Haloprogin: a Topical Antifungal Agent

Haloprogin was shown to be a highly effective agent for the treatment of experimentally induced topical mycotic infections in guinea pigs. Its in vitro spectrum of activity also includes yeasts, yeastlike fungi (Candida species), and certain gram-positive bacteria. The in vitro and in vivo antifungal activity of haloprogin against dermatophytes was equal to that observed with tolnaftate. The striking differences between the two agents were the marked antimonilial and selective antibacterial activities shown by haloprogin, contrasted with the negligible activities found with tolnaftate. Addition of serum decreased the in vitro antifungal activity of haloprogin to a greater extent than that of tolnaftate; however, diminished antifungal activity was not observed when haloprogin was applied topically to experimental dermatophytic infections. Based on its broad spectrum of antimicrobial activity, haloprogin may prove to be a superior topical agent in the treatment of dermatophytic and monilial infections in man.     

支气管扩张合并感染患者病原体分布及其与病情的关系

目的 探讨支气管扩张合并感染患者病原体分布及其与病情的关系,为该类患者的治疗提供参考.方法 选取2018年6月至2019年6月我院收治的76例支气管扩张合并感染急性加重期患者为研究对象,对所有患者痰液标本进行病毒PCR检测,同时进行细菌培养以及实验室检查,分析所有患者病原体分布.比较不同病情程度患者病原体分布情况,同时...     

慢性萎缩性胃炎患者肠道菌群特征

探讨不同炎症程度慢性萎缩性胃炎（CAG）患者肠道菌群特征,为该类患者的治疗提供参考。

对36例健康人（健康对照组）和8例轻度炎症（轻度炎症组）、26例中度炎症（中度炎症组）、8例重度炎症（重度炎症组）的CAG患者的粪便样本进行16S rRNA基因高通量测序（V4—V5区）,采用Sobs、Shannon、Simpson、Ace、Chao指数评估4组对象肠道菌群的物种丰富度与多样性;采用PLS-DA分析评估4组对象肠道微生物群落结构;采用LDA与LEfSe分析确定4组对象相对丰度存在显著差异的肠道菌群;采用PICRUSt预测CAG患者显著富集肠道菌属的代谢通路信息。

与健康对照组相比,轻、中、重度炎症组患者肠道菌群Sobs、Ace、Chao、Simpson指数有降低趋势,但差异均无统计学意义（均P＞0.05）。Ruminococcus_gnavus_group、norank_f_Ruminococcaceae、Erysipelatoclostridium、Actinomyces在轻度炎症组中显著富集,Flavonifractor、Sellimonas在中度炎症组中显著富集,Eubacterium_rectale_group、Erysipelotrichaceae_UCG-003、Tyzzerella_3、Coprococcus_1、Candidatus_Soleaferrea在重度炎症组中显著富集。此外,Lachnospiraceae_UCG-004、Eubacterium_nodatum_group的丰度在健康对照组、轻度炎症组、中度炎症组、重度炎症组中呈递增趋势;Anaerostipes、Ruminiclostridium_9、Halomonas、Pelagibacterium的丰度在健康对照组、轻度炎症组、中度炎症组、重度炎症组中呈递减趋势,但差异均无统计学意义（均P＞0.05）。PICRUSt分析结果显示4组对象肠道菌群代谢通路相似,但是代谢通路的丰度不同,其中重度炎症组患者肠道菌群代谢功能潜力高于健康对照组、轻度炎症组和中度炎症组。

CAG患者肠道菌群变化的总体特征为产丁酸盐的菌属丰度减少,促炎菌属的丰度增加。促炎菌属可能通过附着于肠道上皮导致黏膜屏障受损和肠道通透性增加,影响宿主免疫反应,引起炎症。

     

