Osteoarthritis and psoriasis arthritis are two degenerative forms of arthritis that share similar yet also different manifestations at the histological,cellular,and clinical levels.Rheumatologists have marked them as ...Osteoarthritis and psoriasis arthritis are two degenerative forms of arthritis that share similar yet also different manifestations at the histological,cellular,and clinical levels.Rheumatologists have marked them as two entirely distinct arthropathies.Given recent dis-coveries in disease initiation and progression,potential mechanisms,cellular signaling path-ways,and ongoing clinical therapeutics,there are now more opportunities for discovering osteoarthritis drugs.This review summarized the osteoarthritis and psoriasis arthritis signaling pathways,crosstalk between BMP,WNT,TGF-β,VEGF,TLR,and FGF signaling pathways,bio-markers,and anatomical pathologies.Through bench research,we demonstrated that regen-erative medicine is a promising alternative for treating osteoarthritis by highlighting significant scientific discoveries on entheses,multiple signaling blockers,and novel molecules such as immunoglobulin new antigen receptors targeted for potential drug evaluation.Furthermore,we offered valuable therapeutic approaches with a multidisciplinary strategy to treat patients with osteoarthritis or psoriasis arthritis in the coming future in the clinic.展开更多
Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilate...Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilated heart disease in infants. We report through this clinical case, the fourth case of infantile ALCAPA diagnosed in Senegal in a 7-month-old infant. The symptomatology began around the age of 2 months, with a grumpy state associated with more marked crying and moaning during feedings and bowel movements. The mother reported hospitalization for a severe lung infection when she was 6 months old. The examination noted an infant in poor general condition, retarded growth and weight, and a 3/6th holosystolic murmur at the apex. Troponinemia was positive at 43.90 ng/L. The electrocardiogram showed Q waves on the lower side, a sub endocardial lesion on the upper side and a ST segment elevation in aVR. Doppler echocardiography showed dilated cardiomyopathy with a mean alteration of systolic function of the left ventricle at 37%, a mean mitral insufficiency and a strong suspicion of a birth anomaly of the left coronary artery. The CT scan confirmed the diagnosis of ALCAPA. Surgicalreimplantation of the left coronary artery at the aortic level was performed at 10 months of life with a favourable outcome at D50 postoperative.展开更多
INTRODUCTIONIt is axiomatic that the most effective and soundlybased plan of treatment of any disorder is one aimedat the mechanism or mechanisms responsible for itsdevelopment.This basic notion,coupled withrecent rep...INTRODUCTIONIt is axiomatic that the most effective and soundlybased plan of treatment of any disorder is one aimedat the mechanism or mechanisms responsible for itsdevelopment.This basic notion,coupled withrecent reports in which,surprisingly there is atotal lack of reference to the probable involvementof autonomic-arc-reflexes in the展开更多
AIM To investigate the secreting functions of saliva in patients with TCM Piyinxu (Spleen yin deficiency). METHODS According to the traditional Chinese medical diagnositic standard, 25 cases of Piyinxu (male 15, ...AIM To investigate the secreting functions of saliva in patients with TCM Piyinxu (Spleen yin deficiency). METHODS According to the traditional Chinese medical diagnositic standard, 25 cases of Piyinxu (male 15, female 10, aged from 26～70, average 45 years) were observed and compared with 20 cases of Shenyinxu (Kidney yin deficiency) patients (male 11, female 9, aged from 35～75, average 50) and 30 normal persons (male 17, female 13, aged from 35～65, average 49). After acid stimulation, the secretion flow was measured, the saliva amylase and protein were surveyed using the automatic biochemical analyzer. Statistical analysis was carried out with Kruskal Wallis test and one way factorial ANOVA test. RESULTS In Piyinxu patients, the saliva′s secreting flow rate (0 27ml/min±0 016ml/min) and amylase per min (2134 13IU/min±343 51IU/min) was lower than that in normal subjects (0 46ml/min±0 027ml/min and 3501 63IU/min±1099 63IU/min, P <0 01) and higher than that in Shenyinxu group (0 13ml/min±0 051ml/min and 951 62IU/min±383 17IU/min, P <0 01). But there was no significant difference between each group in total salivary protein (Piyinxu group 3 07g/L±0 60g/L, Shenyinxu 3 01g/L±0 90g/L and control 2 94g/L±1 13g/L, P =0 869), amylase per volume and the ratio of the amylase to the protein ( P =0 173 and 0 436). CONCLUSION The secreting functions of saliva in Piyinxu patients are low.展开更多
AIM To investigate the etiologic association of pancreas divisum (PD) with chronic pancreatitis and to clarify its pathogenesis. METHODS A PD canine model was established in 32 dogs. The dogs were randomly divided ...AIM To investigate the etiologic association of pancreas divisum (PD) with chronic pancreatitis and to clarify its pathogenesis. METHODS A PD canine model was established in 32 dogs. The dogs were randomly divided into 4 groups ( n =8). Group Ⅰ: The communicating branch between the dorsal and ventral pancreatic ducts was partly ligated. Group Ⅱa: The communicating branch was amputated and completely ligated. Group Ⅱb: The dorsal duct was amputated and ligated at 2mm distance to the minor papilla. Group Ⅲ: A sham operation without any amputation or ligation was performed. Before and after operation, the activities of serum