BACKGROUND & AIMS: :Aim: To determine the prognostic value of Glasgow Prognostic Score (GPS) in acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) requiring hospitalization.Methods: Hospital electronic database of 129 patients with AECOPD was retrospectively searched and CRP levels, complete blood count, arterial blood gas (ABG) values and pulmonary function test (PFT) parameters of patients were recorded. Hospital mortality and need for ICU transfer were determined as adverse outcomes from files of cases.Results: 106 of 129 patients were male (82.2%) and rest of them were female (17.8%). GPS 0 was not observed in any patient, GPS 1 was observed in 101 patients, and GPS 2 was observed in 28 patients. The rate of adverse outcomes (ICU/Ex) was significantly increased in the GPS 2 group when compared to the GPS 1 group (X2:7.631, p < 0.01). Logistic regression analysis indicated that pH≤7.35 (p < 0.05, OR: 5.65, CI: 1.35-23.58%) and GPS 2 score (p < 0.05, OR: 5.52, CI: 1.45-20.97%) were independent predictors for adverse outcomes for AECOPD.Conclusion: Our results demonstrate that the GPS may have predictive value for adverse outcomes in patients with AECOPD.

背景与目标： 目的：确定格拉斯哥预后评分（GPS）在需要住院的慢性阻塞性肺疾病（AECOPD）急性加重中的预后价值。方法：回顾性搜索129例AECOPD患者的医院电子数据库，并检索CRP水平，全血细胞计数，记录患者的动脉血气（ABG）值和肺功能测试（PFT）参数。从病例档案中确定医院死亡率和需要ICU转移为不良结果。结果：129例患者中有106例为男性（82.2％），其余为女性（17.8％）。在任何患者中均未观察到GPS 0，在101位患者中观察到GPS 1，在28位患者中观察到GPS 2。与GPS 1组相比，GPS 2组的不良结局发生率（ICU / Ex）显着增加（X2：7.631，p <0.01）。 Logistic回归分析表明pH≤7.35（p <0.05，OR：5.65，CI：1.35-23.58％）和GPS 2评分（p <0.05，OR：5.52，CI：1.45-20.97％）是不良后果的独立预测因子结论：我们的结果表明，GPS可能对AECOPD患者的不良结局具有预测价值。

BACKGROUND & AIMS: INTRODUCTION:Acute exacerbation (AE) is a major cause of disease progression and death in patients with chronic obstructive pulmonary disease (COPD), accounting for majority of medical expenditures. Correct inhalation therapy is effective in preventing AE attacks. However, inappropriate usage of dry powder inhaler, partially due to the unrecovered peak inhalation flow rate (PIFR) after acute exacerbation of COPD (AECOPD), results in increased risk of early treatment failure. Therefore, we designed a multicentre, randomised clinical trial to determine whether PIFR-based optimised inhalation therapy and training on inhaler usage at discharge could effectively reduce early treatment failure events. METHODS AND ANALYSIS:A total of 416 hospitalised patients just recovering from AECOPD will be recruited and equally randomised into the PIFR group and the control group at a 1:1 ratio. The PIFR group will receive additive support before discharge, including choice of PIFR-guided inhaler and education on its usage. PIFR is measured by InCheck DIAL. In comparison, the control group will receive inhalers based on judgement of the respiratory physician. The primary outcome of the study is 30-day treatment failure rate. Other endpoints include PIFR, error rate of inhalation device use, satisfaction with inhalation devices, 30-day mortality, 90-day mortality, symptoms and quality of life of patients, and COPD-related treatment costs. ETHICS AND DISSEMINATION:The trial has been approved by the Ethics Committee of Zhongshan Hospital of Fudan University (B2019-142). Participants will be screened and enrolled from hospitalised patients with AECOPD by clinicians, with no public advertisement for recruitment. After the trial has completed, the results will be reported to the public through conference presentations and peer-reviewed journals. TRIAL REGISTRATION NUMBER:NCT04000958.

