Environmental monitoring of airborne formaldehyde (FA) using sensitive methodologies is fundamental to prevent health risks. The objective of this study was to compare three different FA monitoring methods during the ...Environmental monitoring of airborne formaldehyde (FA) using sensitive methodologies is fundamental to prevent health risks. The objective of this study was to compare three different FA monitoring methods during the daily activities of an anatomic pathology laboratory. Daily eight-hour measurements deriving from Radiello® passive diffusive samplers (PDS), NEMo XT continuous optical sensor (COS), and multi-gas 1512 photoacoustic monitor (MPM) were simultaneously compared over a period of 14 working days. Given the different daily distributions of the measurements performed by the three devices, all measurements were time-aligned for comparison purposes. The 95% limit of agreement (LOA) method was applied to estimate the degree of concordance of each device with respect to the others. Formaldehyde arithmetic mean measured using PDS was 32.6 ± 10.4 ppb (range: 19.8 - 62.7). The simultaneous measures performed by COS and MPM were respectively 42.4 ± 44.8 ppb (range: 7.0 - 175.0) and 189.0 ± 163.7 ppb (range: 40.0 - 2895.4). The MPM geometric mean (171.3 ppb) was approximately five times higher than those derived from COS (32.3 ppb) and PDS (31.4 ppb). The results of the LOA method applied to log-transformed FA data showed the same systematic discrepancies between MPM and the other two devices. A good agreement between PDS and COS could lead to a tailored approach according to the individual specificity of these techniques. This tool may be useful for accurately assessing the risk of FA exposure among healthcare workers. However, the limited specificity of the MPM does not support its use as a monitoring method for FA in the workplace.展开更多
Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hos...Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.展开更多
Objective:Leptin(LEP)is an obesity-associated adipokine associated with tumor cell growth.We examined the relevance of genetic variants of LEP and leptin receptor(LEPR)to colorectal cancer(CRC)survival by using data f...Objective:Leptin(LEP)is an obesity-associated adipokine associated with tumor cell growth.We examined the relevance of genetic variants of LEP and leptin receptor(LEPR)to colorectal cancer(CRC)survival by using data from the Newfoundland Familial Colorectal Cancer Study.Methods:A total of 532 patients newly diagnosed with CRC between 1997 and 2003 were followed up until April 2010.Data on their demographics and lifestyles were collected via questionnaires.Genotyping of blood samples was performed with the Illumina Human Omni-Quad Bead chip.Multivariable Cox models were used to assess the relationships of 35 tag single-nucleotide polymorphisms(SNPs)in LEP and LEPR with overall survival(OS),disease-free survival(DFS),and CRC-specific survival.Results:At the gene level,LEP was associated with DFS(P=0.017),and LEPR was associated with both DFS(P=0.021)and CRCspecific survival(P=0.013)in patients with CRC.In single-SNP analysis,LEP rs11763517,LEPR rs9436301,and LEPR rs7602 were associated with DFS after adjustment for multiple testing.The LEPR haplotypes G-C-T(rs7534511-rs9436301-rs1887285)and A-A-G(rs7602-rs970467-rs9436748)were associated with prolonged OS among patients with CRC overall(G-C-T:HR,0.63;95%CI,0.43–0.93;A-A-G:HR,0.59;95%CI,0.38–0.91)and those diagnosed with colon cancer(G-C-T:HR,0.54;95%CI,0.34–0.86;A-A-G:HR,0.49;95%CI,0.29–0.83).Similar results were observed for DFS.Moreover,significant interactions were found among LEPR rs7602(A vs.G),LEPR rs1171278(T vs.C),red meat intake,and BMI status:the associations between these variants and prolonged DFS were limited to patients with below-median red meat consumption and body mass index(BMI)<25 kg/m2.Conclusions:Polymorphic variations in the LEP and LEPR genes were associated with survival of patients after CRC diagnosis.The LEP/LEPR-CRC survival association was modified by participants’red meat intake and BMI.展开更多
Objective:China is one of the countries with the heaviest burden of gastric cancer(GC)in the world.Understanding the epidemiological trends and patterns of GC in China can contribute to formulating effective preventio...Objective:China is one of the countries with the heaviest burden of gastric cancer(GC)in the world.Understanding the epidemiological trends and patterns of GC in China can contribute to formulating effective prevention strategies.Methods:The data on incidence,mortality,and disability-adjusted life-years(DALYs)of GC in China from1990 to 2019 were obtained from the Global Burden of Disease Study(2019).The estimated annual percentage change(EAPC)was calculated to evaluate the temporal trends of disease burden of GC,and the package Nordpred in the R program was used to perform an age-period-cohort analysis to predict the numbers and rates of incidence and mortality in the next 25 years.Results:The number of incident cases of GC increased from 317.34 thousand in 1990 to 612.82 thousand in2019,while the age-standardized incidence rate(ASIR)of GC decreased from 37.56 per 100,000 in 1990 to 30.64 per 100,000 in 2019,with an EAPC of-0.41[95%confidence interval(95%CI):-0.77,-0.06].Pronounced temporal trends in mortality and DALYs of GC were observed.In the next 25 years,the numbers of new GC cases and deaths are expected to increase to 738.79 thousand and 454.80 thousand,respectively,while the rates of incidence and deaths should steadily decrease.The deaths and DALYs attributable to smoking were different for males and females.Conclusions:In China,despite the fact that the rates of GC have decreased during the past three decades,the numbers of new GC cases and deaths increased,and will continue to increase in the next 25 years.Additional strategies are needed to reduce the burden of GC,such as screening and early detection,novel treatments,and the prevention of risk factors.展开更多
AIM: Obesity and insulin resistance (IR) are closely related to hepatic steatosis (HS), and adiponectin is a hepatic insulin sensitizer that has important effects in liver function. This study aims at investigating th...AIM: Obesity and insulin resistance (IR) are closely related to hepatic steatosis (HS), and adiponectin is a hepatic insulin sensitizer that has important effects in liver function. This study aims at investigating the relationship between serum adiponectin concentration and the presence of HS. METHODS: We carried out a cross-sectional study in a check-up unit of a University Hospital in Mexico City. We enrolled 196 subjects, comprising 98 subjects with HS (27 women, 71 men) and 98 controls (37 women and 61 men). Anthropometric, metabolic and biochemical variables were measured in the two groups. Serum adiponectin and leptin concentrations were determined, their association with grade of HS tested, and concentrations, according to quartiles, compared between cases and controls. X2 analysis for linear trends was used to test for a dose-response relationship and logistic regression analysis was conducted to test for a protective effect of adiponectin. RESULTS: The HS subjects were older and more obese than controls, with a central obesity pattern. In the fourth quartile of adiponectin concentrations, HS was less common and severe. In a multivariate model of the fourth quartile of the adiponectin concentrations, we observed a protective effect (OR = 0.17, 95%CI: 0.04-0.67, P= 0.01). In subjects with more severe HS, we observed higher leptin concentrations, and caloric intakes, total fat and iron consumption were higher than in controls. CONCLUSION: The results of the present study suggest that a high serum concentration of adiponectin is associated with a protective effect against HS.展开更多