phospholipase A2 (PLA2) and amylase (Ams) were assayed and the basal pressures of the ducts were measured when secretin was injected. Pancreatic ductography and the pathologic examination were made. RESULTS The activities of serum PLA2 and Ams in Group Ⅰ,Ⅱa and Ⅱb were significantly increased 5-80 days after operation. At sacrifice, the basal pressures of the ventral duct were significantly higher 30min-60min after provocation in Group Ⅰ, Ⅱa and Ⅱb. The pressures of the dorsal duct were significantly increased in Group Ⅱb but no difference in Group Ⅰ and Ⅱa. Under light microscopy the fibrosis of interlobus and periducts, the destruction of acini and infiltration of inflammatory cell in dorsal and ventral pancreas were found in Group Ⅱb. But in Group Ⅰ and Ⅱa, these findings were present only in ventral pancreas. The electron microscopy showed that in ventral pancreas of Groups Ⅰ and Ⅱa and the dorsal and ventral pancreas of Group Ⅱb, the rough endoplasmic reticulum of the acinar cells showed granules scaling, fusion and dilatation. The zymogen granules decreased and the mitochondria was swollen. CONCLUSION PD is one of etiologic factors in chronic pancreatitis. The pathogenesis is the functional obstruction of the minor papilla at the peak stage of secretion.展开更多
According to the American Diabetes Association,diabetes was the seventh leading cause of death,and diabetic retinopathy the leading cause of blindness in working age adults in the United States in 2010.Diabetes is cha...According to the American Diabetes Association,diabetes was the seventh leading cause of death,and diabetic retinopathy the leading cause of blindness in working age adults in the United States in 2010.Diabetes is characterized by hyperglycemia associated with either hypoinsulinemia or insulin resistance,and over time,this chronic metabolic condition may lead to various complications including kidney failure,heart attacks,and retinal degeneration.In order to better understand the molecular basis of this disease and its complications,animal models have been the primary approach used to investigate the effects of diabetes on various tissues or cell types of the body,including the retina.However,inherent to these animal models are critical limitations that make the insight gained from these models challenging to apply to the human pathology.These difficulties in translating the knowledge obtained from animal studies have led a growing number of research groups to explore the diabetes complications,especially diabetic retinopathy,on tissues from human donors.This review summarizes the data collected from diabetic patients at various stages of diabetic retinopathy and classifies the data based upon their relevance to the main aspects of diabetic retinopathy:retinal vasculature dysfunction,inflammation,and neurodegeneration.This review discusses the importance of those studies to discriminate and establish the relevance of the findings obtained from animal models but also the limitations of such approaches.展开更多
Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a n...Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a number of non-diabetic patients after acute ischemic stroke, presumably as a stress response. The aim of this review is to summarize the main effects of hyperglycemia when associated to ischemic injury in acute stroke patients, highlighting the clinical and neurological outcomes in these conditions and after the administration of the currently approved pharmacological treatment, i.e. insulin. The disappointing results of the clinical trials on insulin(including the hypoglycemic events) demand a change of strategy based on more focused therapies. Starting from the comprehensive evaluation of the physiopathological alterations occurring in the ischemic brain during hyperglycemic conditions, the effects of various classes of glucose-lowering drugs are reviewed, such as glucose-like peptide-1 receptor agonists, DPP-4 inhibitors and sodium glucose cotransporter 2 inhibitors, in the perspective of overcoming the up-to-date limitations and of evaluating the effectiveness of new potential therapeutic strategies.展开更多
AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic...AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic macular edema（DME）. METHODS： This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity（BCVA） measurement, MAIA microperimetry, and SDOCT. DME morphology, including central retinal thickness（CRT） and central retinal volume（CRV）; integrity of the external limiting membrane（ELM） and photoreceptor inner segment/outer segment（IS/OS） junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold（AT）-retinal sensitivity, macular integrity index（MI）, fixation points within a circle of radius 1°（P1） and 2°（P2）, and bivariate contour ellipse area considering 63% and 95% of the fixation points（A63 and A95, respectively）. RESULTS： MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA（log MAR）, total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA（log MAR）, AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION： Functional（BCVA and visual field） and morphological parameters（retinal thickness） were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.展开更多
Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division an...Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.展开更多