背景与目标： 简介：急性加重（AE）是慢性阻塞性肺疾病（COPD）患者疾病进展和死亡的主要原因，占医疗支出的大部分。正确的吸入疗法可有效预防AE发作。但是，干粉吸入器使用不当，部分是由于COPD急性加重（AECOPD）后未恢复峰值吸入流速（PIFR），导致早期治疗失败的风险增加。因此，我们设计了一项多中心随机临床试验，以确定基于PIFR的优化吸入疗法和出院吸入器使用培训是否可以有效减少早期治疗失败事件。
方法与分析：总共416名刚从AECOPD中恢复的住院患者将被招募，并按1：1的比例平均分为PIFR组和对照组。 PIFR组将在出院前获得额外的支持，包括选择PIFR引导的吸入器并对其使用进行教育。 PIFR由InCheck DIAL测量。相比之下，对照组将根据呼吸内科医师的判断接受吸入剂。该研究的主要结果是30天的治疗失败率。其他指标包括PIFR，吸入装置使用的错误率，吸入装置的满意度，30天死亡率，90天死亡率，患者的症状和生活质量以及与COPD相关的治疗费用。
伦理与传播：该试验已得到复旦大学中山医院伦理委员会的批准（B2019-142）。将由临床医生从住院的AECOPD患者中筛选并招募参与者，而不会公开招募广告。试验完成后，结果将通过会议报告和同行评审期刊向公众报告。
试用注册号：NCT04000958。

BACKGROUND & AIMS: :Hospital at home and early discharge schemes for patients experiencing an acute exacerbation of their chronic obstructive pulmonary disease, appear to be an effective and safe option for selected patients and these services have become increasingly common. Here we discuss the evaluation of such schemes including: the rationale for evaluation; aspects of quality which might be considered for evaluation; the role of evaluation frameworks, quantitative and qualitative evaluation and steps in planning an evaluation.

背景与目标： ：对于慢性阻塞性肺疾病急性加重的患者，住院和早期出院计划对于某些患者而言似乎是一种有效而安全的选择，并且这些服务已变得越来越普遍。在这里，我们讨论对此类计划的评估，包括：评估的理由；可以考虑进行评估的质量方面；评估框架，定量和定性评估的作用以及规划评估的步骤。

BACKGROUND & AIMS: BACKGROUND:This study was conducted to compare the effectiveness of noninvasive ventilation (NIV) with pressure support (NIV-PSV) to noninvasive neurally-adjusted ventilatory assist (NIV-NAVA) during COPD exacerbation. METHODS:In this study, 40 subjects with COPD and acute hypercapnic respiratory failure were randomized to receive either NIV-NAVA (n = 20) or NIV-PSV (n = 20) via a critical care ventilator. Subjects' vital parameters, arterial blood gas values, patient-ventilator asynchrony events, and asynchrony index were noted at specific time intervals in both groups. The duration of NIV, rate of NIV failure, and length hospital stay were also recorded for these 2 modes of NIV. RESULTS:NIV-NAVA significantly reduced the total number (median [interquartile range]) of asynchrony events compared to NIV-PSV: 22 (15-32.5) versus 65 (50.75-104.25), respectively, P = .002. Severe asynchrony defined as asynchrony index > 10% was also significantly lower in NIV-NAVA than in NIV-PSV (P < .001). There was no significant difference between the 2 groups regarding improvement in gas exchange and vital parameters. Rate of failure of NIV (P = .73), duration of the requirement of ventilatory support (P = .40), and hospital length of stay (P = .46) were also comparable between the 2 modes of ventilation. CONCLUSIONS:Compared to NIV-PSV, NIV-NAVA was associated with better patient-ventilator synchrony and a reduction in the number of asynchrony events in subjects with an exacerbation of COPD, with similar effects on improvement in gas exchange, duration of NIV, hospital lenght of stay, and rate of NIV failure. (Clinicaltrials.gov registration NCT02912689.).

背景与目标： 背景：本研究旨在比较无创通气（NIV）和压力支持（NIV-PSV）与无创神经调节通气辅助（NIV-NAVA）在COPD急性发作期间的有效性。
方法：在这项研究中，将40名患有COPD和急性高碳酸血症性呼吸衰竭的受试者随机分配通过危重监护呼吸机接受NIV-NAVA（n = 20）或NIV-PSV（n = 20）。在两组中的特定时间间隔记录受试者的生命参数，动脉血气值，患者-呼吸机异步事件和异步指数。还记录了这两种NIV模式的NIV持续时间，NIV失败率和住院时间。
结果：与NIV-PSV相比，NIV-NAVA显着减少了异步事件的总数（中位数[四分位数范围]）：分别为22（15-32.5）和65（50.75-104.25），P = .002。 NIV-NAVA中定义为异步指数> 10％的严重异步也显着低于NIV-PSV（P <.001）。两组之间在气体交换和生命参数改善方面无显着差异。 NIV的失败率（P = .73），需要通气支持的持续时间（P = .40）和住院时间（P = .46）在两种通气模式之间也具有可比性。
结论：与NIV-PSV相比，NIV-NAVA与COPD恶化的患者更好的通气同步性和异步事件次数减少相关，对改善气体交换，NIV持续时间，医院具有相似的作用停留时间和NIV失败率。 （Clinicaltrials.gov注册号为NCT02912689。）。

