Pneumonia is one of the most common medical complications after stroke.Stroke-associated pneumonia (SAP) can not only increase the length of hospital stay and medical cost of patients,but also an important risk factor for mortality and morbidity in patients with stroke.All these indicate that the importance of prediction and prevention of SAP.This article reviews the advances in research on the prediction and prevention of SAP.

OBJECTIVE To observe the preventive effect of and to study the immunomechanism of Fangan 1 prescription (traditional Chinese medicine prescription) on repetitive upper respiratory infection in aged people. METHODS Sixty five old patients with repetitive upper respiratory infection as study objects were divided randomly into treatment group and control group and their T lymphocyte subset was detected. RESULTS CD3 and CD4 were decreased in different degree among them, the difference was significant in comparison with the healthy aged (P

Objective To investigate the efficacy of the combination ofJiangtang decoction and insulin in the treatment of type 1 diabetes mellitus in children.Methods A total of 43 children with type 1 diabetes mellitus were enrolled and randomly allocated to either a insulin group (control group) and a insulin plusJiangtang decoction group (treatment group) using the table of random digits, with 23 patients in the control group and 20 in the treatment group. The patients in the control group were treated with insulin, and those in the treatment group were administrated withJiangtangdecoction on the basis of the treatment in the control group for 2 months. Body mass index (BMI), fasting plasma glucose (FPG), postprandial blood glucose (PBG) and hemoglobin A1c (HbA1c) were measured.Results The levels of FPG, PBG and HbA1c were significantly decreased in the treatment group (twere 3.376, 54.493, and 2.798, respectively; allP<0.01), and the PBG level was significantly decreased in the control group (t=29.714,P=0.000). The levels of FPG, PBG and HbA1c in the treatment group were significantly lower than those in the control group (twere 2.715, 2.191 and 5.627, respectively;P<0.05 orP<0.01). There was no difference in BMI between the treatment group and the control group (t=0.159,P=0.874). The proportion of patients with HbA1c <7.5% in the treatment group (60.0%, 12/20) was higher than that in the control group (26.1%, 6/23;χ2=5.055,P=0.025).Conclusion Combination ofJiangtang decoction and insulin can decrease the level of FPG, PBG and HbAlc, and its therapeutic effect is superior to insulin alone for type 1 diabetes in children.

Objective:To discuss the role of incision for short-term outcomes of simultaneous resection in synchronous colorec-tal liver metastases (sCRLM). Methods:We reviewed the data of 37 patients who underwent simultaneous resection between January 2009 and December 2014 in our department and compared the short-term outcomes between Mercedes and midline incisions. Results:Mercedes and midline incisions were used in 19 and 18 patients, respectively. The two groups showed similarities in patient characteris-tics, major hepatectomy, surgery time, blood loss, and hilar block time. The midline group comprised more rectal cancer patients (P<0.001). The two groups did not differ significantly in complication incidence (47.4%vs. 16.7%, P=0.08) and postoperative stay time (22.1 ± 9.5 d vs. 17.2 ± 6.7 d, P=0.08). At body mass index (BMI)<25, the complication incidence (P=0.046) and postoperative stay time (P=0.051) were lower in the midline group than in the Mercedes group. Conclusion:Midline incision provided similar exposure in simultaneous resection for sCRLM and was better than Mercedes incision in rectal cancer patients. Patients with midline incision may attain better short-term outcomes if BMI is<25.

Objective:To study the changes of serum IL 1?,IL 6,IL 8,TNF ? and sIL 2R and its relationship with disease activity in adult Still disease patients.Methods:Serum levels of IL 1?,IL 6,IL 8,TNF ? and sIL 2R were assessed by ELISA in 18 adult Still disease patients before and one month after treatment with prednisone.Results: Active adult Still disease patients had significant elevated erythrocyte sedimentation rate (ESR) and serum levels of C reactive protein (CRP),IL 1?,IL 6,IL 8,TNF ? and sIL 2R.After one month treatment with prednisone,ESR and serum levels of CRP,IL 6,TNF ? and sIL 2R significantly decreased.There was a significant correlation between ESR values and serum IL 6,TNF ? and sIL 2R levels,and between serum CRP levels and IL 6,TNF ? and sIL 2R levels.Serum IgG,IgA and IgM levels in active adult Still disease patients were similar to those in healthy controls.Conclusion: There are no changes in serum immunoglobulins but significant increases of serum IL 1?,IL 6,IL 8,TNF ? and sIL 2R levels in active adult Still disease.Serum levels of IL 6,TNF ? and sIL 2R are related to the activity of adult Still disease.