AIM： To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy.METHODS： A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twe...AIM： To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy.METHODS： A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared.RESULTS： Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles （100.00% vs 42.37%, P 〈 0.0002） but simethicone failed to demonstrate improvement in adequacy of colon preparation （90.16% vs 81.36%, P = 0.17）. Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication.CONCLUSION： The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.展开更多
AIM:To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS:Out of 1366 hepatitis B surface antigen(HBsAg) positive subjects consecutively observed in 79 Italian hos...AIM:To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS:Out of 1366 hepatitis B surface antigen(HBsAg) positive subjects consecutively observed in 79 Italian hospitals,53(4.3%) showed as the only cofactor hepatitis D virus(HDV) infection [hepatitis B virus(HBV)/HDV group],130(9.5%) hepatitis C virus(HCV)(group HBV/HCV),6(0.4%) human immunodeficiencyvirus(HIV)(group HBV/HIV),138(10.2%) alcohol abuse(group HBV/alcohol);109(8.0%) subjects had at least two cofactors and 924 were in the cofactor-free(CF) group.RESULTS:Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis(P < 0.001),those in group HBV/HDV were younger(P < 0.001),more frequently resided in the south of the country and had cirrhosis(P <0.001),those in group HBV/HCV were older(P < 0.001) and more frequently had cirrhosis(P < 0.001).These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients.Multivariate analysis showed that an older age [odds ratio(OR) 1.06,95% CI:1.05-1.08],alcohol abuse with more than 8 drinks daily(OR 2.89,95% CI:1.81-4.62) and anti-HDV positivity(OR 3.48,95% CI:2.16-5.58) are all independently associated with liver cirrhosis.This association was found also for anti-HCV positivity in univariate analysis,but it was no longer associated(OR 1.23,95% CI:0.84-1.80) at multivariate analysis.CONCLUSION:Older age,HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection,while HCV replication plays a lesser role in the severity of hepatic damage.展开更多
AIM: To investigate the cellular defects by analyzing the (Th1/Th2) cytokine levels in vaccine responders and non-responders. METHODS: Peripheral blood mononuclear cell (PBMC) from responders and non-responders were s...AIM: To investigate the cellular defects by analyzing the (Th1/Th2) cytokine levels in vaccine responders and non-responders. METHODS: Peripheral blood mononuclear cell (PBMC) from responders and non-responders were stimulated with or with out recombinant HBsAg or PHA. Broad spectrum of cytokines viz (Th1) IFN-γ, IL-2, TNF-α, IL-12 and (Th2) IL-10, IL-4 were measured after in vitro stimulation with recombinant HBsAg and were compared with respective antibody titers. RESULTS: A significant decrease (P = 0.001) in Th1 and Th2 cytokines namely, IL-2, INF-γ, TNF-α and IL-10in non-responders was observed. The level of IL-4 was not significant between the three groups. Furthermore, despite a strong Th1 and Th2 cytokine response, the level of IL-12 was elevated in high-responders compared to other groups (P = 0.001) and demonstrated a positive correlation with anti-HBs titers and Th1 cytokine response. CONCLUSION: Our findings suggest that unrespon-siveness to recombinant hepatitis B vaccines (rHB) is multifactorial, including specific failure of antigen presentation or the lack of both T helper Th1 and Th2 response.展开更多
BACKGROUND Acute respiratory distress syndrome(ARDS)is a major cause of death in patients with severe acute pancreatitis(SAP).Although a series of prediction models have been developed for early identification of such...BACKGROUND Acute respiratory distress syndrome(ARDS)is a major cause of death in patients with severe acute pancreatitis(SAP).Although a series of prediction models have been developed for early identification of such patients,the majority are complicated or lack validation.A simpler and more credible model is required for clinical practice.AIM To develop and validate a predictive model for SAP related ARDS.METHODS Patients diagnosed with AP from four hospitals located at different regions of China were retrospectively grouped into derivation and validation cohorts.Statistically significant variables were identified using the least absolute shrinkage and selection operator regression method.Predictive models with nomograms were further built using multiple logistic regression analysis with these picked predictors.The discriminatory power of new models was compared with some common models.The performance of calibration ability and clinical utility of the predictive models were evaluated.RESULTS Out of 597 patients with AP,139 were diagnosed with SAP(80 in derivation cohort and 59 in validation cohort)and 99 with ARDS(62 in derivation cohort and 37 in validation cohort).Four identical variables were identified as independent risk factors for both SAP and ARDS:heart rate[odds ratio(OR)=1.05;95%CI:1.04-1.07;P<0.001;OR=1.05,95%CI:1.03-1.07,P<0.001],respiratory rate(OR=1.08,95%CI:1.0-1.17,P=0.047;OR=1.10,95%CI:1.02-1.19,P=0.014),serum calcium concentration(OR=0.26,95%CI:0.09-0.73,P=0.011;OR=0.17,95%CI:0.06-0.48,P=0.001)and blood urea nitrogen(OR=1.15,95%CI:1.09-1.23,P<0.001;OR=1.12,95%CI:1.05-1.19,P<0.001).The area under receiver operating characteristic curve was 0.879(95%CI:0.830-0.928)and 0.898(95%CI:0.848-0.949)for SAP prediction in derivation and validation cohorts,respectively.This value was 0.892(95%CI:0.843-0.941)and 0.833(95%CI:0.754-0.912)for ARDS prediction,respectively.The discriminatory power of our models was improved compared with that of other widely used models and the calibration ability and clinical utility of the prediction models performed adequately.CONCLUSION The present study constructed and validated a simple and accurate predictive model for SAPrelated ARDS in patients with AP.展开更多
