• 【胎儿和母体QRS复合体重合对胎儿心率可靠性的影响。】 复制标题 收藏 收藏
    DOI:10.1007/s11517-006-0054-0 复制DOI
    作者列表:Matonia A,Jezewski J,Kupka T,Horoba K,Wrobel J,Gacek A
    BACKGROUND & AIMS: :Bioelectrical fetal heart activity being recorded from maternal abdominal surface contains more information than mechanical heart activity measurement based on the Doppler ultrasound signals. However, it requires extraction of fetal electrocardiogram from abdominal signals where the maternal electrocardiogram is dominant. The simplest technique for maternal component suppression is a blanking procedure, which relies upon the replacement of maternal QRS complexes by isoline values. Although, in case of coincidence of fetal and maternal QRS complexes, it causes a loss of information on fetal heart activity. Its influence on determination of fetal heart rate and the variability analysis depends on the sensitivity of the heart-beat detector used. The sensitivity is defined as an ability to detect the incomplete fetal QRS complex. The aim of this work was to evaluate the influence of the maternal electrocardiogram suppression method used on the reliability of FHR signal being calculated.
    背景与目标: : 从母体腹部表面记录的生物电胎儿心脏活动比基于多普勒超声信号的机械心脏活动测量包含更多信息。但是,它需要从母体心电图占主导地位的腹部信号中提取胎儿心电图。抑制母体成分的最简单技术是消隐程序,该程序依赖于用等值线值代替母体QRS复合物。尽管在胎儿和母体QRS复合物重合的情况下,它会导致有关胎儿心脏活动的信息丢失。它对确定胎儿心率和变异性分析的影响取决于所使用的心跳检测器的灵敏度。敏感性定义为检测不完整胎儿QRS复合物的能力。这项工作的目的是评估所使用的母体心电图抑制方法对所计算的FHR信号可靠性的影响。
  • 【克罗恩病的Interleukin-12和Th1免疫反应: 发病相关性和治疗意义。】 复制标题 收藏 收藏
    DOI:10.3748/wjg.v12.i35.5606 复制DOI
    作者列表:Peluso I,Pallone F,Monteleone G
    BACKGROUND & AIMS: :Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory disorders of the gastrointestinal tract that share clinical and pathological characteristics. The most accredited hypothesis is that both CD and UC result from a deregulated mucosal immune response to normal constituents of the gut microflora. Evidence, however, indicates that the main pathological processes in these two diseases are distinct. In CD, the tissue-damaging inflammatory reaction is driven by activated type 1 helper T-cell (Th1), whereas a humoral response predominates in UC. Consistently, a marked accumulation of macrophages making interleukin (IL)-12, the major Th1-inducing factor, is seen in CD but not in UC mucosa. Preliminary studies also indicate that administration of a monoclonal antibody blocking the IL-12/p40 subunit can be useful to induce and maintain clinical remission in CD patients. Notably, the recently described IL-23 shares the p40 subunit with IL-12, raising the possibility that the clinical benefit of the anti-IL-12/p40 antibody in CD may also be due to the neutralization of IL-23 activity. This review summarizes the current information on the expression and functional role of IL-12 and IL-12-associated signaling pathways both in patients with CD and experimental models of colitis, thus emphasizing major differences between IL-12 and IL-23 activity on the development of intestinal inflammation.
    背景与目标: 克罗恩病 (CD) 和溃疡性结肠炎 (UC) 是胃肠道的慢性炎症性疾病,具有共同的临床和病理特征。最受认可的假设是,CD和UC都是由于对肠道微生物群落正常成分的粘膜免疫反应失调所致。然而,有证据表明,这两种疾病的主要病理过程是不同的。在CD中,破坏组织的炎症反应是由激活的1型辅助T细胞 (Th1) 驱动的,而在UC中,体液反应占主导地位。一致地,在CD中观察到产生主要Th1-inducing因子白介素 (IL)-12的巨噬细胞的明显积累,但在UC粘膜中未见。初步研究还表明,施用阻断IL-12/p40亚基的单克隆抗体可用于诱导和维持CD患者的临床缓解。值得注意的是,最近描述的IL-23与IL-12共享p40亚基,这增加了CD中anti-IL-12/p40抗体的临床益处也可能归因于IL-23活性的中和的可能性。这篇综述总结了有关CD患者和结肠炎实验模型中IL-12和IL-12-associated信号通路的表达和功能作用的最新信息,从而强调了IL-12和IL-23活性在肠道炎症发展中的主要差异。
  • 【具有局部视网膜功能障碍的CRB1杂合子: 对leber先天性黑蒙的基因检测的意义。】 复制标题 收藏 收藏
    DOI:10.1167/iovs.05-1637 复制DOI
    作者列表:Yzer S,Fishman GA,Racine J,Al-Zuhaibi S,Chakor H,Dorfman A,Szlyk J,Lachapelle P,van den Born LI,Allikmets R,Lopez I,Cremers FP,Koenekoop RK
    BACKGROUND & AIMS: PURPOSE:To test human CRB1 heterozygotes for possible clinical or functional retinal changes and to evaluate whether a patient with Leber congenital amaurosis (LCA) with CRB1 mutations not consistent with previously described CRB1 phenotypes carried a modifier allele in another LCA gene. METHODS:Seven unrelated heterozygous carriers of CRB1 mutations underwent phenotyping by full eye examinations (indirect ophthalmoscopy and slit lamp biomicroscopy) and functional testing (standard full-field electroretinography [ERG] and multifocal ERG). For genotyping of the LCA patients and their parents, denaturing high-performance liquid chromatography (dHPLC) analyses were performed, followed by sequence analysis of CRB1, followed by sequence analysis of the AIPL1 and CRX genes to identify a putative modifier effect in a patient with an atypical CRB1 phenotype. RESULTS:Reduced full-field ERG b-wave amplitudes were observed with scotopic -2 dB flash (140 microV; P < 0.05), normal full-field cone ERGs, and significant regional retinal dysfunction on mfERG in five of seven carriers of CRB1 mutations. A known AIPL1 mutation (p. R302L) was identified as a potential modifier allele in a patient with LCA carrying two CRB1 mutations and with a prominent maculopathy. CONCLUSIONS:In human heterozygotes of CRB1 mutations (parents of offspring with LCA), distinctive regional retinal dysfunctions were found by multifocal ERG measurements that were consistent with the focal histologic abnormalities reported for the two CRB1 knockout mice models. This phenotypic finding may identify CRB1 carriers and point to the causal gene defect in affected LCA offspring, significantly facilitating the molecular diagnostic process. Evidence suggests a modifier allele in AIPL1 in a patient with LCA with prominent atrophic macular lesions and homozygous defects in CRB1.
    背景与目标:
  • 【MRI引导的阿尔茨海默病内侧颞叶血流的SPECT测量。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Julin P,Lindqvist J,Svensson L,Slomka P,Wahlund LO
    BACKGROUND & AIMS: UNLABELLED:In this study, we assessed the accuracy and reliability of MRI-guided SPECT measurements of medial temporal lobe blood flow in Alzheimer's disease (AD).