重症急性胰腺炎患者肠黏膜屏障损伤与血清二胺氧化酶和TLR9水平及肠道菌群和其代谢产物的相关性

探究重症急性胰腺炎患者肠黏膜屏障损伤与血清二胺氧化酶（DAO）、Toll样受体9（TLR9）水平及肠道菌群和其代谢产物的相关性,为该类患者的治疗提供参考。

选取2020年1月至2022年1月在我院进行诊疗的急性胰腺炎患者107例为研究组,根据其病情严重程度将其分为轻中症组（n=51）和重症组（n=56）。另选同期50例在我院进行健康体检的志愿者纳入对照组。比较各组对象不同时间点的血清DAO和TLR9水平、肠黏膜屏障损伤指标（内毒素、D-乳酸、乳果糖/甘露醇比值）、肠道菌群情况及肠道菌群代谢产物水平。

与对照相比较,研究组患者的血清DAO、TLR9、内毒素、D-乳酸水平和乳果糖/甘露醇比值以及肠道肠球菌、酵母菌数量均显著升高,肠道双歧杆菌、消化球菌、乳杆菌数量以及丙酸、丁酸、乙酸水平均显著降低（均P＜0.05）。重症组和轻中症组患者入院24 h、48 h、72 h时的血清DAO、TLR9水平呈现为先升高后降低的趋势,且重症组患者各时间点的血清DAO、TLR9水平均高于轻中症组（均P＜0.05）。重症组和轻中症组患者入院24 h、48 h、72 h时的内毒素、D-乳酸水平及乳果糖/甘露醇比值均呈现先升高后降低的趋势,且重症组患者各时间点的内毒素、D-乳酸水平及乳果糖/甘露醇比值均高于轻中症组（均P＜0.05）。患者内毒素水平与DAO、TLR9水平、双歧杆菌、消化球菌、乳杆菌、乙酸、丁酸水平均呈正相关（均P＜0.05）,与肠球菌、酵母菌数量均呈负相关（均P＜0.05）,与丙酸水平无显著相关性（P＞0.05）。患者D-乳酸水平与双歧杆菌、消化球菌、乳杆菌、乙酸、丁酸、肠球菌、酵母菌水平均无显著相关性（P＞0.05）,与DAO、TLR9、丙酸水平均呈正相关（均P＜0.05）。乳果糖/甘露醇比值与双歧杆菌、消化球菌、乳杆菌、乙酸水平均呈负相关（均P＜0.05）,与DAO、TLR9、酵母菌、丁酸水平均呈正相关（均P＜0.05）,与丙酸水平无显著相关性（P＞0.05）。

重症急性胰腺炎患者肠黏膜屏障损伤更重,血清DAO、TLR9、内毒素、D-乳酸水平及乳果糖/甘露醇比值均显著升高,同时患者的肠黏膜屏障损伤程度与其血清DAO、TLR9水平、肠道菌群数量及代谢产物水平具有相关性。

     

Low serum calcium: a new,important indicator of COVID-19 patients from mild/moderate to severe/critical

Background: Coronavirus disease 2019 (COVID-19) virus is still spreading, finding out the initial hits of viral infection is important to minimize the mild/moderate population, prevent disease aggravation and organs dysfunction.Objective: We investigated COVID-19 patients with different serum calcium levels.Design: We checked the serum calcium level of the patients based on days after symptom onset as well as the severity of COVID-19. We also checked multiorgan injuries and immune cytokines level in their blood.Results: Both mild/moderate and severe critical cases we observed showed low calcium level in the early stage of viral infection, while the severe/critical cases showed significant lower calcium level than mild/moderate cases in the early stage. We also found that low calcium level related to severe/critical multiorgan injuries especially in the mild/moderate population. Proinflammatory cytokine IL-6 also correlated to calcium change in both mild/moderate and severe/critical cases.Conclusions: Our finding indicates that calcium balance is a primal hit of COVID-19 and a biomarker of clinical severity at the beginning of symptom onset. Calcium is closely associated with virus-associated multiple organ injuries and the increase in inflammatory cytokines. Our results provide a new, important indicator of COVID-19 patients from mild/moderate to severe/critical: serum calcium.     