AIM:To investigate the level of mucosal expression and the involvement of the receptor for the advanced glycation end products(RAGE)in delayed apoptosis and tumor necrosis factor(TNF)-αproduction in Crohn’s disease(...AIM:To investigate the level of mucosal expression and the involvement of the receptor for the advanced glycation end products(RAGE)in delayed apoptosis and tumor necrosis factor(TNF)-αproduction in Crohn’s disease(CD).METHODS:Surgical and endoscopic specimens from both inflamed and non-inflamed areas of the ileum and/or colon were collected from 20 and 14 adult CD patients,respectively,and used for the assessment of RAGE expression by means of immunohistochemistry and western blotting analysis.Normal tissues from 21 control subjects were used for comparison.The same polyclonal anti-human RAGE antibody(R and D System)was used in all experimental conditions.RAGE staining was quantized by a score including both the amount of positive cells and intensity of immunoreactivity;cellular pattern was also described.The effects of RAGE blocking on apoptotic rate and TNF-αproduction were investigated on immune cells freshly isolated from CD mucosa and incubated both with and without the muramyl dipeptide used as antigenic stimulus.Statistical analysis was performed via the test for trend,with regression models to account for intra-patient correlations.A 2-sided P<0.05 was considered significant.RESULTS:In inflamed areas,RAGE expression in both the epithelial and lamina propria compartments was higher than control tissues(P=0.001 and 0.021,respectively),and a cluster of positive cells were usually found in proximity of ulcerative lesions.Similar results were obtained in the lamina propria compartment of non-inflamed areas(P=0.025).The pattern of staining was membranous and granular cytosolic at the epithelial level,while in the lamina propria it was diffuse cytosolic.When evaluating the amount of protein expression by immunoblotting,a significant increase of both surface area and band intensity(P<0.0001 for both)was observed in CD inflamed areas compared to control tissue,while in non-inflamed areas a significant increase was found only for band intensity(P<0.005).Moreover,a significantly lower expression in noninflamed areas in comparison with inflamed areas was found for both surface area and band intensity(P<0.0006 for both).Finally,RAGE blocking largely affects both the apoptotic rate of mucosal cells(towards an increase in both non-inflamed and inflamed areas of P<0.001 and<0.0001,respectively)and TNF-αsecretion(towards a decrease in both non-inflamed and inflamed areas of P<0.05 and<0.01,respectively),mainly in the presence of antigenic stimulation.CONCLUSION:RAGE is up-regulated in CD,especially in inflamed areas,and it appears to play a role in the mechanisms involved in chronic inflammation.展开更多
Our study was to investigate the epidemiological characteristics of M.tuberculosis from a national tuberculosis referral center in China. All strains isolated from TB patients, were genotyped by the RD105 deletion, 8 ...Our study was to investigate the epidemiological characteristics of M.tuberculosis from a national tuberculosis referral center in China. All strains isolated from TB patients, were genotyped by the RD105 deletion, 8 and 51 SNP loci and VNTR. The high differentiation SNPs of modern Beijing strains were analyzed for protein function and structure. 413 M. tuberculosis were included. Of 379 Beijing lineage M. tuberculosis, ＇modern＇ and ＇ancient＇ strains respectively represented 85.5% （324/379） and 14.5% （55/379）. Rv2494 （V48A） and Rv0245 （Sl03F） were confirmed as high differentiation SNPs associated with modern strains. In a word, Modern Beijing lineage M.tuberculosis was dominant and the structural models suggested that modern sub-lineage may more easily survive in ＇extreme＇ host condition.展开更多
AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature sea...AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios(OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen(HBs Ag) positive] were included. The comparison group consisted of HBs Agnegative kidney transplant recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of Der Simonian and Laird. The protocol for this metaanalysis is registered with PROSPERO(International Prospective Register of Systematic Reviews; no. CRD42017080657).RESULTS Ten observational studies with a total of 87623 kidney transplant patients were enrolled. Compared to HBs Ag-negative recipients, HBs Ag-positive status was significantly associated with increased risk of mortality after kidney transplantation(pooled OR = 2.48; 95%CI: 1.61-3.83). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBs Ag-positive recipients and year of study(slopes =-0.062, P = 0.001). HBs Agpositive status was also associated with increased risk of renal allograft failure with pooled OR of 1.46(95%CI: 1.08-1.96). There was also a significant negative correlation between year of study and risk of allograft failure(slopes =-0.018, P = 0.002). These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients. We found no publication bias as assessed by the funnel plots and Egger's regression asymmetry test with P = 0.18 and 0.13 for the risks of mortality and allograft failure after kidney transplantation in HBs Ag-positive recipients, respectively.CONCLUSION Among kidney transplant patients, there are significant associations between HBs Ag-positive status and poor outcomes including mortality and allograft failure. However, there are potential improvements in patient and graft survivals in HBs Ag-positive recipients overtime.展开更多
Objectives To investigate the positive rate of different hepatitis B virus （HBV） serological markers, and the demographic factors related to HBV infection. Methods We enrolled all patients tested for HBV serologica...Objectives To investigate the positive rate of different hepatitis B virus （HBV） serological markers, and the demographic factors related to HBV infection. Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen （HBsAg）, HBV surface antibody （HBsAb）, hepatitis B e antigen （HBeAg）, hepatitis B e antibody （HBeAb）, HBV core antibody （HBcAb）, and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and department, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed. Results Among 27 409 samples included, 2681 （9.8%） were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%, 5.8%, and 4.7%, respectively. The positive rate of HBsAg of males （13.3%） was higher than that of females （7.3%, P=0.000）. Among the 2681 HBsAg （＋） patients, 1230 （45.9%） had HBV-DNA test, of whom 564 （45.9%） were positive. Patients with HBsAg （＋）, HBeAg （＋）, and HBcAg （＋） result usually had high positive rate of HBV-DNA results （71.8%, P=0.000）. Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.展开更多
AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication. METHODS: From April 2006 to June 2010, we retro...AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication. METHODS: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test(UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d. RESULTS: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and thirdline therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate. CONCLUSION: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and secondline treatment can still be triple therapy with amoxicillin and tinidazole.展开更多
The study of the origin of SARS coronavirus(SARS CoV)and SARS-like coronavirus(SL-CoV)is very important for the prevention of novel human infections with these viruses.Recently,Ge et al.suggest that Chinese horseshoe ...The study of the origin of SARS coronavirus(SARS CoV)and SARS-like coronavirus(SL-CoV)is very important for the prevention of novel human infections with these viruses.Recently,Ge et al.suggest that Chinese horseshoe bats are natural reservoirs of SARSCoV[1].But this conclusion is incorrect.It should be"Chinese horseshoe bats are natural reservoirs of SLCoV"[2-7].The paper also has several methodological problems,leading to errors in the conclusions.展开更多
AIM: To evaluate the ability of the McGill Brisbane Symptom Score (MBSS) to predict survival in resectable pancreatic head adenocarcinoma (PHA) patients.
