). METHODS AND RESULTS:A total of 101 consecutive CHF patients (mean age 74 ± 10 years, 53% male) with moderate or severe functional TR were enrolled. Each patient underwent at least 2 echocardiography examinations in an interval of >6 months. Clinical follow-up was made after a median of 305 (interquartile range 164-365) days after the last echocardiography. The primary end point was all-cause mortality. Forty-two patients (42%) died during follow-up. Baseline right atrial (RA) area, TR volume increase and RV enlargement over time were significantly higher in nonsurvivors than survivors (all P < .05). Compared to baseline levels, systolic pulmonary artery pressure (sPAP) was significantly reduced in nonsurvivors during follow-up echocardiography (54 ± 19 vs 49 ± 21 mm Hg; P = .010), but significantly increased in survivors (48 ± 17 vs 54 ± 17 mm Hg; P = .001). Multivariable survival analysis suggested that baseline RA area ≥27 cm2 (hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.21-4.80; P = .013), follow-up TR proximal isovelocity surface area regurgitant volume increase ≥15 mL (HR 2.27, 95% CI 1.20-4.31; P = .012), RV middle diameter increase ≥10 mm (HR 2.38, 95% CI 1.10-5.11; P = .027), and sPAP reduction ≥10 mm Hg (HR 3.04, 95% CI 1.51-6.13; P = .002) were determinants of 1-year all-cause mortality after the last echocardiography. Patients with 2 or 3 of these determinants were faced with significantly increased 1-year mortality (88% or 100%). CONCLUSIONS:Dynamic RV morphologic and functional changes during serial echocardiography are associated with significantly increased mortality risk in CHF patients with moderate or severe functional TR.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVE:To assess the effect of daptomycin compared with vancomycin on the clinical and economic outcomes in patients with complicated skin and skin structure infections. DESIGN:Prospective, open-label study. SETTING:Level 1 trauma center in Detroit, Michigan. PATIENTS:Fifty-three adult patients with complicated skin and skin structure infections at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection who were treated with daptomycin and a matched cohort of 212 patients treated with vancomycin. INTERVENTION:Patients in the prospective arm received intravenous daptomycin 4 mg/kg every 24 hours for at least 3 days but not more than 14 days. Historical controls received at least 3 days of vancomycin dosed to achieve trough concentrations of 5-20 microg/ml. MEASUREMENTS AND MAIN RESULTS:Outcomes evaluated included blinded assessments of clinical resolution, duration of therapy, and costs. The most common diagnoses were cellulitis (31%), abscess (22%), and both cellulitis with abscess (37%). Microbiology differed significantly between groups, with S. aureus found in 27 patients (51%) in the daptomycin group and 167 patients (79%) in the vancomycin group and MRSA in 22 (42%) and 159 (75%), respectively (p<0.001). The proportions of patients with clinical improvement or resolution of their infections on days 3 and 5 were 90% versus 70% and 98% versus 81% in the daptomycin versus vancomycin groups, respectively (p<0.01 for both comparisons), and 100% at the end of therapy in both groups. Among patients with complete resolution of their infections (41 patients [77%] with daptomycin vs 89 patients [42%] with vancomycin, p<0.05), median duration of intravenous therapy was 4 and 7 days, respectively, (p<0.001), and hospital costs were $5027 and $7552 (p<0.001). CONCLUSIONS:Patients receiving daptomycin achieved more rapid resolution of symptoms and clinical cure and had a decreased duration of inpatient therapy compared with those receiving vancomycin. This study suggests that daptomycin is a cost-effective alternative to vancomycin for complicated skin and skin structure infections.

背景与目标：

BACKGROUND & AIMS: :The elbow is a key link in the function of the upper extremity and therefore, is subject to various stresses and strains. These stresses may be in the form of a single macrotrauma or repetitive microtrauma with each having its effect on the architecture of the elbow. In dealing with athletes with elbow disorders, one is faced with the challenge of maintaining mobility while achieving maximal stability. Therefore, what has been proposed are treatment formulas for some of the more common elbow fractures that affect the athletic population, which the author has found to be quite useful in achieving these goals.

背景与目标： : 肘部是上肢功能的关键环节，因此承受各种应力和应变。这些应力可以是单个宏观创伤或重复性微创伤的形式，每种应力都对肘部的结构产生影响。在与患有肘部疾病的运动员打交道时，人们面临着在保持运动能力的同时实现最大稳定性的挑战。因此，已经提出了一些影响运动人群的较常见的肘部骨折的治疗公式，作者发现这对于实现这些目标非常有用。

BACKGROUND & AIMS: AIM:Postoperative drains have historically been used for the prevention and early detection of intra-abdominal collections. However, current evidence suggests that prophylactic drain placement following colorectal surgery has no significant clinical benefit. This is reflected in the enhanced recovery after surgery (ERAS) guidelines, which recommend against their routine use. The Ileus Management International study found more than one-third of participating centres across the world routinely used drains in the majority of colorectal resections. The aim of the present study is to audit international compliance with ERAS guidelines regarding the use of postoperative drains in colorectal surgery. METHOD:This prospective, multicentre audit will be conducted via the student- and trainee-led EuroSurg Collaborative network across Europe, South Africa and Australasia. Data will be collected on consecutive patients undergoing elective and emergency colorectal surgery with 30-day follow-up. This will include any colorectal resection, formation of colostomy/ileostomy and reversal of stoma. The primary end-point will be adherence to ERAS guidelines for intra-abdominal drain placement. Secondary outcomes will include the following: time to diagnosis of intra-abdominal postoperative collections; output and time to removal of drains; and 30-day postoperative complications defined by the Clavien-Dindo classification. CONCLUSION:This protocol describes the methodology for the first international audit of intra-abdominal drain placement after colorectal surgery. The study will be conducted across a large collaborative network with quality assurance and data validation strategies. This will provide a clear understanding of current practice and novel evidence regarding the efficacy and safety of intra-abdominal drain placement in colorectal surgical patients.

背景与目标：

BACKGROUND & AIMS: :Streptococcus pneumoniae endocarditis is most commonly associated with pneumonia. It is relatively uncommon disease but its severity makes it clinically relevant. We present a case and review of sinusitis complicated by both pneumococcal endocarditis and cavernous sinus thrombosis. Both endocarditis and dural sinus thrombosis are known complications of facial infections. To our knowledge, this is the first reported case of both S. pneumoniae endocarditis and dural sinus thrombosis complicating sinusitis. A case report and review of the literature is presented.

背景与目标： : 肺炎链球菌和心内膜炎是最常见的肺炎。这是相对罕见的疾病，但其严重程度使其具有临床相关性。我们介绍了一例并回顾了并发肺炎球菌性心内膜炎和海绵窦血栓形成的鼻窦炎。心内膜炎和硬脑膜窦血栓形成都是面部感染的已知并发症。据我们所知，这是第一例报道的肺炎链球菌心内膜炎和硬脑膜窦血栓形成并发鼻窦炎的病例。提出了病例报告和文献综述。