Disease characteristics and serological responses in patients with differing severity of COVID-19 infection: A longitudinal cohort study in Dhaka,Bangladesh

BackgroundCOVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients.Methodology/Principal findingsThis longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases.Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases.Conclusion/SignificanceWe report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection.     

不同病情妊娠高血压综合征患者凝血指标及血小板参数检测的临床价值及其妊娠结局研究

目的:研究不同病情妊娠高血压综合征患者凝血指标及血小板参数检测的临床价值及其妊娠结局。方法:2017年2月～2018年12月期间,我院收治的120例妊娠高血压综合征患者作为研究对象,将其按照疾病严重程度的不同分为轻度组45例、中度组40例以及重度组35例。分别比较三组患者的各项凝血指标、血小板参数、产妇不良妊娠结局以及新生儿不良妊娠结局。结果:重度组部分凝血活酶时间(APTT)、凝血酶时间(TT)较轻度组和中度组缩短,而纤维蛋白原(FIB)较轻度组和中度组升高(P0.05),且中度组FIB高于轻度组(P0.05)。重度组血小板数量(PLT)低于轻度组和中度组,而平均血小板体积(MPV)高于轻度组和中度组(P0.05),中度组PLT低于轻度组,而MPV高于轻度组(P0.05)。重度组胎盘早剥、剖腹产、产后出血的发生率高于中度组和轻度组,且中度组高于轻度组(P0.05)。重度组新生儿窒息、早产、呼吸窘迫的发生率高于中度组、轻度组,且中度组高于轻度组(P0.05)。结论:临床工作中可通过联合检测凝血指标及血小板参数,从而有利于评估妊娠高血压综合征患者的病情严重程度,同时有助于预测妊娠结局。     

Relation between severity of Alzheimer's disease and costs of caring

BACKGROUND: Data from the Canadian Study of Health and Aging (CSHA) were used to examine the relation between severity of Alzheimer''s disease, as measured by the Mini-Mental State Examination (MMSE), and costs of caring. METHODS: The CSHA was a community-based survey of the prevalence of dementia, including subtypes such as Alzheimer''s disease, among elderly Canadians. Survey subjects with a diagnosis of possible or probable Alzheimer''s disease were grouped into disease severity levels of mild (MMSE score 21-26), mild to moderate (MMSE score 15-20), moderate (MMSE score 10-14) and severe (MMSE score below 10). Components of care available from the CSHA were use of nursing home care, use of medications, use of community support services by caregivers and unpaid caregiver time. Costs were calculated from a societal perspective and are expressed in 1996 Canadian dollars. RESULTS: The annual societal cost of care per patient increased significantly with severity of Alzheimer''s disease. The cost per patient was estimated to be $9451 for mild disease, $16,054 for mild to moderate disease, $25,724 for moderate disease and $36,794 for severe disease. Institutionalization was the largest component of cost, accounting for as much as 84% of the cost for people with severe disease. For subjects living in the community, unpaid caregiver time and use of community services were the greatest components of cost and increased with disease severity. INTERPRETATION: The societal cost of care of Alzheimer''s disease increases drastically with increasing disease severity. Institutionalization is responsible for the largest cost component.     