AIM To assess prevalence of pre-existing atrial fibrillation(AF) and/or incidence of AF following liver transplantation, and the trends of patient's outcomes overtime; to evaluate impact of pre-existing AF and pos...AIM To assess prevalence of pre-existing atrial fibrillation(AF) and/or incidence of AF following liver transplantation, and the trends of patient's outcomes overtime; to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation. METHODS A literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception throughMarch 2018. We included studies that reported:(1) prevalence of pre-existing AF or incidence of AF following liver transplantation; or(2) outcomes of liver transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing randomeffect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO(International Prospective Register of Systematic Reviews, No. CRD42018093644). RESULTS Twelve observational studies with a total of 38586 liver transplant patients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4%(95%CI: 4.9%-5.9%) and pooled estimated incidence of AF following liver transplantation was 8.5%(95%CI: 5.2%-13.6%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF(P = 0.08) or post-operative AF after liver transplantation(P = 0.54). The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34(2 studies; 95%CI: 1.10-5.00). In addition, pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients(3 studies; OR: 5.15, 95%CI: 2.67-9.92, I2 = 64%). With limited studies, two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality, cerebrovascular events, post-transplant acute kidney injury, and increased risk of graft failure among liver transplant recipients(P < 0.05).CONCLUSION The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4% and 8.5%, respectively. Incidence of AF following liver transplant does not seem to decrease overtime. Preexisting AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.展开更多
We sought to determine the impact of implantable cardioverter-defibrillator(ICD) therapy in patients with familial arrhythmogenic right ventricular cardiomyopathy(ARVC). Arrhythmogenic right ventricular cardiomyopathy...We sought to determine the impact of implantable cardioverter-defibrillator(ICD) therapy in patients with familial arrhythmogenic right ventricular cardiomyopathy(ARVC). Arrhythmogenic right ventricular cardiomyopathy is a cause of sudden cardiac death, which may be prevented by ICD. We studied 11 families in which a 3p25 deoxyribonucleic acid(DNA) haplotype at locus ARVD5 segregated with disease and compared mortality in subjects who received an ICD with that in control subjects who were matched for age, gender, ARVC status, and family. Subjects(n=367) at 50%a priori risk of inheriting ARVC were classified as high risk(HR)(n=197), low risk(n=92), or unknown(n=78) on the basis of clinical events,DNA haplotyping, and/or pedigree position. Forty-eight HR subjects(30 males, [median age 32 years] and 18 females [median age 41 years]) were followed after ICD(secondary to ventricular tachycardia [VT] in 27%). Survival was compared with 58 HR control subjects who were alive at the same age to-the-day at which the ICD subject received the device. In the HR group, 50%of males were dead by 39 years and females by 71 years: relative risk of death was 5.1(95%confidence interval 3 to 8.5) for males. The five-year mortality rate after ICD in males was zero compared with 28%in control subjects(p=0.009). Within five years, the ICD fired for VT in 70%and for VT >240 beats/min in 30%, with no difference in discharge rate when analyzed by ICD indication. The unknown mutation at the ARVD5 locus causing ARVC results in high mortality. Risk stratification using genetic haplotyping and ICD therapy produced improved survival for males.展开更多
Objective:To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department(ED). Study design:All children hospitalized for bacterial meningitis between 1995 and ...Objective:To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department(ED). Study design:All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein,procalcitonin PCT ,white blood cell WBC count,neutrophil count) and cerebrospinal fluid (CSF) findings (protein,glucose,WBC count,neutrophil count) available in the ED were determined.Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison. Results:Among the 167 patients included,21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86%and 60%sensitivity rates,respectively.PCT (≥0.5 ng/mL) and CSF protein (≥0.5 g/L) were the best biologic tests,with 89%and 86%sensitivity rates,89%and 78%specificity rates,adjusted odds ratios of 108 (95%CI,15-772) and 34 (95%CI,5-217),and areas under the ROC curves of 0.95 and 0.93,respectively. Conclusion:PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.展开更多
Aims: Although outcomes after acute myocardiat infarction(AMI) seemed to be superior with primary percutaneous coronary intervention(PPCI) relative to fibrinolysis(FL), the extent to which treatment delay modulates th...Aims: Although outcomes after acute myocardiat infarction(AMI) seemed to be superior with primary percutaneous coronary intervention(PPCI) relative to fibrinolysis(FL), the extent to which treatment delay modulates this treatment effect is unclear. Methods and results: Twenty-five randomized trials(n=7743) testing the efficacy of PPCI vs. FL were identified in journal articles and abstract listings published between 1990 and 2002. Of these, individual patient data from 22 trials(n=6763) were pooled, and multi-level logistic regression assessed the relationship among treatment, treatment delay, and 30-day mortality. Treatment delay was divided into ‘ presentation delay’ [symptom onset to randomization; FL: median 143(IQR: 91-225) min; PPCI: 140(91-220) min] and hospital-sp3ecific ‘ PCI-related delay’ [median time from randomization to PPCI minus median time to FL per hospital; median 55(IQR: 37-74) min]. PPCI was associated with a significant 37% reduction in 30-day mortality [adjusted OR, 0.63; 95% CI(0.42-0.84)]. Although, there was no heterogeneity in the treatment effect by presentation delay(pBreslow-Day=0.88), the absolute mortality reduction by PPCI widened over time(1.3% 0-1 h to 4.2% >6 h after symptom onset). When the PCI-related delay was< 35min, the relative(67 vs. 28% pBreslow-Day=0.004) and absolute(5.4 vs. 2.0% ) mortality reduction was significantly higher than those with longer delays. Conclusion: PPCI was associated with significantly lower 30-day mortality relative to FL, regardless of treatment delay. Although logistic and economic constraints challenge the feasibility of ‘ PPCI-for-all’ , the benefit of timely treatment underscores the importance of a comprehensive, unified approach to delivery of cardiac care in all AMI patients.展开更多
文摘Environmental monitoring of airborne formaldehyde (FA) using sensitive methodologies is fundamental to prevent health risks. The objective of this study was to compare three different FA monitoring methods during the daily activities of an anatomic pathology laboratory. Daily eight-hour measurements deriving from Radiello® passive diffusive samplers (PDS), NEMo XT continuous optical sensor (COS), and multi-gas 1512 photoacoustic monitor (MPM) were simultaneously compared over a period of 14 working days. Given the different daily distributions of the measurements performed by the three devices, all measurements were time-aligned for comparison purposes. The 95% limit of agreement (LOA) method was applied to estimate the degree of concordance of each device with respect to the others. Formaldehyde arithmetic mean measured using PDS was 32.6 ± 10.4 ppb (range: 19.8 - 62.7). The simultaneous measures performed by COS and MPM were respectively 42.4 ± 44.8 ppb (range: 7.0 - 175.0) and 189.0 ± 163.7 ppb (range: 40.0 - 2895.4). The MPM geometric mean (171.3 ppb) was approximately five times higher than those derived from COS (32.3 ppb) and PDS (31.4 ppb). The results of the LOA method applied to log-transformed FA data showed the same systematic discrepancies between MPM and the other two devices. A good agreement between PDS and COS could lead to a tailored approach according to the individual specificity of these techniques. This tool may be useful for accurately assessing the risk of FA exposure among healthcare workers. However, the limited specificity of the MPM does not support its use as a monitoring method for FA in the workplace.