AIM: To investigate if there is a correlation between electrical activity measured by electrogastrography (EGG) and contractile activity of the stomach as measured by antroduodenal manometry (ADM). We also studied whe...AIM: To investigate if there is a correlation between electrical activity measured by electrogastrography (EGG) and contractile activity of the stomach as measured by antroduodenal manometry (ADM). We also studied whether the underlying motility disorder could be predicted from EGG parameters. METHODS: We compared 21 parameters measured from EGG with 8 parameters measured from ADM. The ability of EGG to identify the underlying diagnosis was tested by comparing EGG parameters for each diagnosis group against other patients. The study comprised recordings from 148 patients and 125 females. Their median age was 45 (range 17-76) years. RESULTS: We found few and weak correlations between EGG and ADM. Specifically the correlation between parameters reflecting the response to meal was poor (r = -0.07, P = 0.39). The discriminatory power of EGG for underlying motility disorder was also low. Patients with slow transit constipation (STC) showed a lower postprandial power in normogastric (3.7 ± 0.5 vs 4.0 ± 0.5) and tachygastric (3.5 ± 0.4 vs 3.7 ± 0.4) regions, a lower percentage of time with normogastria [87.2 (56.5-100)% vs 95.7 (0-100)%], and a higher percentage of time with tachygastria [9.3 (0-33)% vs 3.5 (0-100)%] and bradygastria [1.8 (0-20)% vs 0 (0-17.1)%]. Patients with irritable bowel syndrome had a higher percentage of time with normogastria [96.5 (62.5-100)% vs 93.3 (0-100)%] and a less unstable dominant frequency as measured by the instability coefficient [15 (3-77) vs 24 (2-72)]. CONCLUSION: EGG and ADM seem to measure different aspects of gastric motor activity but cannot show a spatial correlation. The diagnostic value of EGG is poor, but EGG may have some value for the identification of patients with STC.展开更多
IM To study the plasma level of gastrointestinal hormones and gastric emptying in patients with peptic ulcer. METHODS Thirty patients with gastric ulcer (GU), and 29 duodenal ulcer (DU) and 12 controls were studie...IM To study the plasma level of gastrointestinal hormones and gastric emptying in patients with peptic ulcer. METHODS Thirty patients with gastric ulcer (GU), and 29 duodenal ulcer (DU) and 12 controls were studied. Plasma levels of SS, VIP and SP were measured by radioimmunoassay, and gastric emptying half time (GET1/2) was determined with TC99mresin solid meal method. RESULTS GET1/2(min) was significantly longer in GU than that in controls (659±148 vs 533±43, P<001) and plasma VIP levels (ng/L) were significantly higher than in controls (375±107 vs 184±59, P<005). There was a significant positive correlation between GET1/2 and plasma VIP levels (r=055,P<001). No significant changes were found in SS and SP in GU compared with controls (P>005). GET1/2 in DU was markedly shorter than the control group (417±102 vs 533±43, P<001), and plasma SS levels (ng/L) significantly lower than those in controls (64±25 vs 119±34,P<001), there was a significant positive correlation between GET1/2 and SS levels (r=056,P<001). Plasma SP levels (ng/L) in DU were significantly higher than the controls (544±127 vs 416±58,P<001),there was a significant negative correlation between GET1/2 and SP levels (r=-068,P<001). No significant difference was found in the plasma VIP levels between DU and controls (P>005).CONCLUSION VIP elevation may contribute to the GET1/2 delay and the occurrence of GU. The increased SP and lowered SS may play important roles in the GET1/2 acceleration and the pathogensis of DU.展开更多
Non-alcoholic fatty liver disease(NAFLD) is a major health care problem and represents the hepatic expression of the metabolic syndrome. NAFLD is classified as nonalcoholic fatty liver(NAFL) or simple steatosis,and no...Non-alcoholic fatty liver disease(NAFLD) is a major health care problem and represents the hepatic expression of the metabolic syndrome. NAFLD is classified as nonalcoholic fatty liver(NAFL) or simple steatosis,and non-alcoholic steatohepatitis(NASH). NASH is characterized by the presence of steatosis and inflammation with or without fibrosis. The physiopathology of NAFL and NASH and their progression to cirrhosis involve several parallel and interrelated mechanisms,such as,insulin resistance(IR),lipotoxicity,inflammation,oxidative stress,and recently the gut-liver axis interaction has been described. Incretin-based therapies could play a role in the treatment of NAFLD. Glucagon-like peptide-1(GLP-1) is an intestinal mucosa-derived hormone which is secreted into the bloodstream in response to nutrient ingestion; it favors glucose-stimulated insulin secretion,inhibition of postprandial glucagon secretion and delayed gastric emptying. It also promotes weight loss and is involved in lipid metabolism. Once secreted,GLP-1 is quickly degraded by dipeptidyl peptidase-4(DPP-4). Therefore,DPP-4 inhibitors are able to extend the activity of GLP-1. Currently,GLP-1 agonists and DPP-4 inhibitors represent attractive options for the treatment of NAFLD and NASH. The modulation of lipid and glucose metabolism through nuclear receptors,such as the farsenoid X receptor,also constitutes an attractive therapeutic target. Obeticholic acid is a potent activator of the farnesoid X nuclear receptor and reduces liver fat content and fibrosis in animal models. Ursodeoxycholic acid(UDCA) is a hydrophilic bile acid with immunomodulatory,antiinflammatory,antiapoptotic,antioxidant and antifibrotic properties. UDCA can improve IR and modulate lipid metabolism through its interaction with nuclear receptors such as,TGR5,farnesoid X receptor-a,or the small heterodimeric partner. Finally,pharmacologic modulation of the gut microbiota could have a role in the therapy of NAFLD and NASH. Probiotics prevent bacterial translocation and epithelial invasion,inhibit mucosal adherence by bacteria,and stimulate host immunity. In animal models,probiotics prevent obesity,decrease transaminase levels,and improve IR and liver histology in NASH.展开更多