肠道菌群分析及粪便炎性标志物检测在炎症性肠病活动度评估中的作用

目的 探讨肠道菌群和粪便炎性标志物在炎症性肠病（IBD）活动度评估中的临床价值。方法 共纳入120例IBD患者为研究组,其中溃疡性结肠炎（UC）患者68例,克罗恩病（CD）患者52例。选择30例经结肠镜检查正常的健康体检者为对照组。采集全部研究对象的新鲜粪便标本进行粪便细菌培养及炎性标志物检测,比较不同疾病活动度IBD患者的肠道菌群及粪便钙卫蛋白（FC）、乳铁蛋白（LF）、基质金属蛋白酶-9（MMP-9）、髓过氧化酶（MPO）水平的变化。结果 与对照组比,UC和CD患者肠道中肠杆菌、肠球菌、拟杆菌、消化球菌及酵母菌数量均明显增加（P＜0.05）,双歧杆菌、乳杆菌及真杆菌数量明显减少（P＜0.05）。UC患者梭菌数量较对照组增加（P＜0.05）,CD患者梭菌数量较对照组减少（P＜0.05）。UC、CD活动期患者肠杆菌、肠球菌、拟杆菌、消化球菌及酵母菌数量明显多于缓解期患者（P＜0.05）,双歧杆菌、乳杆菌及真杆菌数量明显少于缓解期患者（P＜0.05）,且重度活动期患者肠道菌群改变较轻、中度活动期改变更明显（P＜0.05）。UC活动期患者梭菌数量明显多于缓解期（P＜0.05）,CD活动期患者梭菌数量明显少于缓解期（P＜0.05）。UC和CD患者粪便中FC、LF、MMP-9及MPO水平均显著高于对照组（P＜0.05）。UC、CD活动期患者FC、LF、MMP-9及MPO水平显著高于缓解期患者（P＜0.05）,且重度活动期患者高于轻、中度活动期患者（P＜0.05）。结论 肠道菌群变化和粪便中FC、LF、MMP-9及MPO水平可作为IBD患者疾病活动性评估的辅助指标。     

Enzyme levels in bronchoalveolar lavage fluid and serum of active pulmonary tuberculosis patients

Bronchoalveolar lavage (BALF) was found to be a useful index of cell damage. It has been observed that the enzymes in BALF could give an idea of cell damage in a pulmonary disease. Acid phosphatase, alkaline phosphatase, leucine aminopeptidase and gamma-glutamyl-transpeptidase were assessed in mild, moderate, and severe pulmonary tuberculosis patients and Mantoux-negative normal controls. Activities of these enzymes were found to be higher in patients and were increasing with the severity of the disease. Increase in these enzymes in pulmonary tuberculosis patients could be attributed to lung tissue damage.     

血清Visfatin、PRDX1水平与克罗恩病患者活动度指标和肠道菌群的相关性分析

摘要 目的：分析血清内脂素（Visfatin）、过氧化物还原蛋白1（PRDX1）水平与克罗恩病（CD）患者活动度指标和肠道菌群的相关性。方法：选取2019年4月~2022年12月期间联勤保障部队第九一〇医院收治的146例CD患者，根据简化克罗恩病疾病活动指数（CDAI）将所有CD患者分为中重度活动组（n=36）、轻度活动组（n=49）、缓解期组（n=61）。对比三组血清Visfatin、PRDX1、C反应蛋白（CRP）水平、血沉（ESR）、肠道菌群数量。采用Pearson相关性分析血清Visfatin、PRDX1与 CDAI、 CRP、ESR和肠道菌群数量的相关性。结果：中重度活动组、轻度活动组的血清Visfatin、PRDX1水平高于缓解期组，且中重度活动组血清Visfatin、PRDX1水平高于轻度活动组（P<0.05）。中重度活动组、轻度活动组的CRP、ESR高于缓解期组，且中重度活动组CRP、ESR高于轻度活动组（P<0.05）。中重度活动组、轻度活动组的肠球菌、大肠杆菌高于缓解期组，且中重度活动组的肠球菌、大肠杆菌高于轻度活动组（P<0.05），中重度活动组、轻度活动组的双歧杆菌、类杆菌低于缓解期组，且中重度活动组的双歧杆菌、类杆菌低于轻度活动组（P<0.05）。Pearson相关性分析显示，血清Visfatin、PRDX1、 CRP水平与 肠球菌、大肠杆菌菌群数量、CDAI、ESR呈正相关，而与双歧杆菌、类杆菌菌群数量呈负相关（P<0.05）。结论：CD患者的血清Visfatin、PRDX1升高，可导致疾病进展，肠道菌群紊乱加重。     