    METHODS:Interactively aligned three-dimensional MP-RAGE MRI and 99mTc-HMPAO SPECT images were used for MRI-guided measurement of medial temporal lobe CBF in eight control subjects and eight patients with probable AD. Intraoperator reliability was assessed by repeated alignment and measurement by one experienced operator. Accuracy was assessed by examining two subjects with fiducial markers.

    RESULTS:The alignment error was less than 1 SPECT pixel size (3.5 mm) and the coefficient of variation in repeated measures of medial temporal-to-cerebellar CBF ratios was 3.2%. The difference in mean medial temporal-to-cerebellar CBF ratios between eight control subjects and eight AD patients was 12%. Also by using three-dimensional seed-grow defined healthy brain reference regions, there were significant differences between control subjects and AD patients in medial temporal blood flow. Furthermore, the volumes of the MRI-defined medial temporal ROIs were smaller in the AD patients. The best separation between AD patients and control subjects was achieved by combining MRI measurements of atrophy and SPECT measurements of CBF.

    CONCLUSION:These data show that the accuracy and reliability of MRI-guided SPECT measurements of medial temporal CBF clearly allow the detection of changes in AD. Also, a direct comparison of structural and functional changes is possible by this methodology, which might improve the early diagnosis of AD.

    背景与目标: 未标记 : 在这项研究中,我们评估了MRI引导的SPECT测量阿尔茨海默氏病 (AD) 内侧颞叶血流的准确性和可靠性。
    方法 : 交互式对齐的三维MP-RAGE MRI和99mTc-HMPAO SPECT图像用于MRI引导的8名对照受试者和8名可能患有AD的患者的内侧颞叶CBF测量。一位经验丰富的操作员通过重复对准和测量来评估操作员内部的可靠性。通过检查两个具有基准标记的受试者来评估准确性。
    结果 : 对齐误差小于1 SPECT像素大小 (3.5毫米),并且重复测量的变异系数内侧颞-小脑CBF比3.2%。12% 了八名对照受试者和八名AD患者之间平均内侧颞与小脑CBF比率的差异。同样,通过使用三维种子生长定义的健康大脑参考区域,对照组和AD患者在内侧颞血流方面存在显着差异。此外,在AD患者中,MRI定义的内侧颞roi的体积较小。通过结合萎缩的MRI测量和CBF的SPECT测量,可以实现AD患者与对照组之间的最佳分离。
    结论 : 这些数据表明,MRI引导的内侧颞CBF SPECT测量的准确性和可靠性显然可以检测AD的变化。此外,通过这种方法可以直接比较结构和功能变化,这可能会改善AD的早期诊断。
  • 【氯氮平治疗帕金森氏病左旋多巴诱发的精神病: 回顾性研究。】 复制标题 收藏 收藏
    DOI:10.1177/089198879701000205 复制DOI
    作者列表:Widman LP,Burke WJ,Pfeiffer RF,McArthur-Campbell D
    BACKGROUND & AIMS: Levodopa-induced psychosis can complicate the treatment of Parkinson's disease (PD). In this retrospective, uncontrolled report, we describe our experience treating PD-related psychosis with clozapine, emphasizing those patients treated for longer than 1 year. Twenty-seven patients were treated, 14 for longer than 1 year. Most patients showed a rapid improvement from baseline within 1 month using the Clinical Global Impression and Global Psychosis Rating Scores. Five patients discontinued the drug due to side effects, but only two patients reported side effects after 6 months of treatment. Clozapine appears to be effective in treating PD related psychotic symptoms while not interfering with motor function.