The dying-back hypothesis holds that the damage to neuromuscular junctions and distal axons in amyotrophic lateral sclerosis occurs at the earliest stage of the disease.Previous basic studies have confirmed early dama...The dying-back hypothesis holds that the damage to neuromuscular junctions and distal axons in amyotrophic lateral sclerosis occurs at the earliest stage of the disease.Previous basic studies have confirmed early damage to neuromuscular junctions,but it is difficult to obtain such evidence directly in clinical practice.In this prospective cross-sectional study,we recruited 22 patients with early amyotrophic lateral sclerosis with disease duration < 12 months and with clinical symptoms limited to the upper limbs.We also recruited 32 healthy controls.Repetitive nerve stimulation was performed,and patients were followed for 12 months.We found a significant change in the response to repetitive nerve stimulation in amyotrophic lateral sclerosis patients without spontaneous electromyographic activity.Patients that were prone to denervation had an increased decrement response of target muscles after repetitive nerve stimulation.These results suggest that changes in response to repetitive nerve stimulation may occur before denervation in amyotrophic lateral sclerosis patients.The damage to lower motor neurons is more obvious in patients with a higher percentage of repetitive never stimulation-related amplitude decrements.This study was approved by the Institutional Ethics Committee of Peking University Third Hospital(approval No.M2017198) on August 24,2017.展开更多
Kidney transplantation is considered the treatment of choice for end-stage kidney disease patients.However,the residual cardiovascular risk remains significantly higher in kidney transplant recipients(KTRs)than in the...Kidney transplantation is considered the treatment of choice for end-stage kidney disease patients.However,the residual cardiovascular risk remains significantly higher in kidney transplant recipients(KTRs)than in the general population.Hypertension is highly prevalent in KTRs and represents a major modifiable risk factor associated with adverse cardiovascular outcomes and reduced patient and graft survival.Proper definition of hypertension and recognition of special phenotypes and abnormal diurnal blood pressure(BP)patterns is crucial for adequate BP control.Misclassification by office BP is commonly encountered in these patients,and a high proportion of masked and uncontrolled hypertension,as well as of white-coat hypertension,has been revealed in these patients with the use of ambulatory BP monitoring.The pathophysiology of hypertension in KTRs is multifactorial,involving traditional risk factors,factors related to chronic kidney disease and factors related to the transplantation procedure.In the absence of evidence from large-scale randomized controlled trials in this population,BP targets for hypertension management in KTR have been extrapolated from chronic kidney disease populations.The most recent Kidney Disease Improving Global Outcomes 2021 guidelines recommend lowering BP to less than 130/80 mmHg using standardized BP office measurements.Dihydropyridine calcium channel blockers and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers have been established as the preferred first-line agents,on the basis of emphasis placed on their favorable outcomes on graft survival.The aim of this review is to provide previous and recent evidence on prevalence,accurate diagnosis,pathophysiology and treatment of hypertension in KTRs.展开更多
Left ventricular contractility was measured using Doppler echocardiography in 37 pa-tients with rheumatic mitral valve disease.Myocardial pathological lesions were studied quanti-tatively by means of the image analysi...Left ventricular contractility was measured using Doppler echocardiography in 37 pa-tients with rheumatic mitral valve disease.Myocardial pathological lesions were studied quanti-tatively by means of the image analysis system and light microscopic examination.The resultsshowed that attenuated cardiac function is due to pathological change of the mitral valve andpathological lesions of the left ventrieular myocardium including increased interstitial fibrosis,thickened intramyocardial arterial wall leading to concentric narrowing of the lumen,hyper-trophic myocardial fiber and endocardial proliferation.Since mitral valve replacement can notcorrect the irreversible myocardial pathological lesions,perioperative protection of the my-ocardium should be emphasized,and intraoperative injury to the myocardium should be mini-mized as far as possible.展开更多
Chronic fatigue syndrome (CFS) is a poorly understood condition primarily characterized by debilitateing, persistent or recurrent fatigue, increased physical and mental fatigability, cognitive impairment and widesprea...Chronic fatigue syndrome (CFS) is a poorly understood condition primarily characterized by debilitateing, persistent or recurrent fatigue, increased physical and mental fatigability, cognitive impairment and widespread musculoskeletal pain. During the past two decades, there have been heated debates about CFS among researchers, practitioners and patients. The existence of the disorder has been questioned, its underlying pathophysiology debated and an effective treatment opposed (such as antidepressants, stimulants or antibiotics). A lot of multidisciplinary literature is found about CFS, but to date, many psychiatrists seem to unknown the existence of this illness or think that it is a purely psychological disorder. However, CFS is sitting on the border between medicine and psychiatry. The aim of this review is to make psychiatrists aware of the existence of CFS and that they will, one day, be confronted with the management of this illness. Thus, this update allows understanding what is CFS, the diversity of physiopathology underlined and its management.展开更多