重症支气管哮喘患者肺泡灌洗液病原菌分布及血清CRP和TNFα水平

目的 研究重症支气管哮喘患者肺泡灌洗液中病原菌分布及血清C反应蛋白(CRP)、肿瘤坏死因子(TNFα)水平,为该病的治疗提供参考。 方法 选取2017年5月至2019年5月我院收治的支气管哮喘患者为研究对象,按照病情严重程度分为重度组(n=85)和轻度组(n=80)。收集两组患者肺泡灌洗液并进行细菌培养,同时抽取两组患者静脉血检测血清CRP、TNFα水平。采用Spearman相关系数分析法分析血清CRP、TNFα水平与哮喘程度的关系。 结果 重度组患者肺泡灌洗液中检出革兰阳性菌23株,占36.51%;革兰阴性菌38株,占60.32%;真菌2株,占3.17%。革兰阳性菌中肺炎链球菌占47.83%,金黄色葡萄球菌占30.43%;革兰阴性菌中大肠埃希菌占23.68%,流感嗜血杆菌占26.32%。重度组患者肺泡灌洗液中革兰阴性菌比例及血清CRP与TNFα水平均显著高于轻度组(均P结论 重度支气管哮喘患者肺泡灌洗液中革兰阴性菌占比较高,同时其血清CRP、TNFα水平也较高。CRP、TNFα水平与哮喘严重程度成正比。     

婴幼儿呼吸道合胞病毒感染严重程度与基因分型及血清炎症因子水平的相关性

目的 探讨婴幼儿呼吸道合胞病毒(respiratory syncytial virus,RSV)感染严重程度与病毒基因分型及血清IL10、IL17、IL27水平的相关性。 方法 选取2017年3月1日至2018年3月1日我院收治的77例呼吸道合胞病毒感染患儿作为研究对象,对患儿鼻咽部位的分泌物进行取样,对呼吸道合胞病毒亚型和基因型进行检测,按照病情的严重程度,将患者分为轻度组、中度组和重度组。对各组患儿病情程度,RSV亚型分布及血清IL10、IL17、IL27水平进行比较。 结果 轻度组患儿病情评分为(1.22±0.11)分,中度组为(4.89±0.98)分,重度组为(7.08±0.97)分。77份RSV阳性标本共检出A亚型48例,B亚型29例,其中轻度组、中度组及重度组患者中的A亚型感染人数比例分别为52.17%,60.00%,78.95%。A亚型病毒中NA1型为优势基因型。重度组患儿中NA1型的比例显著高于中度组和轻度组。B亚型病毒中BA9为优势基因型。轻度组患儿BA9型比例显著高于中度组和重度组。轻度组患儿血清IL10、IL17、IL27水平最低,重度组IL10、IL17、IL27的水平最高(均P结论 不同病情程度呼吸道合胞病毒感染患儿其病毒基因型分布及血清炎症因子的水平存在显著差异,病毒基因型与疾病的严重程度具有相关性。病毒基因型及血清炎症因子的水平可以作为判断此类患儿病程的标志物。     

Overexpression of CD163, CD204 and CD206 on Alveolar Macrophages in the Lungs of Patients with Severe Chronic Obstructive Pulmonary Disease

