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Anti-p200 pemphigoid is an uncommon subepidermal autoimmune bullous disease that, unlike many other autoimmune bullous diseases, has not previously been associated with hematological diseases. The diagnosis of anti-p200 pemphigoid in a patient with congruent clinical features requires the demonstration of subepidermal blistering, with linear deposition of immunoglobulin (Ig) G and/or C3 at the dermoepidermal junction on direct immunofluorescence, and a floor-binding pattern on indirect immunofluorescence. In addition, the detection of antibodies against p200 antigen via immunoblotting is ideal but not readily accessible in many facilities, leading to a potential under-recognition and under-diagnosis of this condition. In this case report, we describe a 53-year-old gentleman with recently diagnosed acquired hemophilia A who developed a concurrent vesiculobullous eruption and was evaluated to have anti-p200 pemphigoid. Both of his conditions were controlled with immunosuppression via prednisolone and cyclophosphamide. While we acknowledge the contemporaneous occurrence of both diseases in this patient may be a mere coincidence, it is important to recognize the possibility of this association given the potential clinical significance. Whether the activity of one disease parallels the other will require further evaluation.
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Objective:To assess the risk of venous thromboembolism (VTE) and anticoagulation-related bleeding of acute critical emergency patients staying in the emergency department at least 72 h, so as to improve the ability of emergency physicians to identify risk factors of VTE and their awareness of safety prevention in these patients.Methods:Multicenter emergency internal medicine patients meeting the inclusion criteria at the same time were collected. Padua and Caprini scores were used to evaluate the risk of VTE and the HAS-BLED score was used to assess the risk of anticoagulation-related bleeding.Results:A total of 930 emergency patients from 7 medical centers were enrolled in our study from January 15, 2021 to March 15, 2021. The proportion of high-risk population with VTE was 50.22% with Padua score and 78.49% with Caprini score, respectively. The proportion of high-risk bleeding (HAS-BLED score) was 40.43%.Conclusions:More than half of the acute critical ill patients who stay in emergency department for more than 72 h are at high risk of VTE. This group of patients have a relatively low risk of anticoagulation-related bleeding.
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Objective:To evaluate the efficacy of T 2* mapping and zoomed imaging with parallel transmission technique (ZOOMit) intravoxel incoherent motion (IVIM) DWI in differentiating benign and malignant thyroid nodules. Methods:The data of 67 patients with thyroid nodules confirmed by surgery and pathology in Ma′anshan People′s Hospital from July 2019 to March 2020 were retrospectively collected. There were a total of 80 nodules, of which 39 were benign nodules and 41 were malignant nodules. All patients underwent MRI including T 2WI, T 2* mapping, and ZOOMit IVIM sequence scans before surgery to measure the T 2*, D, D *, and f values of the nodules. The comparison of the parameters between benign and malignant nodules was evaluated by independent sample t test or Wilcoxon rank sum test. A combined parameter model was established through two-class logistic regression and the predicted probability value was calculated. The ROC curve was used to evaluate the diagnostic efficacy of each parameter and the combined parameter model in differentiating between benign and malignant thyroid nodules. Results:The T 2*, D, f values of benign thyroid nodule group were higher than that in malignant group, and the difference was statistically significant ( P<0.05). The difference of D * value between two groups was not statistically significant ( Z=1.258, P= 0.215). The area under ROC curve (AUC) of T 2*, D, and f values for identifying benign and malignant nodules was 0.703, 0.892, and 0.743, the diagnostic sensitivity was 80.2%, 84.1%, and 80.0%, and the specificity was 65.6%, 81.3%, and 75.0%, respectively. The AUC of T 2*combined with D, T 2*with D * and T 2* with f was 0.925, 0.709, and 0.743, the diagnostic sensitivity was 96.2%, 80.4%, and 80.0%, and the specificity was 81.2%, 65.6%, and 75.0%, respectively. Conclusion:D, f and T 2* derived from ZOOMit IVIM have good value in differentiating between benign and malignant thyroid nodules, and the combination of T 2* and D parameters has the higher diagnostic efficacy.