Trauma-induced coagulopathy （TIC） is a clinical syndrome caused by imbalance between clotting, anti- coagulation and fibrinolysis resulting from multiple pathological factors such as hemorrhage and tissue injury in ...Trauma-induced coagulopathy （TIC） is a clinical syndrome caused by imbalance between clotting, anti- coagulation and fibrinolysis resulting from multiple pathological factors such as hemorrhage and tissue injury in the early stage of trauma, and is closely related to the outcome of trauma patients. It is proved in growing evidence that the endogenous coagulation disturbance in trauma itself is the activating factor of TIC, rather than dilution or other acquired coagulopathy. Therefore, a thorough understanding of the molecular mechanisms in the pathogenesis and progression is crucial for effective prevention and treatment in patients with TIC. This review focuses on transitions in the concept of TIC and mechanical progress.展开更多
文摘Osteoarthritis and psoriasis arthritis are two degenerative forms of arthritis that share similar yet also different manifestations at the histological,cellular,and clinical levels.Rheumatologists have marked them as two entirely distinct arthropathies.Given recent dis-coveries in disease initiation and progression,potential mechanisms,cellular signaling path-ways,and ongoing clinical therapeutics,there are now more opportunities for discovering osteoarthritis drugs.This review summarized the osteoarthritis and psoriasis arthritis signaling pathways,crosstalk between BMP,WNT,TGF-β,VEGF,TLR,and FGF signaling pathways,bio-markers,and anatomical pathologies.Through bench research,we demonstrated that regen-erative medicine is a promising alternative for treating osteoarthritis by highlighting significant scientific discoveries on entheses,multiple signaling blockers,and novel molecules such as immunoglobulin new antigen receptors targeted for potential drug evaluation.Furthermore,we offered valuable therapeutic approaches with a multidisciplinary strategy to treat patients with osteoarthritis or psoriasis arthritis in the coming future in the clinic.
文摘Bland-White-Garland syndrome or ALCAPA is an abnormality of birth of the left coronary artery from the pulmonary artery. It is a diagnostic and therapeutic emergency because it is a curable cause of hypokinetic dilated heart disease in infants. We report through this clinical case, the fourth case of infantile ALCAPA diagnosed in Senegal in a 7-month-old infant. The symptomatology began around the age of 2 months, with a grumpy state associated with more marked crying and moaning during feedings and bowel movements. The mother reported hospitalization for a severe lung infection when she was 6 months old. The examination noted an infant in poor general condition, retarded growth and weight, and a 3/6th holosystolic murmur at the apex. Troponinemia was positive at 43.90 ng/L. The electrocardiogram showed Q waves on the lower side, a sub endocardial lesion on the upper side and a ST segment elevation in aVR. Doppler echocardiography showed dilated cardiomyopathy with a mean alteration of systolic function of the left ventricle at 37%, a mean mitral insufficiency and a strong suspicion of a birth anomaly of the left coronary artery. The CT scan confirmed the diagnosis of ALCAPA. Surgicalreimplantation of the left coronary artery at the aortic level was performed at 10 months of life with a favourable outcome at D50 postoperative.
文摘INTRODUCTIONIt is axiomatic that the most effective and soundlybased plan of treatment of any disorder is one aimedat the mechanism or mechanisms responsible for itsdevelopment.This basic notion,coupled withrecent reports in which,surprisingly there is atotal lack of reference to the probable involvementof autonomic-arc-reflexes in the
文摘AIM To investigate the secreting functions of saliva in patients with TCM Piyinxu (Spleen yin deficiency). METHODS According to the traditional Chinese medical diagnositic standard, 25 cases of Piyinxu (male 15, female 10, aged from 26～70, average 45 years) were observed and compared with 20 cases of Shenyinxu (Kidney yin deficiency) patients (male 11, female 9, aged from 35～75, average 50) and 30 normal persons (male 17, female 13, aged from 35～65, average 49). After acid stimulation, the secretion flow was measured, the saliva amylase and protein were surveyed using the automatic biochemical analyzer. Statistical analysis was carried out with Kruskal Wallis test and one way factorial ANOVA test. RESULTS In Piyinxu patients, the saliva′s secreting flow rate (0 27ml/min±0 016ml/min) and amylase per min (2134 13IU/min±343 51IU/min) was lower than that in normal subjects (0 46ml/min±0 027ml/min and 3501 63IU/min±1099 63IU/min, P <0 01) and higher than that in Shenyinxu group (0 13ml/min±0 051ml/min and 951 62IU/min±383 17IU/min, P <0 01). But there was no significant difference between each group in total salivary protein (Piyinxu group 3 07g/L±0 60g/L, Shenyinxu 3 01g/L±0 90g/L and control 2 94g/L±1 13g/L, P =0 869), amylase per volume and the ratio of the amylase to the protein ( P =0 173 and 0 436). CONCLUSION The secreting functions of saliva in Piyinxu patients are low.