We have previously reported that the lungs of patients with very severe chronic obstructive pulmonary disease (COPD) contain significantly higher numbers of alveolar macrophages than those of non-smokers or smokers. M1 and M2 macrophages represent pro- and anti-inflammatory populations, respectively. However, the roles of M1 and M2 alveolar macrophages in COPD remain unclear. Immunohistochemical techniques were used to examine CD163, CD204 and CD206, as M2 markers, expressed on alveolar macrophages in the lungs of patients with mild to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I (mild) n = 11, II (moderate) n = 9, III (severe) n = 2, and IV (very severe) n = 16). Fifteen smokers and 10 non-smokers were also examined for comparison. There were significantly higher numbers of alveolar macrophages in COPD patients than in smokers and non-smokers. The numbers and percentages of CD163⁺, CD204⁺ or CD206⁺ alveolar macrophages in patients with COPD at GOLD stages III and IV were significantly higher than in those at GOLD stages I and II, and those in smokers and non-smokers. In patients with COPD, there was a significant negative correlation between the number of CD163⁺, CD204⁺ or CD206⁺ alveolar macrophages and the predicted forced expiratory volume in one second. Overexpression of CD163, CD204 and CD206 on lung alveolar macrophages may be involved in the pathogenesis of COPD.     

Quantification of Subgingival Bacterial Pathogens at Different Stages of Periodontal Diseases

Anaerobic gram-negative oral bacteria such as Treponema denticola, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Campylobacter rectus, and Fusobacterium nucleatum are closely associated with periodontal diseases. We measured the relative population (bacterial levels) of these oral pathogens in subgingival tissues of patients at different stages of Korean chronic periodontal diseases. We divided the individuals into those with chronic gingivitis (G), moderate periodontitis (P1), severe periodontitis (P2), and normal individuals (N) (n?=?20 for each group) and subgingival tissue samples were collected. We used real-time PCR with TaqMan probes to evaluate the change of periodontal pathogens among different stages of periodontitis. Bacterial levels of A. actinomycetemcomitans and C. rectus are significantly increased in individuals with chronic gingivitis and moderate periodontitis, but unchanged in severe periodontitis patients. These results suggest that analyzing certain bacterial levels among total oral pathogens may facilitate understanding of the role of periodontal bacteria in the early stages of periodontitis.     

Salivary and serum procalcitonin and C-reactive protein as biomarkers of periodontitis in United States veterans with osteoarthritis or rheumatoid arthritis

Serum procalcitonin (ProCT) is elevated in response to bacterial infections, whereas high sensitivity C-reactive protein (hsCRP) is a nonspecific inflammatory marker that is increased by excess adipose tissue. We examined the efficacy of ProCT and hsCRP as biomarkers of periodontitis in the saliva and serum of patients with arthritis, which is characterized by variable levels of systemic inflammation that potentially can confound the interpretation of inflammatory biomarkers. Blood and unstimulated whole saliva were collected from 33 patients with rheumatoid arthritis (RA) and 50 with osteoarthritis (OA). Periodontal status was assessed by full mouth examination and patients were categorized as having no/mild, moderate or severe periodontitis by standard parameters. Salivary and serum ProCT and hsCRP concentrations were compared. BMI, diabetes, anti-inflammatory medications and smoking status were ascertained from the patient records. Differences between OA and RA in proportionate numbers of patients were compared for race, gender, diabetes, adiposity and smoking status. Serum ProCT was significantly higher in arthritis patients with moderate to severe and severe periodontitis compared with no/mild periodontitis patients. There were no significant differences in salivary ProCT or salivary or serum hsCRP in RA patients related to periodontitis category. Most of the OA and RA patients were middle aged or older, 28.9% were diabetic, 78.3% were overweight or obese, and slightly more than half were either current or past smokers. The OA and RA groups differed by race, but not gender; blacks and males were predominant in both groups. The OA and RA groups did not differ in terms of controlled or uncontrolled diabetes, smoking status or BMI. The RA patients had been prescribed more anti-inflammatory medication than the OA patients. Our results demonstrate that circulating ProCT is a more discriminative biomarker for periodontitis than serum hsCRP in patients with underlying arthritis. Any elevation in salivary and serum hsCRP due to periodontitis apparently was overshadowed by differences among these patients in factors that influence CRP, such as the extent of inflammation between RA and OA, the extent of adipose tissue, the use of anti- inflammatory medications and smoking status. Although our study showed no differences in salivary ProCT related to severity of periodontitis, this biomarker also may be useful with further refinement.     