BACKGROUND & AIMS: :Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system (CNS). MS is thought to be T-cell-mediated, with prior research predominantly focusing on CD4+ T-cells. There is a high prevalence of CNS-specific CD8+ T-cell responses in MS patients and healthy subjects. However, the role of neuroantigen-specific CD8+ T-cells in MS is poorly understood, with the prevalent notion that these may represent pathogenic T-cells. We show here that healthy subjects and MS patients demonstrate similar magnitudes of CD8+ and CD4+ T-cell responses to various antigenic stimuli. Interestingly, CD8+ T-cells specific for CNS autoantigens, but not those specific for control foreign antigens, exhibit immune regulatory ability, suppressing proliferation of CD4+CD25- T-cells when stimulated by their cognate antigen. While CD8+ T-cell-mediated immune suppression is similar between healthy subjects and clinically quiescent treatment-naïve MS patients, it is significantly deficient during acute exacerbation of MS. Of note, the recovery of neuroantigen-specific CD8+ T-cell suppression correlates with disease recovery post-relapse. These studies reveal a novel immune suppressor function for neuroantigen-specific CD8+ T-cells that is clinically relevant in the maintenance of peripheral tolerance and the intrinsic regulation of MS immune pathology.

背景与目标： ：多发性硬化症（MS）是中枢神经系统（CNS）的一种炎症性脱髓鞘疾病。 MS被认为是T细胞介导的，先前的研究主要集中在CD4 T细胞上。在MS患者和健康受试者中，CNS特异性CD8 T细胞反应的发生率很高。然而，人们对神经抗原特异性CD8 T细胞在MS中的作用了解甚少，普遍认为它们可能代表致病性T细胞。我们在这里显示健康的受试者和MS患者表现出相似程度的CD8和CD4 T细胞对各种抗原刺激的反应。有趣的是，对CNS自身抗原具有特异性的CD8 T细胞（而非对控制外源抗原具有特异性的CD8 T细胞）具有免疫调节能力，当受到其同源抗原刺激时抑制CD4 CD25-T细胞的增殖。尽管健康受试者和未经临床治疗的MS患者之间CD8 T细胞介导的免疫抑制作用相似，但在MS急性加重期间，CD8 T细胞介导的免疫抑制作用明显不足。值得注意的是，神经抗原特异性CD8 T细胞抑制的恢复与复发后疾病的恢复相关。这些研究揭示了神经抗原特异性CD8 T细胞的新型免疫抑制功能，在维持外周耐受和MS免疫病理的内在调节方面具有临床意义。

BACKGROUND & AIMS: :The spectrum of the neurological effects of high-altitude exposure can range from high-altitude headache and acute mountain sickness, to the more severe end of the spectrum with high-altitude cerebral edema. In general, patients with known unstable preexisting neurological conditions and those patients with residual neurological deficits from a preexisting neurological condition are discouraged from climbing to high altitudes because of the risk of exacerbation or worsening of symptoms. Although multiple sclerosis exacerbations can be triggered by environmental factors, high-altitude exposure has not been reported as a potential trigger. We are reporting the case of a multiple sclerosis exacerbation presenting in an active duty U.S. Air Force serviceman upon ascending and descending Mt. Fuji within the same day.

背景与目标： ：高海拔暴露对神经系统的影响范围从高海拔头痛和急性高山病到高海拔脑水肿的更为严重的范围。通常，不鼓励患有已知不稳定的先前存在的神经系统疾病的患者和那些因先前存在的神经系统疾病而具有残留神经系统缺陷的患者，因为其有加剧或症状恶化的风险，因此不建议爬升到高海拔地区。尽管环境因素可能触发多发性硬化症恶化，但尚未报道高海拔暴露是潜在的触发因素。我们正在报告一例现役美国空军军人在Mt.Mt.上升和下降时出现多发性硬化症加重的情况。富士在同一天。

BACKGROUND & AIMS: :A 72-year-old woman with a painful left third cranial nerve palsy due to a basilar artery aneurysm situated between the superior cerebellar and posterior cerebral arteries was treated with Guglielmi detachable coils (GDCs). Despite a good initial angiographic result with a small residual neck and improvement in the ocular motility and pain, the patient experienced worsening of the third cranial nerve palsy 15 months later. Cerebral angiography confirmed coil compaction with aneurysmal regrowth. A second endovascular coil embolization resulted in complete obliteration of the aneurysm. The patient experienced complete resolution of the pain and partial resolution of the third cranial nerve palsy. In some patients, a small residual aneurysm neck after endovascular embolization therapy with GDCs can result in delayed aneurysmal regrowth due to coil compaction. Clinical manifestations may herald this dangerous regrowth.