文摘AIM To investigate the etiologic association of pancreas divisum (PD) with chronic pancreatitis and to clarify its pathogenesis. METHODS A PD canine model was established in 32 dogs. The dogs were randomly divided into 4 groups ( n =8). Group Ⅰ: The communicating branch between the dorsal and ventral pancreatic ducts was partly ligated. Group Ⅱa: The communicating branch was amputated and completely ligated. Group Ⅱb: The dorsal duct was amputated and ligated at 2mm distance to the minor papilla. Group Ⅲ: A sham operation without any amputation or ligation was performed. Before and after operation, the activities of serum phospholipase A2 (PLA2) and amylase (Ams) were assayed and the basal pressures of the ducts were measured when secretin was injected. Pancreatic ductography and the pathologic examination were made. RESULTS The activities of serum PLA2 and Ams in Group Ⅰ,Ⅱa and Ⅱb were significantly increased 5-80 days after operation. At sacrifice, the basal pressures of the ventral duct were significantly higher 30min-60min after provocation in Group Ⅰ, Ⅱa and Ⅱb. The pressures of the dorsal duct were significantly increased in Group Ⅱb but no difference in Group Ⅰ and Ⅱa. Under light microscopy the fibrosis of interlobus and periducts, the destruction of acini and infiltration of inflammatory cell in dorsal and ventral pancreas were found in Group Ⅱb. But in Group Ⅰ and Ⅱa, these findings were present only in ventral pancreas. The electron microscopy showed that in ventral pancreas of Groups Ⅰ and Ⅱa and the dorsal and ventral pancreas of Group Ⅱb, the rough endoplasmic reticulum of the acinar cells showed granules scaling, fusion and dilatation. The zymogen granules decreased and the mitochondria was swollen. CONCLUSION PD is one of etiologic factors in chronic pancreatitis. The pathogenesis is the functional obstruction of the minor papilla at the peak stage of secretion.
文摘According to the American Diabetes Association,diabetes was the seventh leading cause of death,and diabetic retinopathy the leading cause of blindness in working age adults in the United States in 2010.Diabetes is characterized by hyperglycemia associated with either hypoinsulinemia or insulin resistance,and over time,this chronic metabolic condition may lead to various complications including kidney failure,heart attacks,and retinal degeneration.In order to better understand the molecular basis of this disease and its complications,animal models have been the primary approach used to investigate the effects of diabetes on various tissues or cell types of the body,including the retina.However,inherent to these animal models are critical limitations that make the insight gained from these models challenging to apply to the human pathology.These difficulties in translating the knowledge obtained from animal studies have led a growing number of research groups to explore the diabetes complications,especially diabetic retinopathy,on tissues from human donors.This review summarizes the data collected from diabetic patients at various stages of diabetic retinopathy and classifies the data based upon their relevance to the main aspects of diabetic retinopathy:retinal vasculature dysfunction,inflammation,and neurodegeneration.This review discusses the importance of those studies to discriminate and establish the relevance of the findings obtained from animal models but also the limitations of such approaches.
基金supported by a grant from Catholic Universitary Center(Centro Universitario Cattolico)-Conferenza Episcopale Italiana,Rome,Italy(to FF)。
文摘Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a number of non-diabetic patients after acute ischemic stroke, presumably as a stress response. The aim of this review is to summarize the main effects of hyperglycemia when associated to ischemic injury in acute stroke patients, highlighting the clinical and neurological outcomes in these conditions and after the administration of the currently approved pharmacological treatment, i.e. insulin. The disappointing results of the clinical trials on insulin(including the hypoglycemic events) demand a change of strategy based on more focused therapies. Starting from the comprehensive evaluation of the physiopathological alterations occurring in the ischemic brain during hyperglycemic conditions, the effects of various classes of glucose-lowering drugs are reviewed, such as glucose-like peptide-1 receptor agonists, DPP-4 inhibitors and sodium glucose cotransporter 2 inhibitors, in the perspective of overcoming the up-to-date limitations and of evaluating the effectiveness of new potential therapeutic strategies.
基金Supported by the Independent Subject of China Academy of Chinese Medical Sciences(No.ZZ0808008)the Independent Subject of the Eye Hospital of China Academy of Chinese Medical Sciences(No.201705)Key Research Project of the Capital Health Development Research Fund(No.2016-1-4181)
文摘AIM： To respectively evaluate macular morphological features and functional parameters by using spectraldomain optical coherence tomography（SD-OCT） and macular integrity assessment（MAIA） in patients with diabetic macular edema（DME）. METHODS： This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity（BCVA） measurement, MAIA microperimetry, and SDOCT. DME morphology, including central retinal thickness（CRT） and central retinal volume（CRV）; integrity of the external limiting membrane（ELM） and photoreceptor inner segment/outer segment（IS/OS） junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold（AT）-retinal sensitivity, macular integrity index（MI）, fixation points within a circle of radius 1°（P1） and 2°（P2）, and bivariate contour ellipse area considering 63% and 95% of the fixation points（A63 and A95, respectively）. RESULTS： MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA（log MAR）, total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA（log MAR）, AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION： Functional（BCVA and visual field） and morphological parameters（retinal thickness） were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.
文摘Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.