    背景与目标: 左旋多巴引起的精神病会使帕金森氏病 (PD) 的治疗复杂化。在这份回顾性,不受控制的报告中,我们描述了我们用氯氮平治疗PD相关精神病的经验,强调了那些治疗时间超过1年的患者。27例患者接受了治疗,其中14例超过1年。使用临床总体印象和总体精神病评分,大多数患者在1个月内从基线显示出快速改善。五名患者因副作用而停药,但只有两名患者在治疗6个月后报告副作用。氯氮平似乎可有效治疗PD相关的精神病性症状,同时不干扰运动功能。
  • 【在其他健康的分枝杆菌疾病患者中发现新的STAT1等位基因。】 复制标题 收藏 收藏
    DOI:10.1371/journal.pgen.0020131 复制DOI
    作者列表:
    BACKGROUND & AIMS: :The transcription factor signal transducer and activator of transcription-1 (STAT1) plays a key role in immunity against mycobacterial and viral infections. Here, we characterize three human STAT1 germline alleles from otherwise healthy patients with mycobacterial disease. The previously reported L706S, like the novel Q463H and E320Q alleles, are intrinsically deleterious for both interferon gamma (IFNG)-induced gamma-activating factor-mediated immunity and interferon alpha (IFNA)-induced interferon-stimulated genes factor 3-mediated immunity, as shown in STAT1-deficient cells transfected with the corresponding alleles. Their phenotypic effects are however mediated by different molecular mechanisms, L706S affecting STAT1 phosphorylation and Q463H and E320Q affecting STAT1 DNA-binding activity. Heterozygous patients display specifically impaired IFNG-induced gamma-activating factor-mediated immunity, resulting in susceptibility to mycobacteria. Indeed, IFNA-induced interferon-stimulated genes factor 3-mediated immunity is not affected, and these patients are not particularly susceptible to viral disease, unlike patients homozygous for other, equally deleterious STAT1 mutations recessive for both phenotypes. The three STAT1 alleles are therefore dominant for IFNG-mediated antimycobacterial immunity but recessive for IFNA-mediated antiviral immunity at the cellular and clinical levels. These STAT1 alleles define two forms of dominant STAT1 deficiency, depending on whether the mutations impair STAT1 phosphorylation or DNA binding.
    背景与目标: 转录因子信号转导和转录激活因子-1 (STAT1) 在抵抗分枝杆菌和病毒感染的免疫中起关键作用。在这里,我们描述了来自其他健康的分枝杆菌疾病患者的三个人类STAT1种系等位基因。先前报道的L706S,如新型Q463H和E320Q等位基因,对干扰素 γ (IFNG) 诱导的 γ 激活因子介导的免疫和干扰素 α (IFNA) 诱导的干扰素刺激基因因子3介导的免疫具有内在的有害作用,如用相应等位基因转染的STAT1-deficient细胞所示。然而,它们的表型效应是由不同的分子机制介导的,L706S影响STAT1磷酸化,Q463H和E320Q影响STAT1 DNA结合活性。杂合子患者表现出特异性受损的IFNG诱导的 γ 激活因子介导的免疫力,导致对分枝杆菌的敏感性。实际上,IFNA诱导的干扰素刺激基因因子3介导的免疫不受影响,并且这些患者对病毒性疾病并不特别敏感,这与其他纯合的患者不同,同样有害的STAT1突变对两种表型均隐性。因此,三个STAT1等位基因在IFNG介导的抗分枝杆菌免疫中占主导地位,但在细胞和临床水平上对IFNA介导的抗病毒免疫具有隐性。这些STAT1等位基因定义了两种形式的显性STAT1缺陷,具体取决于突变是否损害STAT1磷酸化或DNA结合。
  • 【舒张期心力衰竭中睡眠呼吸障碍的患病率。】 复制标题 收藏 收藏
    DOI:10.1378/chest.111.6.1488 复制DOI
    作者列表:Chan J,Sanderson J,Chan W,Lai C,Choy D,Ho A,Leung R
    BACKGROUND & AIMS: OBJECTIVE:Sleep-disordered breathing (SDB) is common in congestive heart failure. While isolated diastolic heart failure (DHF) accounts for up to a third of all cases of congestive heart failure, the prevalence of SDB in DHF is unknown. We aim to determine the prevalence and characteristics of SDB in a group of patients with symptomatic DHF.