背景与目标： ：一名因小脑上部和后脑动脉之间的基底动脉瘤而导致左第三颅神经麻痹的痛苦的72岁妇女接受了Guglielmi可分离式线圈（GDC）的治疗。尽管最初的血管造影结果良好，残留的颈部很小，并且眼运动和疼痛有所改善，但患者在15个月后出现了第三颅神经麻痹的恶化。脑血管造影证实线圈压实伴动脉瘤再长。第二次血管内线圈栓塞导致动脉瘤完全消失。患者经历了疼痛的完全缓解和第三颅神经麻痹的部分缓解。在一些患者中，使用GDC进行血管内栓塞治疗后残留的小动脉瘤颈可能会由于线圈压紧而导致延迟的动脉瘤再生长。临床表现可能预示着这种危险的再生长。

BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to investigate the relationship between serum fractalkine (CX3CL1/FKN) level and the multi-slice spiral computed tomography (MSCT) emphysema index in Chinese patients with chronic obstructive pulmonary disease (COPD). METHODS:We detected chemokine CX3CL1 in serum from 95 Chinese patients with COPD by using an enzyme-linked immunosorbent assay. According to the MSCT emphysema index, the selected cases were divided into an emphysema-dominant group (n = 25) and a non-emphysema-dominant group (n = 70). RESULTS:There were significant differences in body mass index and lung function between the two groups. The serum level of CX3CL1 in the emphysema-dominant group was significantly higher than that in the non-emphysema-dominant group. Through multivariate logistic regression analysis, it was found that high serum CX3CL1 levels were independently associated with emphysema, with a relative risk of 2.617 (95% CI 1.018-6.121; P = 0.029). The percentage of frequent acute exacerbations during the first year of follow-up was significantly higher in the high-level serum CX3CL1 group (P = 0.039). After 3 years of follow-up, there was no significant difference in the CT emphysema index between the high and low serum CX3CL1 groups (P = 0.503). CONCLUSION:Our results suggest that the serum level of CX3CL1 is related to the MSCT emphysema index. Chemokine CX3CL1 might be a useful predictor for identifying frequent exacerbation and emphysema severity in patients with COPD.

背景与目标： 目的：本研究旨在探讨中国慢性阻塞性肺疾病（COPD）患者血清fractalkine（CX3CL1 / FKN）水平与多层螺旋CT（MSCT）气肿指数之间的关系。
方法：我们采用酶联免疫吸附法检测了中国95例COPD患者血清中的趋化因子CX3CL1。根据MSCT肺气肿指数，将入选病例分为以气肿为主的组（n = 25）和非以气肿为主的组（n = 70）。
结果：两组之间的体重指数和肺功能存在显着差异。肺气肿为主组的血清CX3CL1水平明显高于非肺气肿为主组。通过多因素logistic回归分析，发现高血清CX3CL1与肺气肿独立相关，相对风险为2.617（95％CI 1.018-6.121； P = 290.029）。高水平血清CX3CL1组在随访的第一年中频繁发生急性加重的比例明显更高（P = 0.039）。随访3年后，高和低血清CX3CL1组之间的CT肺气肿指数无显着差异（P = 0.503）。
结论：我们的结果表明，血清CX3CL1水平与MSCT肺气肿指数有关。趋化因子CX3CL1可能是确定COPD患者频繁加重和肺气肿严重程度的有用预测指标。

BACKGROUND & AIMS: INTRODUCTION:There is scant evidence to quantify the risk of contact sports such as football to patients with epilepsy. This retrospective review was performed to evaluate the incidence of injuries or seizure exacerbation related to football participation in patients with epilepsy. METHODS:Between the years 1994 and 2004, 157,709 consecutive clinic notes were searched for mention of "football" and "epilepsy" or "seizure". Resulting notes were reviewed to quantify the number of seizure exacerbations and the number of injuries in this cohort. RESULTS:Seven of 44 subjects with epilepsy (15.9%) experienced injury while playing football. Four of 32 (12.5%) patients experienced seizure exacerbation during a time when they were concurrently participating in football though 3 of these patients stopped taking or were weaned off of their antiepileptic drugs (AEDs). One in 32 patients with epilepsy (3.1%) had an exacerbation of seizures while playing football and consistently taking AEDs. CONCLUSION:The risk of injury and seizure exacerbation due to participation in football for patients with epilepsy is low. Clinicians should use their best judgment in deciding whether contact sports increase risks for a particular patient based on individual seizure frequency, concurrent neurological and medical issues, and medication adverse effects.