基金funded by the Major National Science and Technology Projects for the Control and Prevention of Major Infectious Diseases of China(2017ZX10201302-003)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2016-I2M-1-013).
文摘Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.
基金grants from the National Natural Science Foundation of China(Grant No.82003533)the CNS-ZD Tizhi and Health Fund(Grant No.CNS-ZD2020-82)+3 种基金funded by the Canadian Institutes of Health Research Team grant(Grant No.CIHR-CPT79845)Canadian Institutes of Health Research Team in Interdisciplinary Research on Colorectal Cancer Studentship(Grant No.205835)the National Cancer Institutes of Health under RFA#CA-08-502cooperative agreements with members of the Colon Cancer Family Registry and principal investigators:Ontario Registry for Studies of Familial Colorectal Cancer(Grant No.U01 CA074783)。
文摘Objective:Leptin(LEP)is an obesity-associated adipokine associated with tumor cell growth.We examined the relevance of genetic variants of LEP and leptin receptor(LEPR)to colorectal cancer(CRC)survival by using data from the Newfoundland Familial Colorectal Cancer Study.Methods:A total of 532 patients newly diagnosed with CRC between 1997 and 2003 were followed up until April 2010.Data on their demographics and lifestyles were collected via questionnaires.Genotyping of blood samples was performed with the Illumina Human Omni-Quad Bead chip.Multivariable Cox models were used to assess the relationships of 35 tag single-nucleotide polymorphisms(SNPs)in LEP and LEPR with overall survival(OS),disease-free survival(DFS),and CRC-specific survival.Results:At the gene level,LEP was associated with DFS(P=0.017),and LEPR was associated with both DFS(P=0.021)and CRCspecific survival(P=0.013)in patients with CRC.In single-SNP analysis,LEP rs11763517,LEPR rs9436301,and LEPR rs7602 were associated with DFS after adjustment for multiple testing.The LEPR haplotypes G-C-T(rs7534511-rs9436301-rs1887285)and A-A-G(rs7602-rs970467-rs9436748)were associated with prolonged OS among patients with CRC overall(G-C-T:HR,0.63;95%CI,0.43–0.93;A-A-G:HR,0.59;95%CI,0.38–0.91)and those diagnosed with colon cancer(G-C-T:HR,0.54;95%CI,0.34–0.86;A-A-G:HR,0.49;95%CI,0.29–0.83).Similar results were observed for DFS.Moreover,significant interactions were found among LEPR rs7602(A vs.G),LEPR rs1171278(T vs.C),red meat intake,and BMI status:the associations between these variants and prolonged DFS were limited to patients with below-median red meat consumption and body mass index(BMI)<25 kg/m2.Conclusions:Polymorphic variations in the LEP and LEPR genes were associated with survival of patients after CRC diagnosis.The LEP/LEPR-CRC survival association was modified by participants’red meat intake and BMI.
基金supported by the National Key Research and Development Program of China(No.2017YFC0907003)the National Natural Science Foundation of China(No.81973116 and 81573229)the Joint Research Funds for Shandong University and Karolinska Institute(No.SDU-KI-2020-03)。
文摘Objective:China is one of the countries with the heaviest burden of gastric cancer(GC)in the world.Understanding the epidemiological trends and patterns of GC in China can contribute to formulating effective prevention strategies.Methods:The data on incidence,mortality,and disability-adjusted life-years(DALYs)of GC in China from1990 to 2019 were obtained from the Global Burden of Disease Study(2019).The estimated annual percentage change(EAPC)was calculated to evaluate the temporal trends of disease burden of GC,and the package Nordpred in the R program was used to perform an age-period-cohort analysis to predict the numbers and rates of incidence and mortality in the next 25 years.Results:The number of incident cases of GC increased from 317.34 thousand in 1990 to 612.82 thousand in2019,while the age-standardized incidence rate(ASIR)of GC decreased from 37.56 per 100,000 in 1990 to 30.64 per 100,000 in 2019,with an EAPC of-0.41[95%confidence interval(95%CI):-0.77,-0.06].Pronounced temporal trends in mortality and DALYs of GC were observed.In the next 25 years,the numbers of new GC cases and deaths are expected to increase to 738.79 thousand and 454.80 thousand,respectively,while the rates of incidence and deaths should steadily decrease.The deaths and DALYs attributable to smoking were different for males and females.Conclusions:In China,despite the fact that the rates of GC have decreased during the past three decades,the numbers of new GC cases and deaths increased,and will continue to increase in the next 25 years.Additional strategies are needed to reduce the burden of GC,such as screening and early detection,novel treatments,and the prevention of risk factors.