    METHODS:Twenty subjects with symptomatic DHF (New York Heart Association class II or III) and isolated diastolic dysfunction on echocardiography were assessed with lung function tests, modified sleep and health questionnaire, and overnight polysomnography. Significant SDB was defined as an apnea/hypopnea index (AHI) > 10.

    RESULTS:Thirteen female and seven male subjects (mean age, 65+/-6.0 years; mean body mass index (BMI), 28+/-3.2) were evaluated, of whom 17 (85%) had a diagnosis of hypertension. Overall sleep quality was poor, with fragmentation and frequent arousals associated with respiratory events. Fifty-five percent of the patients had significant SDB, mainly obstructive apneas. BMI and the prevalence of hypertension were similar in patients with and without SDB. The deceleration time, an index of diastolic dysfunction, was more prolonged in the group with SDB (236+/-40 ms vs 282+/-31 ms; p<0.05). As a group, a lower minimum percentage arterial oxygen saturation during sleep, but not the AHI was associated with more severe degree of diastolic dysfunction on echocardiogram, including a lower ratio between the early peak transmittal flow velocity and the late peak atrial systolic velocity (rho=0.57; p<0.05) and a prolonged isovolumic relaxation time (rho=-0.54; p<0.05).

    CONCLUSIONS:SDB is common in patients with DHF. Patients with DHF and SDB may be associated with worse diastolic dysfunction than those without SDB, although a causal relationship remains to be established.