背景与目标： 简介：没有足够的证据来量化癫痫患者接触足球等接触性运动的风险。这项回顾性研究旨在评估癫痫患者因足球参与而导致的受伤或癫痫发作加重的发生率。
方法：在1994年至2004年之间，共检索到157,709篇临床笔记，以提及“足球”和“癫痫病”或“癫痫发作”。回顾了结果记录，以量化该队列中癫痫发作加重的数量和受伤的数量。
结果：44名癫痫患者中有7名（15.9％）在踢足球时受伤。 32例患者中有4例（12.5％）在同时参加足球比赛期间发作性癫痫发作加重，尽管其中3例患者停止服用或断奶了抗癫痫药（AED）。 32名癫痫患者中有1名（3.1％）在踢足球和持续服用AED时癫痫发作加重。
结论：癫痫患者因参加足球运动而受伤和癫痫发作加剧的风险较低。临床医生应根据个人的癫痫发作频率，并发的神经和医学问题以及药物不良反应，根据自己的最佳判断来判断接触运动是否会增加特定患者的风险。

BACKGROUND & AIMS: Background:Patients with tuberculosis-destroyed lungs (TDLs), with airflow limitation, have clinical characteristics similar to those of patients with chronic obstructive pulmonary disease (COPD). Acute exacerbation is an important factor in the management of TDL. Therefore, the aim of this study was to investigate the factors associated with acute exacerbations in patients with stable TDL with airflow limitation. Methods:We evaluated the clinical characteristics, such as lung function, image findings, and serum laboratory findings, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin (IL)-6, in patients with TDL with chronic airflow limitation (n=94). We evaluated the correlation of these parameters with acute exacerbation. Results:We found that patients with exacerbation were more likely to have bronchiectasis than those without exacerbation (patients with exacerbation, 66.7%; patients without exacerbation, 30.5%; P=0.001). CRP and IL-6 levels were significantly higher in patients with exacerbation than in those without exacerbation (P=0.001 and P<0.001, respectively). Bronchiectasis [OR, 3.248; 95% confidence interval (CI), 1.063-9.928; P=0.039] and elevated IL-6 levels (OR, 1.128; 95% CI, 1.013-1.257; P=0.028) were the most important parameters associated with acute exacerbation in patients with TDL with airflow limitation. Conclusions:Patients with bronchiectasis and high IL-6 levels may require more intensive treatment to prevent acute exacerbation.

背景与目标： 背景：患有肺结核病（TDLs），气流受限的患者具有与慢性阻塞性肺疾病（COPD）患者相似的临床特征。急性加重是控制TDL的重要因素。因此，本研究的目的是调查与气流受限的稳定TDL患者急性加重相关的因素。
方法：我们评估了患有TDL的TDL患者的临床特征，例如肺功能，图像表现和血清实验室表现，包括C反应蛋白（CRP），红细胞沉降率（ESR）和白介素（IL）-6。慢性气流受限（n = 94）。我们评估了这些参数与急性加重的相关性。
结果：我们发现，加重患者比无加重患者更容易患支气管扩张（加重患者为66.7％；无加重患者为30.5％； P = 0.001）。加重患者的CRP和IL-6水平显着高于无加重患者（分别为P = 0.001和P <0.001）。支气管扩张[OR，3.248; 95％置信区间（CI），1.063-9.928； P = 0.039]和升高的IL-6水平（OR，1.128； 95％CI，1.013-1.257； P = 0.028）是与气流受限的TDL患者急性加重相关的最重要参数。
结论：支气管扩张和高IL-6的患者可能需要更深入的治疗，以防止急性加重。