文摘AIM: Obesity and insulin resistance (IR) are closely related to hepatic steatosis (HS), and adiponectin is a hepatic insulin sensitizer that has important effects in liver function. This study aims at investigating the relationship between serum adiponectin concentration and the presence of HS. METHODS: We carried out a cross-sectional study in a check-up unit of a University Hospital in Mexico City. We enrolled 196 subjects, comprising 98 subjects with HS (27 women, 71 men) and 98 controls (37 women and 61 men). Anthropometric, metabolic and biochemical variables were measured in the two groups. Serum adiponectin and leptin concentrations were determined, their association with grade of HS tested, and concentrations, according to quartiles, compared between cases and controls. X2 analysis for linear trends was used to test for a dose-response relationship and logistic regression analysis was conducted to test for a protective effect of adiponectin. RESULTS: The HS subjects were older and more obese than controls, with a central obesity pattern. In the fourth quartile of adiponectin concentrations, HS was less common and severe. In a multivariate model of the fourth quartile of the adiponectin concentrations, we observed a protective effect (OR = 0.17, 95%CI: 0.04-0.67, P= 0.01). In subjects with more severe HS, we observed higher leptin concentrations, and caloric intakes, total fat and iron consumption were higher than in controls. CONCLUSION: The results of the present study suggest that a high serum concentration of adiponectin is associated with a protective effect against HS.
基金Supported by The Gastroenterological Association of Thailand
文摘AIM： To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy.METHODS： A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared.RESULTS： Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles （100.00% vs 42.37%, P 〈 0.0002） but simethicone failed to demonstrate improvement in adequacy of colon preparation （90.16% vs 81.36%, P = 0.17）. Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication.CONCLUSION： The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.
基金Supported by A grant from the Progetto di Ricerca di Interesse Nazionale 2000in part with a grant from the Viral Hepatitis ProjectIstituto Superiore di Sanità,D.leg.vo 30/12/1992 n.502
文摘AIM:To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS:Out of 1366 hepatitis B surface antigen(HBsAg) positive subjects consecutively observed in 79 Italian hospitals,53(4.3%) showed as the only cofactor hepatitis D virus(HDV) infection [hepatitis B virus(HBV)/HDV group],130(9.5%) hepatitis C virus(HCV)(group HBV/HCV),6(0.4%) human immunodeficiencyvirus(HIV)(group HBV/HIV),138(10.2%) alcohol abuse(group HBV/alcohol);109(8.0%) subjects had at least two cofactors and 924 were in the cofactor-free(CF) group.RESULTS:Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis(P < 0.001),those in group HBV/HDV were younger(P < 0.001),more frequently resided in the south of the country and had cirrhosis(P <0.001),those in group HBV/HCV were older(P < 0.001) and more frequently had cirrhosis(P < 0.001).These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients.Multivariate analysis showed that an older age [odds ratio(OR) 1.06,95% CI:1.05-1.08],alcohol abuse with more than 8 drinks daily(OR 2.89,95% CI:1.81-4.62) and anti-HDV positivity(OR 3.48,95% CI:2.16-5.58) are all independently associated with liver cirrhosis.This association was found also for anti-HCV positivity in univariate analysis,but it was no longer associated(OR 1.23,95% CI:0.84-1.80) at multivariate analysis.CONCLUSION:Older age,HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection,while HCV replication plays a lesser role in the severity of hepatic damage.
基金Serum Institute of India, Pune, India and Indian Council for Medical Research (ICMR) New Delhi, India
文摘AIM: To investigate the cellular defects by analyzing the (Th1/Th2) cytokine levels in vaccine responders and non-responders. METHODS: Peripheral blood mononuclear cell (PBMC) from responders and non-responders were stimulated with or with out recombinant HBsAg or PHA. Broad spectrum of cytokines viz (Th1) IFN-γ, IL-2, TNF-α, IL-12 and (Th2) IL-10, IL-4 were measured after in vitro stimulation with recombinant HBsAg and were compared with respective antibody titers. RESULTS: A significant decrease (P = 0.001) in Th1 and Th2 cytokines namely, IL-2, INF-γ, TNF-α and IL-10in non-responders was observed. The level of IL-4 was not significant between the three groups. Furthermore, despite a strong Th1 and Th2 cytokine response, the level of IL-12 was elevated in high-responders compared to other groups (P = 0.001) and demonstrated a positive correlation with anti-HBs titers and Th1 cytokine response. CONCLUSION: Our findings suggest that unrespon-siveness to recombinant hepatitis B vaccines (rHB) is multifactorial, including specific failure of antigen presentation or the lack of both T helper Th1 and Th2 response.
基金Supported by the Chinese Natural Science Foundation,No.32170788.
文摘BACKGROUND Acute respiratory distress syndrome(ARDS)is a major cause of death in patients with severe acute pancreatitis(SAP).Although a series of prediction models have been developed for early identification of such patients,the majority are complicated or lack validation.A simpler and more credible model is required for clinical practice.AIM To develop and validate a predictive model for SAP related ARDS.METHODS Patients diagnosed with AP from four hospitals located at different regions of China were retrospectively grouped into derivation and validation cohorts.Statistically significant variables were identified using the least absolute shrinkage and selection operator regression method.Predictive models with nomograms were further built using multiple logistic regression analysis with these picked predictors.The discriminatory power of new models was compared with some common models.The performance of calibration ability and clinical utility of the predictive models were evaluated.RESULTS Out of 597 patients with AP,139 were diagnosed with SAP(80 in derivation cohort and 59 in validation cohort)and 99 with ARDS(62 in derivation cohort and 37 in validation cohort).Four identical variables were identified as independent risk factors for both SAP and ARDS:heart rate[odds ratio(OR)=1.05;95%CI:1.04-1.07;P<0.001;OR=1.05,95%CI:1.03-1.07,P<0.001],respiratory rate(OR=1.08,95%CI:1.0-1.17,P=0.047;OR=1.10,95%CI:1.02-1.19,P=0.014),serum calcium concentration(OR=0.26,95%CI:0.09-0.73,P=0.011;OR=0.17,95%CI:0.06-0.48,P=0.001)and blood urea nitrogen(OR=1.15,95%CI:1.09-1.23,P<0.001;OR=1.12,95%CI:1.05-1.19,P<0.001).The area under receiver operating characteristic curve was 0.879(95%CI:0.830-0.928)and 0.898(95%CI:0.848-0.949)for SAP prediction in derivation and validation cohorts,respectively.This value was 0.892(95%CI:0.843-0.941)and 0.833(95%CI:0.754-0.912)for ARDS prediction,respectively.The discriminatory power of our models was improved compared with that of other widely used models and the calibration ability and clinical utility of the prediction models performed adequately.CONCLUSION The present study constructed and validated a simple and accurate predictive model for SAPrelated ARDS in patients with AP.
