Journal Detail Information

1

Cite

Share

The significances of peripheral neutrophils CD55 and myeloperoxidase expression in patients with myeloperoxidase-specific anti-neutrophil cytoplasmic antibody associated vasculitis

Xianglian ZHOU ; Meijuan ZHENG ; Zongwen SHUAI ; Lei ZHANG ; Mingming ZHANG ; Shanyu CHEN

Chinese Journal of Internal Medicine.2017;56(6):427-432. doi:10.3760/cma.j.issn.0578-1426.2017.06.008

Objective To investigate the expression of CD55 and myeloperoxidase (MPO) on neutrophils in patients with MPO-specific anti-neutrophil cytoplasmic antibody associated vasculitis(MPO-AAV), and analyze the relationship between the expression and clinical manifestation.Methods Forty untreated patients with active MPO-AAV (patient group) and 30 healthy volunteers (control group) were enrolled in this study.The CD55 on neutrophils and both membrane and cytoplasmic MPO were detected by flow cytometry.Serum fragment-from the activated complement factor B(Ba) and MPO were measured by ELISA.The clinical activity of vasculitis was valued by Birmingham vasculitis activity score-version 3(BVAS-V3).The significance of laboratory data was evaluated by Spearman correlation test and multivariate linear regression analysis.Results (1)The mean fluorescence intensity(MFI) of CD55 expressed on neutrophils was significantly higher than that in control group[4 068.6±2 306.0 vs 2 999.5±1 504.9,P=0.033].Similar results of serum MPO and Ba in patient group were found compared to controls [500.0(381.0, 612.7) IU/L vs 286.9(225.5, 329.1) IU/L,P<0.001;35.2(25.2, 79.5) ng/L vs 18.0(15.0, 28.0) ng/L,P<0.001], respectively.However, MIF of cytoplasmic MPO in patients was significantly lower than that of control group(1 577.1±1 175.9 vs 3 105.3±2 323.0,P=0.003).(2) In patient group, cytoplasmic intensity of MPO was negatively associated with the serum levels of MPO(r=-0.710,P<0.001) and Ba (r=-0.589,P=0.001).Moreover, serum MPO was positively associated with serum Ba(r=0.691,P<0.001).Membrane intensity of CD55 on neutrophils was positively correlated with patient age (r=0.514, P=0.001), C reactive protein (r=0.376, P=0.018), peripheral neutrophils count (r=0.485, P=0.001) and BVAS-V3 (r=0.484, P=0.002), whereas negative correlation between membrane CD55 and disease duration was seen (r=-0.403,P=0.01).(3) The result of multiple linear regression analysis showed there was statistically significant positive correlation between MFI of CD55 expressed on neutrophils and BVAS-V3 (β=0.001,P=0.027).Conclusions In MPO-AAV,CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking AAV, CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking by complement alternative pathway.Activated neutrophils release more MPO and lysosome to intensify the inflammation reaction and aggravate the disease.Thus CD55 might become a new potential target for the treatment of this disease in the future.

2

Cite

Share

The effects of different tidal volume ventilation on right ventricular function in critical respiratory failure patients

Lixia LIU ; Jiaqian WU ; Qiaoyun WU ; Qi ZHANG ; Bin YU ; Shengmei GE ; Yan HUO ; Xiaoting WANG ; Yangong CHAO ; Zhenjie HU

Chinese Journal of Internal Medicine.2017;56(6):419-426. doi:10.3760/cma.j.issn.0578-1426.2017.06.007