BACKGROUND & AIMS: BACKGROUND:Recurring winter smog episodes, recently observed in Poland, have inspired the researches to assess the epidemiological situation concerning the registered exacerbations of respiratory diseases related to worsening of the ambient air quality. MATERIAL AND METHODS:The model comprising the ecological study results and secondary epidemiological data on registered outpatient visits and hospitalizations in the Silesian voivodeship was used. We assessed the effect of smog observed in January 2017 on the number of acute respiratory disorders registered in that month. Aerosanitary situation was obtained from the Provincial Inspectorate for Environmental Protection in Katowice database. RESULTS:It was documented that the increase in PM_2.5 concentration (with simultaneously observed unfavorable meteorological parameters) was related to a higher number of acute respiratory disorders registered daily. Moreover, the increase in the number of outpatient visits due to asthma exacerbation or bronchitis was observed on the first day of episode, and hospitalizations took place with delay of 1-2 days. CONCLUSIONS:The preliminary results indicate the relationship between worsening of ambient air quality during the winter smog and the increase in daily number of registered outpatient visits and hospitalizations due to acute respiratory diseases. Med Pr 2018;69(5):523-530. WSTĘP:Obserwowane w ostatnich latach w Polsce cyklicznie powtarzające się – w każdym sezonie zimowym – epizody smogowe stały się inspiracją do badań nad sytuacją epidemiologiczną zaostrzeń chorób układu oddechowego zarejestrowanych w odpowiedzi na pogorszenie jakości powietrza atmosferycznego. MATERIAŁ I METODY:Na podstawie modelu badania ekologicznego i wtórnych danych epidemiologicznych dotyczących rejestrowanych porad ambulatoryjnych oraz hospitalizacji w województwie śląskim oceniono wpływ smogu ze stycznia 2017 r. na liczbę udzielonych w tym miesiącu świadczeń medycznych z powodu ostrych incydentów oddechowych. Informacje o sytuacji aerosanitarnej w badanym okresie pochodzą z bazy danych Wojewódzkiego Inspektoratu Ochrony Środowiska w Katowicach. WYNIKI:Zaobserwowano wpływ wzrostu stężeń pyłu PM_2,5 (przy jednocześnie notowanych niekorzystnych parametrach meteorologicznych) na zwiększenie dziennej liczby udzielanych świadczeń medycznych z powodu ostrych incydentów oddechowych. Wzrost liczby porad z powodu zaostrzenia astmy oraz zapalenia oskrzeli zanotowano już pierwszego dnia epizodu. Liczba osób hospitalizowanych zwiększyła się natomiast dopiero po 2 dniach. WNIOSKI:Uzyskane wyniki wstępnych badań wskazują na związek między pogorszeniem jakości powietrza w trakcie zimowego epizodu smogowego a wzrostem liczby rejestrowanych porad ambulatoryjnych i hospitalizacji z powodu ostrych chorób układu oddechowego. Med. Pr. 2018;69(5):523–530.

背景与目标： 摘要背景：最近在波兰观察到的冬季烟雾烟雾反复发作，启发了研究人员评估有关与周围空气质量恶化有关的呼吸道疾病恶化的流行病学情况。
材料与方法：使用该模型，该模型包含有关西里西亚省的门诊就诊和住院情况的生态研究结果和次要流行病学数据。我们评估了2017年1月观察到的烟雾对当月登记的急性呼吸系统疾病数量的影响。空气卫生状况是从卡托维兹数据库中的省环境保护监察局获得的。
结果：有证据表明，PM _{2.5 浓度的增加（同时观察到不利的气象参数）与每天登记的急性呼吸系统疾病的增加有关。此外，在发作的第一天就观察到由于哮喘加重或支气管炎引起的门诊就诊人数的增加，并且住院时间延迟了1-2天。
结论：初步结果表明，冬季烟雾笼罩的环境空气质量与急性呼吸系统疾病导致的每日门诊就诊和住院日数增加之间存在相关性。 Med Pr 2018; 69（5）：523-530。
WSTĘP：Obserwowane w ostatnich latach w Polsce cykliczniepowtarzającesię– wkażdymsezonie zimowym – epizody smogowestałysięinspiracjądobadańnadsytugojéwizéwizéwizézéwizézéwizézéwizézéwizézénózó
材料：医务人员：Na podstawie modelu badania ekologicznego iwtórnychdanych epidemiologicznychdotyczącychrejestrowanych porad ambulatoryjnych oraz hospitalizacji wwojewództwieśląskimocenionowpływsmogu smogu。您可以从micesiącuświadczeńmedycznych z powodu ostrychincydentówoddechowych中获取更多信息。信息不完整，有错误，没有错误，没有任何理由。
WYNIKI：ZaobserwowanowpływwzrostustężeńpyłuPM 2,5 < Wzrost liczby porad z powodu zaostrzenia astmy oraz zapalenia oskrzeli zanotowanojużpierwszego dnia epizodu。 Liczbaosóbhospitalizowanychzwiększyłasi na natomiast dopiero po 2 dniach。
尼古拉斯（WNIOSKI）：Uzyskane wy​​nikiwstępnychBadańwskazująnazwiązekmigordzy pogorszeniemjakościpowietrza w trakcie zimowego epivodu smogowego wzrostem liczby rejestrowanych poraddubulbulwego abulatoryjnych我在医院治疗。中公关2018; 69（5）：523-530。}

BACKGROUND & AIMS: :Fibrous dysplasia is a metabolic skeletal disorder in which the medullary spaces of affected bones are replaced by fibro-osseous tissue. Patients with fibrous dysplasia usually become symptomatic during childhood; the adolescent patient we describe is unusual because she was not known to suffer from fibrous dysplasia until she became pregnant and experienced a dramatic reactivation of the symptoms. The therapeutic implication of this case and reproductive counselling for young women with fibrous dysplasia are discussed.