    背景与目标: 目的 : 睡眠呼吸障碍 (SDB) 在充血性心力衰竭中很常见。虽然孤立的舒张性心力衰竭 (DHF) 占所有充血性心力衰竭病例的三分之一,但DHF中SDB的患病率尚不清楚。我们旨在确定一组有症状的DHF患者中SDB的患病率和特征。
    方法 : 通过肺功能测试,改良的睡眠和健康问卷以及过夜多导睡眠图评估了20名有症状的DHF (纽约心脏协会II或III级) 和超声心动图孤立的舒张功能障碍的受试者。显著的SDB定义为呼吸暂停/呼吸不足指数 (AHI)> 10。
    结果 : 13名女性和7名男性受试者 (平均年龄65 +/-6.0岁; 平均体重指数 (BMI),评估了28/-3.2),其中17 (85%) 诊断为高血压。总体睡眠质量较差,与呼吸事件相关的碎片和频繁唤醒。5% 的患者有明显的SDB,主要是阻塞性呼吸暂停。有或没有SDB的患者的BMI和高血压患病率相似。SDB组的减速时间 (舒张功能障碍的指标) 更长 (236/-40 ms vs 282/-31 ms; p<0.05)。作为一组,睡眠期间较低的最低动脉血氧饱和度百分比,但AHI与超声心动图更严重的舒张功能障碍相关,包括早期传播峰值流速与晚期心房收缩峰值流速之间的比率较低 (rho = 0.57; p<0.05) 和延长的等容松弛时间 (rho =-0.54; p<0.05)。
    结论 :SDB在DHF患者中很常见。DHF和SDB的患者可能比没有SDB的患者舒张功能障碍更差,尽管因果关系尚待确定。
  • 【疾病机制: 2型糖尿病的肝脂肪变性-发病机制和临床意义。】 复制标题 收藏 收藏
    DOI:10.1038/ncpendmet0190 复制DOI
    作者列表:Roden M
    BACKGROUND & AIMS: :Hepatic steatosis is defined by an increased content of hepatocellular lipids (HCLs) and is frequently observed in insulin-resistant states including type 2 diabetes mellitus. A dietary excess of saturated fat contributes significantly to HCL accumulation. Elevated HCL levels mainly account for hepatic insulin resistance, which is probably mediated by partitioning of free fatty acids to the liver (fat overflow) and by an imbalance of adipocytokines (decreased adiponectin and/or increased proinflammatory cytokines). Both free fatty acids and adipocytokines activate inflammatory pathways that include protein kinase C, the transcription factor nuclear factor kappaB, and c-Jun N-terminal kinase 1 and can thereby accelerate the progression of hepatic steatosis to nonalcoholic steatohepatitis and cirrhosis. Proton magnetic resonance spectroscopy has made it possible to quantify HCL concentrations and to detect even small changes in these concentrations in clinical settings. Moderately hypocaloric, fat-reduced diets can decrease HCL levels by approximately 40-80% in parallel with loss of up to 8% of body weight. Treatment with thiazolidinediones (e.g. pioglitazone and rosiglitazone) reduces HCL levels by 30-50% by modulating insulin sensitivity and endocrine function of adipose tissue in type 2 diabetes. Metformin improves hepatic insulin action without affecting HCL levels, whereas insulin infusion for 67 h increases HCL levels by approximately 18%; furthermore, HCL levels positively correlate with the insulin dosage in insulin-treated type 2 diabetes. In conclusion, liver fat is a critical determinant of metabolic fluxes and inflammatory processes, thereby representing an important therapeutic target in insulin resistance and type 2 diabetes mellitus.
    背景与目标: : 肝脂肪变性是由肝细胞脂质 (HCLs) 含量增加定义的,在胰岛素抵抗状态 (包括2型糖尿病) 中经常观察到。饮食中过量的饱和脂肪会显着促进HCL的积累。HCL水平升高主要是导致肝胰岛素抵抗的原因,这可能是由游离脂肪酸分配到肝脏 (脂肪溢出) 和脂肪细胞因子失衡 (脂联素减少和/或促炎细胞因子增加) 介导的。游离脂肪酸和脂肪细胞因子都激活炎症途径,包括蛋白激酶C,转录因子核因子kappaB和c 6月N端激酶1,从而可以加速肝脂肪变性向非酒精性脂肪性肝炎和肝硬化的进展。质子磁共振波谱已使量化HCL浓度并在临床环境中检测到这些浓度的微小变化成为可能。中度低热量,减脂饮食可使HCL水平降低约40-80%,同时减少多达8% 的体重。噻唑烷二酮类药物 (例如吡格列酮和罗格列酮) 的治疗通过调节2型糖尿病中脂肪组织的胰岛素敏感性和内分泌功能,将HCL水平降低30-50%。二甲双胍改善肝胰岛素作用而不影响HCL水平,而胰岛素输注67小时可使HCL水平增加约18%; 此外,在胰岛素治疗的2型糖尿病中,HCL水平与胰岛素剂量呈正相关。总之,肝脏脂肪是代谢通量和炎症过程的关键决定因素,因此是胰岛素抵抗和2型糖尿病的重要治疗目标。
  • 【通过微孔过滤测量的外周血中性粒细胞流变学很好地反映了白塞氏病的活动。】 复制标题 收藏 收藏
    DOI:10.1016/s0923-1811(97)00599-9 复制DOI
    作者列表:Iijima S,Otsuka F
    BACKGROUND & AIMS: Activated neutrophils take a long time to pass through a narrow lumen like a micropore, and are supposed to play a deteriorating effect on microcirculation. Although the activation of neutrophils has been demonstrated in Behçet's disease, nobody analyzes the clinical activity of the disease by means of the rheological measure of neutrophils activity. Using a micropore (pore diameter 5 microns) filtration technique, we measured the filtration time of peripheral blood neutrophils, as a rheological measure of their activity, in order to determine the clinical activity of Behçet's disease. Twenty-one patients with Behçet's disease and 14 healthy control individuals were enrolled in the study. Symptoms and signs exhibited in the patients led us to distinguish the Behçet's disease into inactive and active cases. The latter were further differentiated into cases with absent symptoms and with present symptoms. Neutrophil filtration times were 11.5 +/- 4.8 s in the active cases with present symptoms, which were significantly (P < 0.05) larger than those (7.4 +/- 1.9 s) in the active cases with absent symptoms. The latter filtration times were further significantly (P < 0.001) larger than values (3.7 +/- 1.3 s) in the inactive cases and also those (4.8 +/- 1.2 s) in control subjects. Furthermore, increases in the filtration time obtained immediately after the exposure of cells to the chemotactic peptide formyl-methionyl-leucyl-phenylalanine (FMLP10 nM) were significantly (P < 0.01) larger in the active cases with present symptoms than those in the active cases with absent symptoms. The latter were also larger, but not significantly, than those in the inactive cases, and were significantly (P < 0.01) larger than those in control subjects. The present results demonstrate that the micropore filtration method reflects well the rheological activity of neutrophils as well as the clinical status of Behçet's disease. This method is much better than the measurement of O2 production to differentiate between active cases with absent symptoms and inactive patients or even control individuals. Furthermore, it is more sensitive and useful than laboratory data like the CRP value or the number of peripheral blood neutrophils.