Objective To observe and explore the effects of different tidal volume (VT) ventilation on right ventricular (RV) function in patients with critical respiratory failure.Methods Consecutive respiratory failure patients who were treated with invasive ventilator over 24 h in the Department of Critical Care Medicine at the Fourth Hospital of Hebei Medical University from June to December in 2015 were enrolled in this study.Clinical data including patients′ vital signs, ventilator parameters and RV echocardiography were collected within 6 h (D0), day1(D1), day2 (D2) and day3 (D3) after ventilation started.According to the VT, patients with acute respiratory distress syndrome (ARDS) were assigned to low VT group [S6, ≤6 ml/kg predicted body weight (PBW)] and high VT group (L6, >6 ml/kg PBW), while non-ARDS patients were also assigned to low VT group (S8, ≤8 ml/kg PBW) and high VT group (L8, >8 ml/kg PBW).Results A total of 84 patients were enrolled in this study.44.2% ARDS patients and 58.5% non-ARDS patients were in low VT groups.After ventilation, tricuspid annulus plane systolic excursion(TAPSE)decreased progressively in S6 [from 18.30(16.70,20.70) mm to 17.55(15.70,19.50) mm, P=0.001], L6 [from 19.50(17.00,21.00) mm to 16.30(15.00,18.00) mm P=0.001], S8[from 18.00(16.00,21.00) mm to 16.50(15.50,18.00) mm, P=0.001] and L8 [from 19.00(17.50,21.50) mm to 16.35(15.15,17.00) mm, P=0.001] groups.However, TAPSE decreased less in small VT groups (S6 and S8) than those of in large VT groups (S8 and L8) without significant differences.There were not statistical differences between different VT groups in terms of ventilation days, including right ventricle area/left ventricle area (RVarea/LVarea),TAPSE,peak mitral flow velocity of the early rapid filling wave (E),peak mitral flow velocity of the late rapid filling wave (A),early diastolic velocity of the tricuspid annulus (e′),pulmonary artery systolic pressure,inferior vena cava diameter (all P>0.05).Compared to L6 group, low VT (S6 group) resulted in decreased mortality at 28 days [1/19 vs 37.5%(9/24), P=0.014].There were not statistical differences between different VT groups in terms of ventilation days, length of intensive care unit stay, length of hospital stay (all P>0.05).Logistic regression analysis showed that VT could be the independent factor of TAPSE (OR=1.104,95%CI 0.100-1.003,P=0.049).Conclusions Positive pressure mechanical ventilation resulted in RV systolic dysfunction.Lower VT may have the protective effect on RV function.Trial registration Chinese Clinical Trial Registry,ChiCTR-POC-15007563.

3

Cite

Share

Surgical treatment of severe, refractory hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation:a report of 17 patients

Feifei TANG ; Xiaohui ZHANG ; Huan CHEN ; Yuhong CHEN ; Wei HAN ; Jingzhi WANG ; Fengrong WANG ; Yao CHEN ; Xiaojun HUANG ; Lanping XU

Chinese Journal of Internal Medicine.2017;56(6):414-418. doi:10.3760/cma.j.issn.0578-1426.2017.06.006

Objective To investigate the clinical effect and safety of surgical treatment for severe, refractory hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Patients with severe HC, who were admitted to Peking University Institute of Hematology from January 2010 to December 2015, were enrolled in this study.All patients were refractory to medical managements and received bladder surgery including mucous electrocoagulation and/or selective transcatheter arterial embolization.Results A total of 17 patients with severe HC (grade Ⅲ, n=5;grade Ⅳ, n=12) received surgical treatment, including 11 embolization and 18 mucous electrocoagulation.The median time from allo-HSCT to surgery was 107 d (46-179 d) and 75 d after HC.Eight patients only received embolization.Four patients only received mucous electrocoagulation.Five patients were given combined embolization and electrocoagulation.HC was cured in 11 patients, improved in 1 patient, which corresponded to a response rate of 70.6% and complete remission rate of 64.7%.Five patients didn′t respond to these methods.In patients with response, macroscopic hematuria disappeared 3 to 10 days after treatments whereas microscopic hematuria vanished after 25 to 32 days.Both procedures were well tolerated and no severe adverse effects were observed.Conclusion Surgery of bladder mucous electrocoagulation and/or selective arterial embolization are safe and effective for severe HC.