基金Supported by A grant from Direzione ScientificaFondazione IRCCS Policlinico San Matteo-Progetto di Ricerca Correntecode 08061307/11
文摘AIM:To investigate the level of mucosal expression and the involvement of the receptor for the advanced glycation end products(RAGE)in delayed apoptosis and tumor necrosis factor(TNF)-αproduction in Crohn’s disease(CD).METHODS:Surgical and endoscopic specimens from both inflamed and non-inflamed areas of the ileum and/or colon were collected from 20 and 14 adult CD patients,respectively,and used for the assessment of RAGE expression by means of immunohistochemistry and western blotting analysis.Normal tissues from 21 control subjects were used for comparison.The same polyclonal anti-human RAGE antibody(R and D System)was used in all experimental conditions.RAGE staining was quantized by a score including both the amount of positive cells and intensity of immunoreactivity;cellular pattern was also described.The effects of RAGE blocking on apoptotic rate and TNF-αproduction were investigated on immune cells freshly isolated from CD mucosa and incubated both with and without the muramyl dipeptide used as antigenic stimulus.Statistical analysis was performed via the test for trend,with regression models to account for intra-patient correlations.A 2-sided P<0.05 was considered significant.RESULTS:In inflamed areas,RAGE expression in both the epithelial and lamina propria compartments was higher than control tissues(P=0.001 and 0.021,respectively),and a cluster of positive cells were usually found in proximity of ulcerative lesions.Similar results were obtained in the lamina propria compartment of non-inflamed areas(P=0.025).The pattern of staining was membranous and granular cytosolic at the epithelial level,while in the lamina propria it was diffuse cytosolic.When evaluating the amount of protein expression by immunoblotting,a significant increase of both surface area and band intensity(P<0.0001 for both)was observed in CD inflamed areas compared to control tissue,while in non-inflamed areas a significant increase was found only for band intensity(P<0.005).Moreover,a significantly lower expression in noninflamed areas in comparison with inflamed areas was found for both surface area and band intensity(P<0.0006 for both).Finally,RAGE blocking largely affects both the apoptotic rate of mucosal cells(towards an increase in both non-inflamed and inflamed areas of P<0.001 and<0.0001,respectively)and TNF-αsecretion(towards a decrease in both non-inflamed and inflamed areas of P<0.05 and<0.01,respectively),mainly in the presence of antigenic stimulation.CONCLUSION:RAGE is up-regulated in CD,especially in inflamed areas,and it appears to play a role in the mechanisms involved in chronic inflammation.
基金supported by the National Natural Science Foundation of China(No.81273144)Beijing Natural Science Foundation Program and Scientific Research Key Program of Beijing Municipal Commission of Education(KZ201510025024)Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(ZYLX201304)
文摘Our study was to investigate the epidemiological characteristics of M.tuberculosis from a national tuberculosis referral center in China. All strains isolated from TB patients, were genotyped by the RD105 deletion, 8 and 51 SNP loci and VNTR. The high differentiation SNPs of modern Beijing strains were analyzed for protein function and structure. 413 M. tuberculosis were included. Of 379 Beijing lineage M. tuberculosis, ＇modern＇ and ＇ancient＇ strains respectively represented 85.5% （324/379） and 14.5% （55/379）. Rv2494 （V48A） and Rv0245 （Sl03F） were confirmed as high differentiation SNPs associated with modern strains. In a word, Modern Beijing lineage M.tuberculosis was dominant and the structural models suggested that modern sub-lineage may more easily survive in ＇extreme＇ host condition.
文摘AIM To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus(HBV) infection, and the trends of patient's outcomes overtime.METHODS A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios(OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen(HBs Ag) positive] were included. The comparison group consisted of HBs Agnegative kidney transplant recipients. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of Der Simonian and Laird. The protocol for this metaanalysis is registered with PROSPERO(International Prospective Register of Systematic Reviews; no. CRD42017080657).RESULTS Ten observational studies with a total of 87623 kidney transplant patients were enrolled. Compared to HBs Ag-negative recipients, HBs Ag-positive status was significantly associated with increased risk of mortality after kidney transplantation(pooled OR = 2.48; 95%CI: 1.61-3.83). Meta-regression showed significant negative correlations between mortality risk after kidney transplantation in HBs Ag-positive recipients and year of study(slopes =-0.062, P = 0.001). HBs Agpositive status was also associated with increased risk of renal allograft failure with pooled OR of 1.46(95%CI: 1.08-1.96). There was also a significant negative correlation between year of study and risk of allograft failure(slopes =-0.018, P = 0.002). These associations existed in overall analysis as well as in limited cohort of hepatitis C virus-negative patients. We found no publication bias as assessed by the funnel plots and Egger's regression asymmetry test with P = 0.18 and 0.13 for the risks of mortality and allograft failure after kidney transplantation in HBs Ag-positive recipients, respectively.CONCLUSION Among kidney transplant patients, there are significant associations between HBs Ag-positive status and poor outcomes including mortality and allograft failure. However, there are potential improvements in patient and graft survivals in HBs Ag-positive recipients overtime.
基金Supported by the Key Project from Beijing Municipal Science and Technology Commission(D121100003912003)
文摘Objectives To investigate the positive rate of different hepatitis B virus （HBV） serological markers, and the demographic factors related to HBV infection. Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen （HBsAg）, HBV surface antibody （HBsAb）, hepatitis B e antigen （HBeAg）, hepatitis B e antibody （HBeAb）, HBV core antibody （HBcAb）, and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and department, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed. Results Among 27 409 samples included, 2681 （9.8%） were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%, 5.8%, and 4.7%, respectively. The positive rate of HBsAg of males （13.3%） was higher than that of females （7.3%, P=0.000）. Among the 2681 HBsAg （＋） patients, 1230 （45.9%） had HBV-DNA test, of whom 564 （45.9%） were positive. Patients with HBsAg （＋）, HBeAg （＋）, and HBcAg （＋） result usually had high positive rate of HBV-DNA results （71.8%, P=0.000）. Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.