Objective To determine the clinical features of systemic lupus erythematosus (SLE) patients with pancreatitis.Methods The medical records of 46 patients with pancreatitis among 5 233 SLE patients admitted into Peking Union Medical College Hospital from January 1983 to January 2012 were reviewed for retrospective analyses of clinical manifestations,laboratory tests,radiological findings,treatments and prognosis.Results The prevalence of pancreatitis was 0.88％ (46/5 233) in SLE patients.There were 7 males and 39 females with an average age of (33 ± 13) yeats.Acute pancreatitis (n =40) occurred more frequently than chronic pancreatitis (n =6).It appeared mostly in active course of SLE with an involvement of more organs.Hypertriglyceridemia was found in 81.0％ (17/21) lupus-associated acute pancreatitis patients.The average level of triglycerides in severe acute pancreatitis was higher than that in mild acute pancreatitis (P =0.023).The mortality rate of lupus-associated acute pancreatitis was 37.5％ (15/40).Most patients received high-dose glucocorticoid and immunosuppressants.Acute pancreatitis appeared in only 5 patients during the course of steroids pulse therapy and most symptoms were mild.Concomitant infections were correlated with poor prognosis (P ＜ 0.01).The most common manifestations of lupus-associated chronic pancreatitis were abdominal pain,jaundice and pancreatic enlargement.Autoimmune pancreatitis could be the initial manifestation of lupus.Conclusions Pancreatitis with SLE includes acute and chronic pancreatitis.Among them,acute pancreatitis is more common and severe and it usually occurs in patients with active SLE with a high mortality.Hypertriglyceridemia may induce and aggravate lupus-associated acute pancreatitis.Early aggressive management with high-dose steroids and immunosuppressants is recommended.Concomitant infection is a risk factor of poor prognosis.

Objective To survey the incidence of cardiovascular damage in ankylosing spondylitis (AS) patients and explore the related risk factors.And to establish the risk prediction models for the future.Methods The electrocardiogram (ECG) and cardiac ultrasonography (UCG) of 122 AS patients (group A)in the department of rheumatology of Peking Union Medical College Hospital from 2001 to 2011 were analyzed.Fifty-nine AS patients with abnormal ECG and/or UCG findings consisted of the study group (group A1),the other 63 AS patients without cardiovascular damage were the control group (group A2).We selected 100healthy controls (group B).All healthy controls had ECG and UCG tests.The ECG and UCG findings of the group A1 were analyzed,the clinical manifestations and laboratory results were compared between group A1and A2.A univariate analysis and multivariate Logistic regression analysis were carried out to determine the risk factors related to cardiovascular damage in AS.Results The prevalence rate of cardiovascular damage in AS patients was 48.4％ (59/122).While the prevalence of ECG and or UCG abnormality in healthy controls was 12.0％ (12/100),the difference between the two groups was statistically significant (P＜0.05).In group A1,the main findings in ECG were abnormal sinus node function,high voltage in left ventricle and ST-T changes,other findings were atrioventricular block,branch bundle block and premature beats.In group A1,the main findings in UCG were valvular diseases and arterial root widening,other abnormal findings were pericardial effusion,left ventricular diastolic dysfunction and mild pulmonary hypertension.The level of ESR,CRP,RBC,HGB,blood glucose,the number of peripheral joint involvement,the severity of sacroiliac arthritis and the age were significantly different between group A1 and A2 (P＜0.05).Multivariate Logistic regression analysis showed that age and CRP were risk factors for cardiovascular damage in AS patients.Conclusion The prevalence of cardiovascular damage in ankylosing spondylitis is relatively high.Age and CRP are the risk factors contributing to cardiovascular damage in AS patients.