阿尔茨海默病患者血清IL-10、IL-17、IL-33与肠道菌群相对丰度和认知功能的相关性分析

摘要 目的：分析阿尔茨海默病（AD）患者血清白介素（IL）-10、IL-17、IL-33与肠道菌群相对丰度和认知功能的相关性。方法：选择上海交通大学医学院附属第九人民医院老年科以及黄浦分院神经内科于2020年4月~2023年4月期间收治的AD患者 98例作为研究对象。根据临床痴呆评定量表（CDR）将AD患者分为轻度组（n=36）、中度组（n=39）、重度组（n=23）。对比三组患者的IL-10、IL-17、IL-33、肠道菌群相对丰度、认知功能评分。采用Pearson相关性分析AD患者血清IL-10、IL-17、IL-33与肠道菌群相对丰度和认知功能的相关性。结果：重度组、中度组的IL-17水平高于轻度组,且重度组高于中度组（P<0.05）。重度组、中度组IL-10、IL-33水平低于轻度组,且重度组低于中度组（P<0.05）。重度组、中度组的梭菌纲、厚壁菌门、梭菌科、梭菌目低于轻度组,且重度组低于中度组（P<0.05）。重度组、中度组的拟杆菌门、拟杆菌纲、拟杆菌目、产碱杆菌科高于轻度组,且重度组高于中度组（P<0.05）。重度组、中度组简易精神状态量表（MMSE）评分低于轻度组,且重度组低于中度组（P<0.05）。Pearson相关性分析结果显示,IL-10、IL-33与MMSE评分、厚壁菌门、梭菌纲、梭菌目、梭菌科呈正相关,与拟杆菌门、拟杆菌纲、拟杆菌目、产碱杆菌科呈负相关（P<0.05）。IL-17与MMSE评分、厚壁菌门、梭菌纲、梭菌目、梭菌科呈负相关,与拟杆菌门、拟杆菌纲、拟杆菌目、产碱杆菌科呈正相关（P<0.05）。结论：AD患者认知功能下降,血清IL-10、IL-17、IL-33水平异常变化,患者体内肠道菌群相对丰度异常,且IL-10、IL-17、IL-33水平与肠道菌群相对丰度、认知功能存在一定的相关性。     

经颅多普勒血流动力学定量参数对青年脑卒中患者预后的预测价值

摘要 目的：分析经颅多普勒血流动力学定量参数预测青年脑卒中患者预后的价值。方法：病例纳入时间为2018年4月至2022年12月,来源于秦皇岛市第一医院,研究对象为349例青年脑卒中患者,将之作为病例组,根据病情严重程度分为轻、中和重度组,例数分别为97、196例、56例,根据预后情况分为预后不良组和预后良好组,例数分别为27、322例,另选同期358名健康体检青年人群作为对照组。比较病例组与对照组、不同病情严重程度及不同预后患者的血流动力学定量参数,分析血流动力学定量参数与患者、预后的相关性及对患者预后的预测价值。结果：与对照组比较,病例组大脑中动脉搏动指数（PI）更高,平均血流速度（Vm）、收缩期血流速度（Vs）、舒张期血流速度（Vd）、屏气指数（BHI）、脑局部血流量丧失指数（r CBFLI）更低（P<0.05）。重度组大脑中动脉PI高于中度组、轻度组（P<0.05）,中度组高于轻度组（P<0.05）;重度组大脑中动脉Vm、Vs、Vd、BHI、r CBFLI低于中度组、轻度组（P<0.05）,中度组低于轻度组（P<0.05）。预后不良组大脑中动脉PI高于预后良好组（P<0.05）,大脑中动脉BHI、r CBFLI低于预后良好组（P<0.05）。大脑中动脉PI与青年脑卒中患者病情严重程度、预后呈正相关（P<0.05）;大脑中动脉Vm、Vs、Vd、BHI、r CBFLI与青年脑卒中患者病情严重程度呈负相关（P<0.05）;大脑中动脉BHI、r CBFLI与青年脑卒中患者预后呈负相关（P<0.05）。大脑中动脉PI、BHI、r CBFLI联合检测的曲线下面积（AUC）值为0.864,高于大脑中动脉PI、BHI、r CBFLI单独检测（0.698、0.737、0.782,P<0.05）;大脑中动脉BHI、联合检测的敏感度分别为85.19%、81.48%,高于大脑中动脉PI、r CBFLI单独检测（66.67%、62.96%,P<0.05）;大脑中动脉r CBFLI、联合检测的特异度分别为81.68%、78.26%,高于大脑中动脉PI、BHI单独检测（64.29%、67.08%,P<0.05）。结论：青年脑卒中患者PI偏高,Vm、Vs、Vd、BHI、r CBFLI偏低,且PI随患者病情的加重而升高,Vm、Vs、Vd、BHI、r CBFLI随患者病情的加重而降低,另PI、BHI、r CBFLI可评估患者预后情况,三者联合检测对青年脑卒中患者预后的预测价值更高。     