4

Cite

Share

The application of captopril challenge test in the diagnosis of primary aldosteronism

Shi CHEN ; Zhengpei ZENG ; Ailing SONG ; Li ZHU ; Lin LU ; Anli TONG ; Chuan SHI ; Hanzhong LI

Chinese Journal of Internal Medicine.2017;56(6):402-408. doi:10.3760/cma.j.issn.0578-1426.2017.06.004

Objective To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA).Methods A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed.Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA).All patients received CCT.24 h urine sodium was measured in partial patients.Plasma renin activity (PRA), aldosterone (ALD) were detected.Results Compared with EH [PRA: before 0.5(0.2,0.9) μg·L-1·h-1, after 0.8(0.4,1.5) μg·L-1·h-1;ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1,0.9) μg·L-1·h-1, after 0.4(0.1,1.6) μg·L-1·h-1;ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1,0.2) μg·L-1·h-1, after 0.1 (0.1,0.2) μg·L-1·h-1;ALD: before (468±216) pmol/L;after (457±199) pmol/L].After CCT, the suppression rate of ALD [2.8% (-8.8%,15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0,50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients.The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients.In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT.No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group.The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium.No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT.Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without.A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit:ng/dl;PRA unit:μg·L-1·h-1) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%.Conclusions ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2.Seated CCT could replace recumbent CCT as a more confirmatory test.The PRA increasing rate should be taken into consideration when diagnosis of PA.

5

Cite

Share

A prospective control study of Saccharomyces boulardii in prevention of antibiotic-associated diarrhea in the older inpatients

Dongmei ZHANG ; Binbin XU ; Li YU ; Linfu ZHENG ; Longping CHEN ; Wen WANG

Chinese Journal of Internal Medicine.2017;56(6):398-401. doi:10.3760/cma.j.issn.0578-1426.2017.06.003

Objective To study the value of Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in older inpatients.Methods A total of 163 older patients who were treated with wide-spectrum antibiotics at least three days during January 2014 to December 2015 were randomly divided into control and study group.In study group, 81 patients were administrated with oral Saccharomyces boulardii 500 mg twice a day for 21 days.The control group was of no intervention.Morbidity rate of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea, frequency and duration of diarrhea were recorded.Results The incidence of antibiotic-associated diarrhea in study group was significantly lower than that in control group [14.8%(12/81) vs 28.0%(23/82), P<0.05],whereas no difference was seen in the incidence of Clostridium difficile-associated diarrhea [3.7%(3/81) vs 4.9%(4/82), P>0.05] in two groups.The frequency and duration of diarrhea in the study group were significantly lower and shorter than those in control group[(4.3±1.7) times/day vs (6.9±2.0) times/day;(3.0±1.1) days vs (5.7±1.8) days, both P<0.01].Conclusion Saccharomyces boulardii may reduce the incidence of antibiotic-associated diarrhea therefore improving the symptom of diarrhea in older inpatients.

6

Cite

Share

Outcomes of alternative donor allogeneic hematopoietic stem cell transplantation for Fanconi anemia:a five cases report

Wenjing WANG ; Yuqian SUN ; Feifei TANG ; Tingting HAN ; Xiaodong MO ; Jingzhi WANG ; Xiaohui ZHANG ; Xiaojun HUANG ; Lanping XU

Chinese Journal of Internal Medicine.2018;57(1):54-56. doi:10.3760/cma.j.issn.0578-1426.2018.01.010

Five patients with Fanconi anemia who received hematopoietic cell transplantation were retrospectively analyzed. The conditioning regimens included fludarabine, cyclophosphamide and anti-thymocyte globulin. Two patients received both bone marrow and peripheral blood stem cells as the source of stem cell grafts from haploidentical matched related donors, while the others received peripheral blood stem cells from unrelated donors.All patients tolerated well and reached hematopoietic reconstitution. One patient died of intracranial infection.During follow-up,4 patients survived independent of transfusion with full donor chimerism.