    背景与目标: 活化的中性粒细胞需要很长时间才能通过像微孔一样的狭窄管腔,并且应该对微循环起到恶化的作用。尽管在beh ç et病中已经证明了中性粒细胞的激活,但没有人通过中性粒细胞活性的流变学测量来分析该疾病的临床活性。使用微孔 (孔径5微米) 过滤技术,我们测量了外周血中性粒细胞的过滤时间,作为其活性的流变学指标,以确定白塞氏病的临床活性。21名beh ç et病患者和14名健康对照者参加了这项研究。患者表现出的症状和体征使我们将白塞氏病区分为不活跃和活跃的病例。后者进一步分为无症状和现有症状的病例。有症状的活动病例的中性粒细胞过滤时间为11.5 +/- 4.8 s,显著 (P < 0.05) 大于无症状的活动病例的中性粒细胞过滤时间 (7.4 +/- 1.9 s)。后者的过滤时间进一步显著 (P < 0.001) 大于非活性情况下的值 (3.7 +/- 1.3 s),也大于对照受试者中的值 (4.8 +/- 1.2 s)。此外,在细胞暴露于趋化肽甲酰基-甲硫酰基-亮氨酸-苯丙氨酸 (fmlp10nm) 后立即获得的过滤时间的增加在存在症状的活动病例中比在不存在症状的活动病例中显着 (P < 0.01) 大。后者也比不活跃的情况更大,但不显著,并且显著 (P < 0.01) 大于对照组。目前的结果表明,微孔过滤方法很好地反映了嗜中性粒细胞的流变活性以及白塞病的临床状况。此方法比O2产生的测量要好得多,可以区分无症状的活跃病例和不活跃的患者甚至对照组。此外,它比CRP值或外周血中性粒细胞数量等实验室数据更敏感和有用。
  • 【过敏性眼病结膜上皮结构蛋白减少。】 复制标题 收藏 收藏
    DOI:10.1111/j.1398-9995.2006.01207.x 复制DOI
    作者列表:Hughes JL,Lackie PM,Wilson SJ,Church MK,McGill JI
    BACKGROUND & AIMS: AIMS:Allergic eye disease affects up to 20% of the population with varying severity. The conjunctival epithelium plays a key role in allergic eye disease. The purpose of this study was to determine whether the conjunctival epithelium is abnormal in allergic eye disease. METHODS:Conjunctival biopsy samples were taken from patients with seasonal allergic conjunctivitis (SAC) 'in' and 'out of season' and nonatopic control subjects. Specimens were fixed in glycol methacrylate, 2 microm serial sections cut and Image-J used to assess the sites and areas of immuno-staining. RESULTS:E-cadherin, CD44, keratins K5/6, K8, K13, K14, K18 and pan-keratin immuno-staining were all significantly lower in patients 'out of season' compared with normal controls. No structural differences in the epithelium were observed between the two groups. The epithelium of patients 'in season' was thicker and immuno-staining of the above markers similar to controls. CONCLUSIONS:The expression of a wide spectrum of epithelial cell adhesion proteins and cytoskeletal elements is downregulated in the conjunctiva of SAC patients 'out of season' compared with normal controls. We suggest that this could have an important impact on the ability of the epithelium to protect itself against allergen penetration, potentially influencing the development and course of allergic eye disease and offering a novel area for therapeutic control.
    背景与目标:
  • 【内镜经胸交感神经切断术对严重心绞痛心率变异性的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9149(97)00169-0 复制DOI
    作者列表:Tygesen H,Claes G,Drott C,Emanuelsson H,Lomsky M,Lurje L,Rådberg G,Wennerblom B,Wettervik C
    BACKGROUND & AIMS: Endoscopic transthoracic sympathicotomy (ETS) is a recently developed technique to divide sympathetic nerves. ETS has been shown to improve symptoms and reduce ischemia in patients with severe angina pectoris. Low heart rate variability (HRV) in patients with ischemic heart disease carries an adverse prognosis. HRV reflects autonomic response of the heart and a shift in the sympathovagal balance towards parasympathetic dominance could be a marker of improved prognosis. HRV might also be used as an indicator of surgical success in sympathetic heart denervation. Heart rate was recorded in 57 patients before and after ETS. Registration was recorded during controlled respiration in the supine position and at tilt test over 10 minutes and spectral analysis was performed. Twenty-four hour Holter recordings were analyzed in the time domain. During the controlled setting, the high-frequency (HF) component (0.15 to 0.40 Hz) increased significantly whereas the low-frequency (LF) component (0.04 to 0.15 Hz) did not change significantly. The LF/HF ratio at tilt test was reduced from 1.3 to 0.8 (p <0.01). The time-domain analysis showed a significant increase of the mean RR interval (923 to 1,006 ms, p <0.001) and indexes reflecting parasympathetic tone also increased significantly (the root-mean square of difference measured from 24.3 to 29.5 ms, p <0.001 and the proportion of adjacent RR intervals >50% measured from 5.5% to 8.2%, p <0.01), whereas measurements reflecting global HRV did not change. In addition to relief of symptoms and reduced ischemia in severe angina pectoris, ETS caused a shift of sympathovagal balance toward parasympathetic tone. This might explain the anti-ischemic effect and have prognostic implications.