背景与目标： ：纤维异常增生是一种代谢性骨骼疾病，其中受影响的骨骼的髓腔被纤维骨组织所替代。纤维不典型增生的患者通常在儿童时期就出现症状。我们描述的这个青春期患者很不寻常，因为直到她怀孕并经历了剧烈的症状恢复，才知道她患有纤维异型增生。讨论了这种情况的治疗意义和对纤维异常增生的年轻妇女的生殖咨询。

BACKGROUND & AIMS: :Leishmania major-specific T cell lines were derived from mice sensitized to the parasite. The cells were of the CD4+ T cell lineage and, upon adoptive transfer, were found to be capable of inducing parasite-specific delayed-type hypersensitivity. Adoptive transfer of these L. major-specific T cells to syngeneic recipients which were either normal, T cell deficient or B cell and antibody deficient led to exacerbation of infection upon subsequent challenge with L. major. This suggested that host T cells, B cells and antibody were not required for the L. major-specific T cells to exert their exacerbative effect on the course of cutaneous leishmaniasis. Additional studies revealed that the adoptive transfer of graded doses of these L. major-specific T cells always resulted in exacerbation of infection. Study of the localization pattern of the cells following transfer showed that they migrate preferentially to the site of the lesions. Furthermore, although the induction phase of this phenomenon was immunologically specific, its effector phase was not. Finally, T cell clones were derived from the L. major-specific T cell lines. The T cell clones were phenotypically and functionally identical to the T cell lines from which they were derived. Adoptive transfer of these parasite-specific T cell clones to normal syngeneic recipients induced an exacerbated course of infection with L. major. Interestingly, when these cloned T cells were specifically activated in vitro, the cells produced interleukin 2 and interferon-gamma, but no interleukin 4, indicating that they belong to the murine Th1 subset of CD4+ T cells.

背景与目标： ：利什曼原虫主要特异性T细胞系来源于对寄生虫敏感的小鼠。这些细胞属于CD4 T细胞谱系，经过继转移后，能够诱导寄生虫特异性迟发型超敏反应。将这些大肠埃希氏菌特异性T细胞过继转移至正常的T细胞缺陷或B细胞和抗体缺乏的同基因受体，在随后用大肠埃希氏菌攻击后导致感染加重。这表明主要的L.特异性T细胞在皮肤利什曼病病程中发挥加重作用并不需要宿主T细胞，B细胞和抗体。进一步的研究表明，这些主要乳酸链球菌T细胞分级给药的过继转移总是导致感染加重。转移后细胞定位模式的研究表明，它们优先迁移至病变部位。此外，尽管该现象的诱导期在免疫学上是特异性的，但其效应期不是。最后，T细胞克隆衍生自L. major-特异性T细胞系。 T细胞克隆在表型和功能上与它们衍生的T细胞系相同。这些寄生虫特异的T细胞克隆过继转移至正常的同基因受体，导致大肠埃希氏菌感染的病程加剧。有趣的是，当这些克隆的T细胞在体外被特异性激活时，这些细胞产生白介素2和干扰素-γ，但不产生白介素4，表明它们属于CD4 T细胞的鼠Th1子集。

BACKGROUND & AIMS: BACKGROUND:Airway eosinophilia is frequently observed during acute exacerbation of asthma. Interleukin-5 (IL-5) and eotaxin are directly involved in the airway eosinophilia found in persistent asthma. Interrelation between these cytokines is expected to occur in acute exacerbation of asthma. Thus, we evaluated the relevance of interaction between eotaxin and IL-5 in the airway inflammation of acute exacerbation. METHODS:We measured the number of inflammatory cells and the amount of eotaxin and IL-5 in sputum from 22 healthy subjects, 21 asthmatics with acute exacerbation and 16 patients with mild persistent asthma, and reassessed these values in 7 subjects with acute exacerbation after 7 days' treatment with systemic steroid (2 mg/kg/day). Sources of IL-5 and eotaxin were investigated by immunohistochemical staining of sputum cells of 4 cases from each group. RESULTS:Both IL-5 and eotaxin levels were higher in patients with acute exacerbation of asthma than in patients with persistent asthma and normal subjects. IL-5 and eotaxin levels were significantly correlated with eosinophil percentages in mild persistent asthma. Eotaxin staining was found mainly on macrophages and occasionally on eosinophils. Steroid treatment markedly decreased eosinophil percentages and IL-5 levels within 7 days but did not alter eotaxin levels. CONCLUSIONS:Both IL-5 and eotaxin are associated with acute exacerbation of asthma. IL-5 rather than eotaxin is effectively decreased by the inhibitory effect of steroid in acute exacerbation.