7

Cite

Share

Effects of trimetazidine, a myocardial metabolism agent, on regulating 5-hydroxytrytamine system of rats with myocardial infarction and/or depression

Meiyan LIU ; Lijun ZHANG

Chinese Journal of Internal Medicine.2018;57(1):48-53. doi:10.3760/cma.j.issn.0578-1426.2018.01.009

Objective 5-Hydroxytrytamine (5-HT) system was reported to be associated with myocardial infarction (MI) and depression. The aim of the present study was to study the effect of trimetazidine on 5-HT in MI and/or depression rats.Methods Ninety rats were divided into three groups:trimetazidine, sertraline and saline groups (n=30 in each group), and pretreated with trimetazidine, sertarline, or saline, respectively, by gavage once a day for 4 weeks. Thereafter, each group was further divided into three subgroups: MI subgroup, depression subgroup, and MI + depression subgroup. Serum 5-HT,platelet 5-HT,5-HT2A receptor(5-HT2AR),and serotonin transporter(SERT)were detected by enzyme linked immunosorbent assay. Results Similar to sertarline, comparing to saline, trimetazidine treatment increased serum 5-HT [(221±23) pg/ml vs. (176±11) pg/ml; (395±31) pg/ml vs. (195±5) pg/ml; (348±28) pg/ml vs.(183±10)pg/ml],platelet 5-HT[(305±22)pg/ml vs.(130±27)pg/ml;(252±18)pg/ml vs.(175±5) pg/ml;(241±26)pg/ml vs.(181±11)pg/ml],and platelet 5-HT2AR levels[(247±13)pg/ml vs.(197±12)pg/ml;(320±13)pg/ml vs.(193±18)pg/ml;(334±17)pg/ml vs.(206±15)pg/ml]),and lowered platelet SERT levels [(248±11)pg/ml vs.(323±36)pg/ml;(188±7)pg/ml vs.(278±20)pg/ml;(170±23)pg/ml vs.(282±22)pg/ml] in MI,depression and MI+depression subgroups,respectively(all P<0.05).When compared the effect of trimetazidine and sertarline treatment, serum 5-HT and platelet 5-HT2AR in MI group were significantly lower in trimetazidine than in sertraline group (P<0.05), while serum 5-HT and platelet 5-HT, 5-HT2AR in depression group rats were significantly higher in trimetazidine than in sertraline group (P<0.05).Interestingly,platelet 5-HT2AR in MI+depression rats was much higher in trimetazidine than in sertraline group(P<0.05).Conclusions Trimetazidine,a kind of myocardial metabolism agent,could play a role on the regulation of 5-HT,5-HT2AR,and SERT levels in rats with MI and/or depression.

8

Cite

Share

The clinical characteristics, diagnosis and treatment of patients with gout in China

Hui LUO ; Weigang FANG ; Xiaoxia ZUO ; Rui WU ; Xiaoxia LI ; Jinwei CHEN ; Jingguo ZHOU ; Jing YANG ; Hui SONG

Chinese Journal of Internal Medicine.2018;57(1):27-31. doi:10.3760/cma.j.issn.0578-1426.2018.01.005

Objective To investigate the demographic characteristics, clinical features, diagnosis and treatment of patients with gout in China.Methods Clinical data of 6 814 patients with gout from 100 hospitals in 27 provinces, municipalities or autonomous regions in China were collected and analyzed. Results (1)The ratio of male to female in patients with gout was 14.7:1.The mean age of onset was(48.8 ± 15.1)years old.Mean serum urate level was(526.7 ± 132.3)μmol/L.Patients'education background was of U-shaped distribution; (2) Hypertension was the most common comorbidity [15.8%(1 079/6 814)], then overweight or obesity[51.9%(3 536/6 814)];(3)Alcohol and high-purine food intake were dominant triggering factors in men. The diagnosis of gout was made after onset in majority of patients with cardinal symptom arthralgia.Most patients had the disease less than 5 years,and the longer the course,the more flares in the previous year of entry;(4)Febuxostat was the mostly used urate-lowering medication.20.7%(1 412/6 814), 10.8%(739/6 814) and 3.9%(265/6 814) of patients were followed up in 4 weeks, 12 weeks and 24 weeks after registration,and 18.9%(267/1 412),29.1%(215/739)and 38.1%(101/265)of them reached the control target of serum urate levels,respectively.After treatment,patients'liver function was not affected,but serum creatinine levels decreased significantly. Conclusions The proportion of gout patients who reach target serum urate level is very low.Further steps including education and survey need to be carried on.