    背景与目标: 内镜经胸交感神经切开术 (ETS) 是最近开发的一种分裂交感神经的技术。ETS已被证明可以改善严重心绞痛患者的症状并减少缺血。缺血性心脏病患者的低心率变异性 (HRV) 具有不利的预后。HRV反映了心脏的自主反应,交感神经平衡向副交感神经优势的转变可能是预后改善的标志。HRV也可以用作交感神经去神经支配手术成功的指标。在ETS前后记录了57例患者的心率。在仰卧位和倾斜测试的控制呼吸过程中记录了10分钟以上的记录,并进行了光谱分析。在时域中分析了24小时Holter记录。在受控设置期间,高频 (HF) 分量 (0.15至0.40Hz) 显着增加,而低频 (LF) 分量 (0.04至0.15Hz) 没有显着变化。倾斜试验时的LF/HF比从1.3降低到0.8 (p <0.01)。时域分析显示,平均RR间隔显着增加 (923至1,006 ms,p <0.001),反映副交感神经张力的指标也显着增加 (从24.3至29.5 ms测量的均方根差异,p <0.001和相邻RR区间的比例> 50% 从5.5% 到8.2% 测量,p <0.01),而反映整体HRV的测量没有变化。除了缓解症状和减少严重心绞痛的缺血外,ETS还导致交感神经平衡向副交感神经张力转移。这可能解释了抗缺血作用并具有预后意义。
  • 【荷兰用英夫利昔单抗治疗克罗恩病指南。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Vermeire S
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【乳糜泻患者的小麦淀粉不耐受。】 复制标题 收藏 收藏
    DOI:10.1016/S0002-8223(97)00156-9 复制DOI
    作者列表:Chartrand LJ,Russo PA,Duhaime AG,Seidman EG
    BACKGROUND & AIMS: OBJECTIVE:Evaluate in patients with celiac disease the tolerance of prolonged consumption of small amounts of gliadin contained in products containing wheat starch.

    DESIGN:Open 1-year trial of the addition of wheat starch to a gluten-free diet in a cohort of adult patients with biopsy-proven celiac disease who had never consumed wheat starch. The control group consisted of patients with celiac disease who tolerated wheat starch.

    SUBJECTS:Seventeen patients with celiac disease and 14 control patients, all diagnosed according to criteria of the European Society of Pediatric Gastroenterology and Nutrition, were recruited from the Canadian Celiac Association and the Quebec Celiac Foundation.

    SETTING:The study was conducted in the outpatient clinic of the Gastroenterology and Nutrition Service of Ste Justine Hospital, Montreal, Quebec, Canada.

    INTERVENTIONS:Patients were asked to consume four to six portions daily of a wheat starch-containing product, mainly bread, for up to 1 year.

    MAIN OUTCOME MEASURES:The gliadin content of the wheat starch product used in this trial was quantified by enzyme-linked immunosorbent assay. Patient outcome measures included symptoms, nutritional parameters (anthropometric data, complete blood count, serum folate and iron levels), and immunologic parameters (antigliadin antibody and antiendomysium antibody titers).

    RESULTS:A quantifiable amount of immunoreactive gliadin (0.75 mg/100 g) was found in the wheat starch. The majority of the patients with celiac disease (11 of 17) who had never consumed wheat starch previously developed symptoms, which resolved within weeks of discontinuing the product. Relapse of skin lesions was seen in two of three patients with coexisting dermatitis herpetiformis. No weight loss or biochemical changes were observed. Despite the presence of symptoms, antigliadin antibody and antiendomysium antibody determinations were not useful to detect the clinical intolerance.

    APPLICATIONS:The innocuousness of the long-term ingestion of "gluten-free" products containing wheat starch is still unproven, and prolonged use of such products by patients with celiac disease cannot be recommended.