Objective To improve the rheumatologists'understanding of pulmonary artery hypertension (PAH) of adult onset Still's disease (AOSD).Methods Three cases of (AOSD) with (PAH) were reported and the related literatures were reviewed.Results All patients were female.The average age was 29 years old.As the cases showed,the clinical manifestations of AOSD were all before the appearance of PAH symptoms and the interval could be 5 months to 9 years.From the ultrasonic cardiogram estimation,the PASP of these patients was (80±21) mm Hg (1 mm Hg=0.133 kPa) on average.The common characteristics included the severity of AOSD,recurrence after high dose of corticosteroid and various immunosuppressive agents aggressively.In addition,PAH was developed rapidly,and we found that patients were die 1 year later after disease onset.Studies showed that all of their death were related to circulation failure caused by right heart failure combined with obstructive shock.And infection was considered as an important predisposing factor of the obstructive shock.Conclusion From the findings above,we can conclude that ASOD complicated with PAH is rare,and it always develops rapidly.Furthermore,the state of disease is very serious and at the same time,the prognosis remains poor.Rheumatologists should aware this rare condition.

OBJECTIVETo study the short- and long-term effects of multi-glycosides of tripterygium wilfordii (GTWon) the histological structures of testes in pubertal rats and possible mechanisms.

METHODSForty-eight 5-week-old male Sprague-Dawley rats were randomly intragastrically administered with low-does GTW(6 g/kg daily)and high-does GTW (12 mg/kg daily) or 1% sodium carboxymethylcellulose (6 mL/kg, control group) for four weeks. The testes were sampled for detecting histological structures and c-kit expression by immunohistochemistry 24 hrs and four weeks after drug discontinuance.

RESULTSThe number of spermatogenic cells and the expression of c-kit in testes were reduced in the two GTW treatment groups 24 hrs and 4 weeks after drug discontinuance compared with those in the control group(P<0.05). Four weeks after drug discontinuance atrophy and interstitial edema of seminiferous epitheliumin in testes were observed, and the testis weight and the expression of c-kit in testes were reduced in the high-does GTW group compared with those in the control group (P<0.01). There were no significant differences in the parameters observed between the low-dose GTW and the control group 4 weeks after drug discontinuance.

CONCLUSIONSGTW has adverse effects on testes in a dose-dependent manner in puberty rats. Low-dose GTW may cause reversible short-term injuries to testis tissues. The damage of the interstitial tissue of testes induced by high-dose GTW may be one of the causes of long-term injuries of testes.

Animals ; Dose-Response Relationship, Drug ; Glycosides ; pharmacology ; Male ; Organ Size ; drug effects ; Proto-Oncogene Proteins c-kit ; analysis ; Rats ; Rats, Sprague-Dawley ; Sperm Count ; Testis ; chemistry ; drug effects ; pathology ; Tripterygium ; chemistry

OBJECTIVE: To investigate the association of MTHFR C677T and MS A2756G polymorphism with semen quality in China. METHODS: The experimental group included 75 males with oligospermia, asthenospermia or teratospermia. The control group included 72 fertile males with normal fertility and sperm quality. The differences in the frequency of genetic polymorphism of MTHFR C677T and MS A2756G in the 2 groups were analyzed, and the plasma homocysteine (Hcy) level in both groups was detected. RESULTS: The frequency of MTHFR C677T genotypes (CT, TT and CT+TT) in the abnormal sperm group was higher than that in the control group (P<0.05), and it was the same case for T allele between the 2 groups (P<0.05). There was no difference in the frequency of MS A2756G genotypes between the two groups (P>0.05). The Hcy level in abnormal sperm group was higher than that in the control group. In all subjects, the Hcy level of the MTHFR genotypes (CT, TT and CT+TT) was higher than that of the CC genotype, with no difference among the three MS A2756G genotypes. CONCLUSION CT and TT genotypes of MTHFR C677T are associated with abnormal sperm, which might be part of the pathogenesis of abnormal sperms. T allele may be the risk factor in China. The one mechanism of the association between MTHFR C677T polymorphism and semen quality could be higher Hcy level. MS A2756G polymorphism may not associate with semen quality in China.
Alleles ; China ; Genotype ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Polymorphism, Genetic ; Risk Factors ; Semen Analysis