9

Cite

Share

Clinical characteristics and whole exon sequence study of a Chinese family with autosomal dominant lateral temporal lobe epilepsy

Chengyu LI ; Huajun YANG ; Ruijuan LYU ; Qun WANG

Chinese Journal of Internal Medicine.2018;57(1):44-47. doi:10.3760/cma.j.issn.0578-1426.2018.01.008

Objective To explore the genetic characteristics in a Chinese family with autosomal dominant lateral temporal lobe epilepsy (ADLTE) and analyze the correlation between genotype and phenotype. Methods The natural history,clinical data and peripheral blood sample were collected in all patients and two healthy members of this ADLTE family.Whole exon sequence(WES)analysis strategy was used to explore the underlying mutations. Possible causative genetic variation was further confirmed by direct PCR and Sanger sequencing. The genotype-phenotype features were compared with previously reported cases. Results A novel pathogenetic LGI1 frameshift mutation p.T134fs was identified in this study. The clinical phenotype was different from reported. Conclusion This study reports a pathogenic LGI1 mutation in a Chinese ADLTE family for the first time, which suggests that LGI1 is a new genetic abnormality of ADLTE in Chinese.

10

Cite

Share

Association of Crohn's disease with aryl hydrocarbon receptor gene polymorphisms and haplotypes

Chaoqun WU ; Shuguang CAO ; Xuanping XIA ; Changlong XU ; Shenglong XIA ; Xiuqing LIN ; Jie JIN ; Ran DING ; Yi JIANG

Chinese Journal of Internal Medicine.2018;57(1):37-43. doi:10.3760/cma.j.issn.0578-1426.2018.01.007

Objective To explore the relationship of Crohn's disease (CD) susceptibility to aryl hydrocarbon receptor (AhR) polymorphisms and haplotypes in Han population in Wenzhou city, China. Methods A total of 310 CD patients and 573 age-and sex-matched healthy controls were enrolled in our study. Three single nucleotide polymorphisms (SNPs) of AhR(rs10249788,rs2158041,rs2066853) were determined by the improved multiple ligase detection reaction technique. Unconditional logistic regression analyses was applied to analyze the allelic and genotypic differences of each SNP between CD patients and controls, as well as their influence on the clinicopathologic characteristics in CD patients. Analyses of linkage disequilibrium and haplotype were performed by Haploview 4.2 software in all study subjects. Results Compared with the controls, the variant allele (T) and genotype (CT+TT) of (rs2158041) were evidently decreased among CD patients (19.52% vs. 25.04%, P=0.009; 34.19% vs. 44.68%, P=0.003). According to"the Montreal Classification Standards", CD patients were divided into different subgroups. The variant allele(T)and genotype(CT+TT)of(rs2158041)were significantly lower in patients with terminal ileum CD than in controls (16.79% vs. 25.04%, P=0.005; 28.24% vs. 44.68%, P=0.001). Similar conclusions were also drawn in patients with constricting disease when compared with the controls(15.20%vs.25.04%,P=0.003;28.43% vs.44.68%,P=0.003).The three SNPs above were shown to be in a linkage disequilibrium.Compared with the controls respectively,the frequency of haplotype(CCG)was increased in CD patients (44.73% vs. 39.60%, P=0.039), whereas that of haplotype (CTG) was decreased (18.02% vs. 22.78%, P=0.047). Conclusions AhR (rs2158041) variation might influence the risk as well as the location and behavior of CD. The haplotype (CCG) possibly increase the risk of CD development, whereas haplotype(CTG)might decrease it.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share