    背景与目标: 目标 : 评估乳糜泻患者对含有小麦淀粉的产品中含有的少量麦醇溶蛋白的长期食用的耐受性。
    设计 : 在从未食用过小麦淀粉的活检证实的乳糜泻成年患者队列中,将小麦淀粉添加到无麸质饮食中进行了为期1年的开放试验。对照组由耐受小麦淀粉的乳糜泻患者组成。
    受试者 : 17例乳糜泻患者和14例对照患者,均根据欧洲儿科胃肠病与营养学会的标准进行诊断,是从加拿大乳糜泻协会和魁北克乳糜泻基金会招募的。
    设置 : 该研究是在魁北克蒙特利尔Ste Justine医院胃肠病学和营养服务门诊进行的,加拿大。
    干预措施 : 要求患者每天食用四到六份含小麦淀粉的产品,主要是面包,长达1年。
    主要结果指标 : 通过酶联免疫吸附测定法对该试验中使用的小麦淀粉产品的麦醇溶蛋白含量进行了定量。患者结局指标包括症状,营养参数 (人体测量数据,全血细胞计数,血清叶酸和铁水平) 和免疫学参数 (抗麦醇溶蛋白抗体和抗肌内膜抗体滴度)。
    结果 : 在小麦淀粉中发现可定量的免疫反应性麦醇溶蛋白 (0.75 mg/100g)。以前从未食用过小麦淀粉的大多数乳糜泻患者 (17人中有11人) 出现症状,这些症状在停用该产品后的几周内得到缓解。在三名并存的疱疹样皮炎患者中,有两名发现了皮肤病变的复发。未观察到体重减轻或生化变化。尽管存在症状,但抗麦醇溶蛋白抗体和抗肌内膜抗体的测定对检测临床不耐受没有用。
    应用 : 长期摄入含有小麦淀粉的 “无麸质” 产品的无伤害性仍未得到证实,并且不建议乳糜泻患者长期使用此类产品。
  • 【围产期B组链球菌病发病率的降低-美国,1993-1995。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Centers for Disease Control and Prevention (CDC).
    BACKGROUND & AIMS: :Group B streptococcal (GBS) infections are the leading cause of bacterial disease and death among newborns in the United States and an important cause of morbidity among peripartum women and nonpregnant adults with chronic medical conditions. Disease in infants usually presents as sepsis, pneumonia or meningitis but also may include cellulitis or osteomyelitis. In 1990, GBS infections caused an estimated 7600 serious illnesses and 310 deaths among U.S. infants aged < or = 90 days; infections among infants aged < 7 days (i.e., early-onset disease) accounted for approximately 80% of these illnesses. To determine the incidence of GBS disease during 1993-1995, CDC conducted surveillance for this disease in an aggregate population of 12.5 million persons with 190,000 annual live-born infants. This report summarizes the findings of surveillance in this population, which indicate that a statistically significant decline in the incidence of early-onset GBS disease occurred in some surveillance areas.
    背景与目标: : B组链球菌 (GBS) 感染是美国新生儿细菌性疾病和死亡的主要原因,也是围产期妇女和患有慢性疾病的未怀孕成年人发病的重要原因。婴儿的疾病通常表现为败血症,肺炎或脑膜炎,但也可能包括蜂窝织炎或骨髓炎。1990年,GBS感染在 <或 = 90天的美国婴儿中导致估计7600种严重疾病和310例死亡; <7天的婴儿 (即早发疾病) 感染约占这些疾病的80%。为了确定1993-1995年期间GBS疾病的发生率,CDC对1250万名每年有190,000名活产婴儿的人群进行了该疾病的监测。该报告总结了该人群的监测结果,这表明在某些监测地区,早发性GBS疾病的发病率在统计学上显着下降。
  • 【美国风疹和先天性风疹综合征的流行病学概况,1998-2004: 缺乏地方性传播的证据。】 复制标题 收藏 收藏
    DOI:10.1086/505944 复制DOI
    作者列表:Reef SE,Redd SB,Abernathy E,Zimmerman L,Icenogle JP
    BACKGROUND & AIMS: :In 1969, the United States established its national rubella vaccination program. With the success of the program, 32 years later, reports of rubella reached record low numbers. To assess the achievement of elimination of rubella and congenital rubella syndrome (CRS) in the United States, 7 epidemiological criteria were used. Rubella cases reported to the National Notifiable Diseases Surveillance System from 1998 through 2004 and CRS cases reported to the National Congenital Rubella Syndrome Registry from 1998 through 2004 were analyzed. During 1998-2000, the median number of reported rubella cases was 272, whereas, during 2001-2004, the median number reported was 13. The incidence of rubella decreased significantly, from 0.1/100,000 population in 1998 to 0.005/100,000 population in 2004. Since 2001, 5 infants with CRS have been reported--3 were born in 2001, 1 was born in 2003, and 1 was born in 2004. The epidemiological evidence strongly supports the claim that rubella is no longer endemic in the United States. To prevent future rubella outbreaks and CRS cases, current strategies must be maintained.
    背景与目标: : 1969年,美国建立了国家风疹疫苗接种计划。随着该计划的成功,32年后,风疹的报道达到了历史新低。为了评估在美国消除风疹和先天性风疹综合征 (CRS) 的成就,使用了7个流行病学标准。分析了向国家法定疾病监测系统报告的风疹病例1998年2004年和向国家先天性风疹综合征登记1998年2004年报告的CRS病例。在1998-2000年期间,报告的风疹病例的中位数为272,而在2001-2004年期间,报告的中位数为13。风疹的发病率从0.1/100,000人口1998年下降到0.005/100,000人口2004年。自2001年以来,已报告5例CRS婴儿-3例2001年出生,1例2003年出生,1例2004年出生。流行病学证据强烈支持风疹在美国不再流行的说法。为了防止未来的风疹暴发和CRS病例,必须维持当前的策略。

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