基金Supported by funds from the Swedish Research Council (grant 2002-5489) and the Swedish Society of Medicine (Ihre’s fond)
文摘AIM: To investigate if there is a correlation between electrical activity measured by electrogastrography (EGG) and contractile activity of the stomach as measured by antroduodenal manometry (ADM). We also studied whether the underlying motility disorder could be predicted from EGG parameters. METHODS: We compared 21 parameters measured from EGG with 8 parameters measured from ADM. The ability of EGG to identify the underlying diagnosis was tested by comparing EGG parameters for each diagnosis group against other patients. The study comprised recordings from 148 patients and 125 females. Their median age was 45 (range 17-76) years. RESULTS: We found few and weak correlations between EGG and ADM. Specifically the correlation between parameters reflecting the response to meal was poor (r = -0.07, P = 0.39). The discriminatory power of EGG for underlying motility disorder was also low. Patients with slow transit constipation (STC) showed a lower postprandial power in normogastric (3.7 ± 0.5 vs 4.0 ± 0.5) and tachygastric (3.5 ± 0.4 vs 3.7 ± 0.4) regions, a lower percentage of time with normogastria [87.2 (56.5-100)% vs 95.7 (0-100)%], and a higher percentage of time with tachygastria [9.3 (0-33)% vs 3.5 (0-100)%] and bradygastria [1.8 (0-20)% vs 0 (0-17.1)%]. Patients with irritable bowel syndrome had a higher percentage of time with normogastria [96.5 (62.5-100)% vs 93.3 (0-100)%] and a less unstable dominant frequency as measured by the instability coefficient [15 (3-77) vs 24 (2-72)]. CONCLUSION: EGG and ADM seem to measure different aspects of gastric motor activity but cannot show a spatial correlation. The diagnostic value of EGG is poor, but EGG may have some value for the identification of patients with STC.
文摘IM To study the plasma level of gastrointestinal hormones and gastric emptying in patients with peptic ulcer. METHODS Thirty patients with gastric ulcer (GU), and 29 duodenal ulcer (DU) and 12 controls were studied. Plasma levels of SS, VIP and SP were measured by radioimmunoassay, and gastric emptying half time (GET1/2) was determined with TC99mresin solid meal method. RESULTS GET1/2(min) was significantly longer in GU than that in controls (659±148 vs 533±43, P<001) and plasma VIP levels (ng/L) were significantly higher than in controls (375±107 vs 184±59, P<005). There was a significant positive correlation between GET1/2 and plasma VIP levels (r=055,P<001). No significant changes were found in SS and SP in GU compared with controls (P>005). GET1/2 in DU was markedly shorter than the control group (417±102 vs 533±43, P<001), and plasma SS levels (ng/L) significantly lower than those in controls (64±25 vs 119±34,P<001), there was a significant positive correlation between GET1/2 and SS levels (r=056,P<001). Plasma SP levels (ng/L) in DU were significantly higher than the controls (544±127 vs 416±58,P<001),there was a significant negative correlation between GET1/2 and SP levels (r=-068,P<001). No significant difference was found in the plasma VIP levels between DU and controls (P>005).CONCLUSION VIP elevation may contribute to the GET1/2 delay and the occurrence of GU. The increased SP and lowered SS may play important roles in the GET1/2 acceleration and the pathogensis of DU.
文摘Non-alcoholic fatty liver disease(NAFLD) is a major health care problem and represents the hepatic expression of the metabolic syndrome. NAFLD is classified as nonalcoholic fatty liver(NAFL) or simple steatosis,and non-alcoholic steatohepatitis(NASH). NASH is characterized by the presence of steatosis and inflammation with or without fibrosis. The physiopathology of NAFL and NASH and their progression to cirrhosis involve several parallel and interrelated mechanisms,such as,insulin resistance(IR),lipotoxicity,inflammation,oxidative stress,and recently the gut-liver axis interaction has been described. Incretin-based therapies could play a role in the treatment of NAFLD. Glucagon-like peptide-1(GLP-1) is an intestinal mucosa-derived hormone which is secreted into the bloodstream in response to nutrient ingestion; it favors glucose-stimulated insulin secretion,inhibition of postprandial glucagon secretion and delayed gastric emptying. It also promotes weight loss and is involved in lipid metabolism. Once secreted,GLP-1 is quickly degraded by dipeptidyl peptidase-4(DPP-4). Therefore,DPP-4 inhibitors are able to extend the activity of GLP-1. Currently,GLP-1 agonists and DPP-4 inhibitors represent attractive options for the treatment of NAFLD and NASH. The modulation of lipid and glucose metabolism through nuclear receptors,such as the farsenoid X receptor,also constitutes an attractive therapeutic target. Obeticholic acid is a potent activator of the farnesoid X nuclear receptor and reduces liver fat content and fibrosis in animal models. Ursodeoxycholic acid(UDCA) is a hydrophilic bile acid with immunomodulatory,antiinflammatory,antiapoptotic,antioxidant and antifibrotic properties. UDCA can improve IR and modulate lipid metabolism through its interaction with nuclear receptors such as,TGR5,farnesoid X receptor-a,or the small heterodimeric partner. Finally,pharmacologic modulation of the gut microbiota could have a role in the therapy of NAFLD and NASH. Probiotics prevent bacterial translocation and epithelial invasion,inhibit mucosal adherence by bacteria,and stimulate host immunity. In animal models,probiotics prevent obesity,decrease transaminase levels,and improve IR and liver histology in NASH.