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Objective:To explore the diagnostic value of hand tenosynovitis in rheumatoid arthritis (RA).Methods:Seventy-six RA patients were enrolled for hands ultrasound examination. Forty-five RA patients with synovitis and tenosynovitis were selected as the study group, clinical characteristics, laboratory test results, disease activity score for 28 joint counts (DAS28), were evaluated and assessed, and the health assessment questionnaire (HAQ) was filled out, and semi-quantitative classification the ultrasonic indicators (synovial hyperplasia, synovitis, tenosynovitis, bone erosion) were also assessed. Forty-two non-RA patients with hand tenosynovitis were selected as the control group. Mann-whitney U test, Spearman correlation and paired U test were used for statistical analysis. Results:① In the RA group, synovial hyperplasia [7.50(3.00, 17.50)], synovitis [6.00(2.00, 14.00)], tenosynovitis [6.00(2.00, 12.00)], bone erosion [0.50(0.00, 4.00)] were statisticantly different when compared with in non-RA group in hyperplasia [5.00(3.00, 6.00)], synovitis [3.00(2.00, 4.30)], tenosynovitis [2.00(1.00, 3.00)], bone erosion [0.00(0.00, 1.00)] ( Z=2.143, P=0.032; Z=2.756, P=0.006; Z=5.560, P<0.01; Z=2.550, P=0.011). ② In the RA group, synovial hyperplasia and synovitis were positively correlated with swollen joint counts (SJC), tender joint counts (TJC), platelet (PLT), C-reactive pro-tein (CRP) and DAS28 [synovial hyperplasia ( r=0.806, P<0.01; r=0.486, P<0.01; r=0.326, P<0.05; r=0.450, P<0.01; r=0.413, P<0.01); and synovitis ( r=0.819, P<0.01; r=0.446, P<0.01; r=0.351, P<0.05; r=0.481, P<0.01; r=0.412, P<0.01)]. Tenosynovitis was positively correlated with SJC, CRP and DAS28 ( r=0.436, P<0.01; r=0.496, P<0.05; r=0.359, P<0.05) , bone erosion was positively correlated with disease course and anti-cyclic citrullinated peptide (CCP) antibody ( r=0.418, P<0.01; r=0.338, P<0.05) . ③ The sensitivity of synovial hyperplasia, synovitis, tenosynovitis, bone erosion and synovitis combined with tenosynovitis for the diagnosis of RA was 0.41, 0.61, 0.57, 0.48, 0.61 and the specificity was 0.95, 0.76, 1, 0.83, 0.93, respectively. ④ The largest area under the ROC curve was tenosynovitis [area under the curve (AUC)=0.841], the area under the curve of tenosynovitis and synovitis combined with tenosynovitis was significantly different from synovitis hyperplasia, synovitis and bone erosion [tenosynovitis( Z=3.291, P=0.001; Z=2.651, P=0.008; Z=3.032, P=0.002); synovitis combined with tenosynovitis( Z=4.346, P=0.001; Z=3.753, P=0.001; Z=2.547, P=0.012)]. Conclusion:Synovitis has a high sensitivity for the diagnosis of RA, and tenosynovitis has a high specificity for the diagnosis of RA, synovitis combined with tenosynovitis can improve the specificity for the diagnosis of RA.