不同严重程度支气管哮喘患者血清LXA4水平的表达及临床意义

目的:探讨不同严重程度支气管哮喘患者血清脂氧素A4(LXA4)水平的表达及临床意义。方法:选取我院2015年10月到2016年11月收治的支气管哮喘患者86例作为研究组,另选同期我院体检结果为健康的40例志愿者纳入正常对照组,根据病情的不同严重程度将研究组分为轻度持续组(26例)、中度持续组(36例)、重度持续组(24例)。比较正常对照组和研究组患者的血清LXA4水平,比较研究组不同严重程度的第1s用力呼气量占预计值的百分比(FEV1%),并分析支气管哮喘患者的LXA4水平与FEV1%的相关性。结果:轻度持续组、中度持续组、重度持续组和正常对照组血清中LXA4水平整体比较差异有统计学意义(P0.05);中度持续组血清中LXA4水平显著高于轻度持续组、重度持续组和正常对照组,重度持续组血清中LXA4水平显著高于轻度持续组和正常对照组,轻度持续组血清中LXA4水平显著高于正常对照组,差异有统计学意义(P0.05);轻度持续组、中度持续组、重度持续组的FEV1%整体比较差异有统计学意义(P0.05);重度持续组的FEV1%显著低于轻度持续组和中度持续组,中度持续组的FEV1%显著低于轻度持续组,差异有统计学意义(P0.05);经Spearman统计分析,支气管哮喘患者的LXA4水平与FEV1%呈明显的负相关(r=-0.486,P=0.041)。结论:LXA4在支气管哮喘中度持续患者血清中表达最高,在轻度持续患者血清中表达最低,支气管哮喘越严重FEV1%水平越低,同时LXA4水平与FEV1%呈明显的负相关。     

Clostridium difficile in association with sporadic diarrhoea.

A total of 154 patients admitted to an infectious diseases unit were included in a year''s prospective survey of sporadic diarrhoeal disease. Stools from 19 of them yielded Clostridium difficile, generally on more than one occasion. Twelve of these patients were assessed as having a severe or moderately severe gastrointestinal illness: Cl difficile was the only pathogen isolated from 10 of them, and two had an associated salmonella infection. Seven had had a recent course of antibiotics, but five had not taken antibiotics. Faeces from seven patients with moderate or mild gastrointestinal illness yielded Cl difficile, and two of these patients also had an associated salmonella infection. Two patients in this group had no antibiotic history. From these findings, the occurrence of C difficile in faeces could not be described as antibiotic-associated. Faecal Cl difficile cytotoxin was detected in only six patients, and generally at low levels. In such patients a more relevant pathogenic index might take account of the numbers of Cl difficile present and of their toxigenic potential.