文摘The dying-back hypothesis holds that the damage to neuromuscular junctions and distal axons in amyotrophic lateral sclerosis occurs at the earliest stage of the disease.Previous basic studies have confirmed early damage to neuromuscular junctions,but it is difficult to obtain such evidence directly in clinical practice.In this prospective cross-sectional study,we recruited 22 patients with early amyotrophic lateral sclerosis with disease duration < 12 months and with clinical symptoms limited to the upper limbs.We also recruited 32 healthy controls.Repetitive nerve stimulation was performed,and patients were followed for 12 months.We found a significant change in the response to repetitive nerve stimulation in amyotrophic lateral sclerosis patients without spontaneous electromyographic activity.Patients that were prone to denervation had an increased decrement response of target muscles after repetitive nerve stimulation.These results suggest that changes in response to repetitive nerve stimulation may occur before denervation in amyotrophic lateral sclerosis patients.The damage to lower motor neurons is more obvious in patients with a higher percentage of repetitive never stimulation-related amplitude decrements.This study was approved by the Institutional Ethics Committee of Peking University Third Hospital(approval No.M2017198) on August 24,2017.
文摘Kidney transplantation is considered the treatment of choice for end-stage kidney disease patients.However,the residual cardiovascular risk remains significantly higher in kidney transplant recipients(KTRs)than in the general population.Hypertension is highly prevalent in KTRs and represents a major modifiable risk factor associated with adverse cardiovascular outcomes and reduced patient and graft survival.Proper definition of hypertension and recognition of special phenotypes and abnormal diurnal blood pressure(BP)patterns is crucial for adequate BP control.Misclassification by office BP is commonly encountered in these patients,and a high proportion of masked and uncontrolled hypertension,as well as of white-coat hypertension,has been revealed in these patients with the use of ambulatory BP monitoring.The pathophysiology of hypertension in KTRs is multifactorial,involving traditional risk factors,factors related to chronic kidney disease and factors related to the transplantation procedure.In the absence of evidence from large-scale randomized controlled trials in this population,BP targets for hypertension management in KTR have been extrapolated from chronic kidney disease populations.The most recent Kidney Disease Improving Global Outcomes 2021 guidelines recommend lowering BP to less than 130/80 mmHg using standardized BP office measurements.Dihydropyridine calcium channel blockers and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers have been established as the preferred first-line agents,on the basis of emphasis placed on their favorable outcomes on graft survival.The aim of this review is to provide previous and recent evidence on prevalence,accurate diagnosis,pathophysiology and treatment of hypertension in KTRs.
基金Supported by the Youth Foundation of the General Logistics Department of PLA
文摘Left ventricular contractility was measured using Doppler echocardiography in 37 pa-tients with rheumatic mitral valve disease.Myocardial pathological lesions were studied quanti-tatively by means of the image analysis system and light microscopic examination.The resultsshowed that attenuated cardiac function is due to pathological change of the mitral valve andpathological lesions of the left ventrieular myocardium including increased interstitial fibrosis,thickened intramyocardial arterial wall leading to concentric narrowing of the lumen,hyper-trophic myocardial fiber and endocardial proliferation.Since mitral valve replacement can notcorrect the irreversible myocardial pathological lesions,perioperative protection of the my-ocardium should be emphasized,and intraoperative injury to the myocardium should be mini-mized as far as possible.
文摘Chronic fatigue syndrome (CFS) is a poorly understood condition primarily characterized by debilitateing, persistent or recurrent fatigue, increased physical and mental fatigability, cognitive impairment and widespread musculoskeletal pain. During the past two decades, there have been heated debates about CFS among researchers, practitioners and patients. The existence of the disorder has been questioned, its underlying pathophysiology debated and an effective treatment opposed (such as antidepressants, stimulants or antibiotics). A lot of multidisciplinary literature is found about CFS, but to date, many psychiatrists seem to unknown the existence of this illness or think that it is a purely psychological disorder. However, CFS is sitting on the border between medicine and psychiatry. The aim of this review is to make psychiatrists aware of the existence of CFS and that they will, one day, be confronted with the management of this illness. Thus, this update allows understanding what is CFS, the diversity of physiopathology underlined and its management.
文摘Trauma-induced coagulopathy （TIC） is a clinical syndrome caused by imbalance between clotting, anti- coagulation and fibrinolysis resulting from multiple pathological factors such as hemorrhage and tissue injury in the early stage of trauma, and is closely related to the outcome of trauma patients. It is proved in growing evidence that the endogenous coagulation disturbance in trauma itself is the activating factor of TIC, rather than dilution or other acquired coagulopathy. Therefore, a thorough understanding of the molecular mechanisms in the pathogenesis and progression is crucial for effective prevention and treatment in patients with TIC. This review focuses on transitions in the concept of TIC and mechanical progress.