文摘AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication. METHODS: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test(UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d. RESULTS: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and thirdline therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate. CONCLUSION: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and secondline treatment can still be triple therapy with amoxicillin and tinidazole.
文摘The study of the origin of SARS coronavirus(SARS CoV)and SARS-like coronavirus(SL-CoV)is very important for the prevention of novel human infections with these viruses.Recently,Ge et al.suggest that Chinese horseshoe bats are natural reservoirs of SARSCoV[1].But this conclusion is incorrect.It should be"Chinese horseshoe bats are natural reservoirs of SLCoV"[2-7].The paper also has several methodological problems,leading to errors in the conclusions.
文摘AIM: To evaluate the ability of the McGill Brisbane Symptom Score (MBSS) to predict survival in resectable pancreatic head adenocarcinoma (PHA) patients.
文摘AIM To assess prevalence of pre-existing atrial fibrillation(AF) and/or incidence of AF following liver transplantation, and the trends of patient's outcomes overtime; to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation. METHODS A literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception throughMarch 2018. We included studies that reported:(1) prevalence of pre-existing AF or incidence of AF following liver transplantation; or(2) outcomes of liver transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing randomeffect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO(International Prospective Register of Systematic Reviews, No. CRD42018093644). RESULTS Twelve observational studies with a total of 38586 liver transplant patients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4%(95%CI: 4.9%-5.9%) and pooled estimated incidence of AF following liver transplantation was 8.5%(95%CI: 5.2%-13.6%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF(P = 0.08) or post-operative AF after liver transplantation(P = 0.54). The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34(2 studies; 95%CI: 1.10-5.00). In addition, pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients(3 studies; OR: 5.15, 95%CI: 2.67-9.92, I2 = 64%). With limited studies, two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality, cerebrovascular events, post-transplant acute kidney injury, and increased risk of graft failure among liver transplant recipients(P < 0.05).CONCLUSION The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4% and 8.5%, respectively. Incidence of AF following liver transplant does not seem to decrease overtime. Preexisting AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.
文摘We sought to determine the impact of implantable cardioverter-defibrillator(ICD) therapy in patients with familial arrhythmogenic right ventricular cardiomyopathy(ARVC). Arrhythmogenic right ventricular cardiomyopathy is a cause of sudden cardiac death, which may be prevented by ICD. We studied 11 families in which a 3p25 deoxyribonucleic acid(DNA) haplotype at locus ARVD5 segregated with disease and compared mortality in subjects who received an ICD with that in control subjects who were matched for age, gender, ARVC status, and family. Subjects(n=367) at 50%a priori risk of inheriting ARVC were classified as high risk(HR)(n=197), low risk(n=92), or unknown(n=78) on the basis of clinical events,DNA haplotyping, and/or pedigree position. Forty-eight HR subjects(30 males, [median age 32 years] and 18 females [median age 41 years]) were followed after ICD(secondary to ventricular tachycardia [VT] in 27%). Survival was compared with 58 HR control subjects who were alive at the same age to-the-day at which the ICD subject received the device. In the HR group, 50%of males were dead by 39 years and females by 71 years: relative risk of death was 5.1(95%confidence interval 3 to 8.5) for males. The five-year mortality rate after ICD in males was zero compared with 28%in control subjects(p=0.009). Within five years, the ICD fired for VT in 70%and for VT >240 beats/min in 30%, with no difference in discharge rate when analyzed by ICD indication. The unknown mutation at the ARVD5 locus causing ARVC results in high mortality. Risk stratification using genetic haplotyping and ICD therapy produced improved survival for males.
文摘Objective:To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department(ED). Study design:All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein,procalcitonin PCT ,white blood cell WBC count,neutrophil count) and cerebrospinal fluid (CSF) findings (protein,glucose,WBC count,neutrophil count) available in the ED were determined.Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison. Results:Among the 167 patients included,21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86%and 60%sensitivity rates,respectively.PCT (≥0.5 ng/mL) and CSF protein (≥0.5 g/L) were the best biologic tests,with 89%and 86%sensitivity rates,89%and 78%specificity rates,adjusted odds ratios of 108 (95%CI,15-772) and 34 (95%CI,5-217),and areas under the ROC curves of 0.95 and 0.93,respectively. Conclusion:PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.
文摘Aims: Although outcomes after acute myocardiat infarction(AMI) seemed to be superior with primary percutaneous coronary intervention(PPCI) relative to fibrinolysis(FL), the extent to which treatment delay modulates this treatment effect is unclear. Methods and results: Twenty-five randomized trials(n=7743) testing the efficacy of PPCI vs. FL were identified in journal articles and abstract listings published between 1990 and 2002. Of these, individual patient data from 22 trials(n=6763) were pooled, and multi-level logistic regression assessed the relationship among treatment, treatment delay, and 30-day mortality. Treatment delay was divided into ‘ presentation delay’ [symptom onset to randomization; FL: median 143(IQR: 91-225) min; PPCI: 140(91-220) min] and hospital-sp3ecific ‘ PCI-related delay’ [median time from randomization to PPCI minus median time to FL per hospital; median 55(IQR: 37-74) min]. PPCI was associated with a significant 37% reduction in 30-day mortality [adjusted OR, 0.63; 95% CI(0.42-0.84)]. Although, there was no heterogeneity in the treatment effect by presentation delay(pBreslow-Day=0.88), the absolute mortality reduction by PPCI widened over time(1.3% 0-1 h to 4.2% >6 h after symptom onset). When the PCI-related delay was< 35min, the relative(67 vs. 28% pBreslow-Day=0.004) and absolute(5.4 vs. 2.0% ) mortality reduction was significantly higher than those with longer delays. Conclusion: PPCI was associated with significantly lower 30-day mortality relative to FL, regardless of treatment delay. Although logistic and economic constraints challenge the feasibility of ‘ PPCI-for-all’ , the benefit of timely treatment underscores the importance of a comprehensive, unified approach to delivery of cardiac care in all AMI patients.