背景与目标： 背景：哮喘急性发作期间经常观察到气道嗜酸性粒细胞增多。白细胞介素5（IL-5）和嗜酸性粒细胞趋化因子直接参与持续性哮喘中发现的气道嗜酸性粒细胞增多。这些细胞因子之间的相互关系预计会在哮喘的急性加重中发生。因此，我们评估了嗜酸性粒细胞趋化因子和IL-5相互作用在急性加重期气道炎症中的相关性。
方法：我们测量了22名健康受试者，21名急性加重哮喘患者和16名轻度持续性哮喘患者痰液中炎症细胞的数量以及痰中的趋化因子和IL-5的含量，并对7例7岁后急性加重患者的这些值进行了重新评估系统性类固醇（2 mg / kg /天）的治疗天数。通过免疫组化对每组4例痰细胞进行IL-5和嗜酸性粒细胞趋化因子的来源调查。
结果：哮喘急性加重患者的IL-5和嗜酸性粒细胞趋化因子水平均高于持续性哮喘患者和正常人。在轻度持续性哮喘中，IL-5和嗜酸性粒细胞趋化因子水平与嗜酸性粒细胞百分比显着相关。嗜酸性粒细胞趋化因子染色主要在巨噬细胞上发现，偶而在嗜酸性粒细胞上发现。类固醇治疗在7天内显着降低了嗜酸性粒细胞百分比和IL-5水平，但并未改变嗜酸性粒细胞趋化因子的水平。
结论：IL-5和嗜酸性粒细胞趋化因子均与哮喘急性发作有关。类固醇在急性加重中的抑制作用可有效降低IL-5而不是嗜酸性粒细胞趋化因子。

BACKGROUND & AIMS: BACKGROUND:High prevalence of rhinoplasty, controversies about its cutaneous complications and lack of structured studies about relationship between acne vulgaris and rhinoplasty, point out the necessity for performing this study. PURPOSE:To determine the frequency of acne and its exacerbation after rhinoplasty. MATERIALS AND METHODS:In a longitudinal controlled study at a tertiary referral university hospital, the degree of acne before and 1 and 3 months after surgery was measured in 110 patients (30 Male, 80 Female, Mean age: 26.3 ± 6.8) with rhinoplasty and 80 patients (35 Male, 45 Female, Mean age: 24.5 ± 4.6) with septoplasty, based on Global Acne Grading System (GAGS). The data were analyzed by SPSS 16 software. RESULTS:The frequency of acne exacerbation in first post-surgical visit was 27% in case and 3.5% in control subjects (P<0.007). In case group, 42.9% of those who had no acne before surgery, developed mild acne and 14.5% of those with mild acne, turned into moderate acne. In second post-surgical visit 91.7% of those who had moderate acne in first visit, turned into mild acne and 80% of those with severe acne in first post-surgical visit changed into moderate acne without any specific therapy (P<0.0001 and P<0.001, respectively). CONCLUSIONS:Rhinoplasty has significant relationship with acne exacerbation. The severity of acne decreases gradually during 3 months after surgery. For determining the exact course and risk factors of this complication, further studies are needed.

背景与目标： 背景：隆鼻术的高发率，有关其皮肤并发症的争议以及有关寻常痤疮与隆鼻术之间关系的结构化研究的缺乏，都指出进行这项研究的必要性。
目的：确定隆鼻后痤疮的频率及其恶化。
材料与方法：在一家三级转诊大学医院进行的纵向对照研究中，对110例经鼻整形术治疗的患者（男30例，女80例，平均年龄：26.3±6.8）进行了痤疮程度的测量。根据全球痤疮分级系统（GAGS），对80例患者（男35例，女45例，平均年龄：24.5±4.6）进行隔膜成形术。通过SPSS 16软件分析数据。
结果：首次手术后痤疮加重的频率是病例中的27％，对照组中的3.5％（P <0.007）。在病例组中，术前无痤疮的患者中有42.9％出现了轻度痤疮，而轻度痤疮的患者中有14.5％转变为中度痤疮。在第二次手术后访视中，初次访视中有痤疮的患者中有91.7％变为轻度痤疮，而在第一次手术后访视中有80％患有严重痤疮的患者在没有任何特定疗法的情况下变为中度痤疮（P <0.0001和P分别<0.001）。
结论：隆鼻与痤疮恶化有密切关系。痤疮的严重程度在术后3个月内逐渐降低。为了确定这种并发症的确切病程和危险因素，还需要进一步的研究。