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Objective:To summarize the common sites of osteophytes in patients with hand osteoarthritis (OA), and analyze the correlation between the severity of osteophytes and clinical factors.Methods:One hundred and four patients with hand OA were selected and divided into three groups according to the disease duration: <1 year, 1~5 years, >5 years. The first carpometacarpal joint(CMC1), metacarpophalangeal joint(MCP), proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP) were detected by high fre- quency ultrasound. The location of osteophytes and osteophyte semi-quantitative grading scores (OSGS) were recorded. The patients age, disease duration, erythrocyte sedimentation rate (ESR), C-reactionprotein (CRP), the visual analogy score (VAS) and Australian/Canadian osteoarthrits hand index (AUSCAN) were collected. The indicators of different groups were compared, the incidence and location of osteophytes was calculated, and the correlation between osteophytes and clinical factors was analyzed. Data were analyzed by Wilcoxon rank sum test, Kruskal-Wallis test, χ2 test, Spearman correlation analysis. Results:① Osteophytes accounted for 33.56%(1 047/3 120) of the 3 120 joints in hands. There were statistically significant differences in OSGS and AUSCAN in different groups ( H=13.485, P<0.01; H=51.491, P<0.01), while no statistically difference in VAS, ESR and CRP ( H=5.808, P=0.055; H=2.878, P=0.237; H=2.319, P=0.314). ② In different joint areas of hands, PIP accounted for the largest proportion (46.54%, 484/1 040), followed by DIP (46.51%, 387/832), CMC1 (30.77%, 64/208), and MCP accounted for the smallest proportion(10.77%, 112/1 040). There were statistically significant differences in the incidence of osteophytes in different joint areas( χ2=384.194, P<0.01).③ In the interphalangeal joint areas of hands, the largest osteophytes composition ratio was MCP3 (46.43%, 52/112), PIP3 (30.58%, 148/484) and DIP2 (31.01%, 120/387), respectively. ④ OSGS were positively associated with age, disease course, VAS and AUSCAN ( r=0.370, P<0.01; r=0.382, P<0.01; r=0.215, P=0.029; r=0.390; P<0.01), there was no correlation between OSGS and ESR or CRP ( r=0.173, P=0.079; r=0.162, P=0.101). Conclusion:PIP are the most common sites of osteo-phytes in hand OA, followed by DIP. High frequency ultrasound can help the diagnosis and evaluate the severity of hand OA.
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The prevalence and mortality of cardiovascular diseases are still on the rise in China. Percutaneous coronary intervention(PCI)is the most effective strategy to reduce coronary artery stenosis and occlusion, it can also improve clinical symptoms on patients with coronary heart disease. Clinically, a large number of patients still have heartache symptoms after recanalization of the great vessel. During the perioperative period, PCI is often accompanied with adverse events such as oxidative stress, inflammation, calcium overload, endothelial function damage, and thrombus obstruction. More specifically, during the process of PCI, oxidative stress is more severe than other damages. For example, during the reperfusion period of PCI, the outbreak of reactive oxygen species (ROS) can lead to abnormal mitochondrial energy transfer and cell ion homeostasis, resulting in endothelial cell injury, it can also increase the level of vascular permeability, albumin leakage, the adhesion of leukocyte and platelet, and the level of vascular stenosis. After PCI, traditional Chinese medicine(TCM) brings vasucular restenosis into the category of " palpitation" . The movement of Qi and bloods is tightly related to the five Zang-orans. When the movement of Qi and blood is stagnant, the function of the heart's blood production and circulation is blocked, resulting in Qi of deficiency and blood stasis, thus causing a state of physical weakness. Moreover, at present, Probucol and Ticagrelor and other first-line clinical drugs have certain limitations, and ignore the body' s current status of " essential illusory and real" , unable to coordinate the relationship between the body' s Qi and blood, Yin, Yang and five zang-organs. The purpose of this research is to perform the negative effects of oxidative stress on coronary artery based on the molecular research of modern medicine accompanied with acknowledgement of TCM and to conclude the process of researching prevention and treatment of TCM, and to provide reference for the treatment of coronary artery and coronary artery experimental study.
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Objective:To study the effect of combined decoction and single decoction of Houpu Wenzhongtang on rats with deficiency-cold of spleen and stomach from the perspective of metabonomics, to find out the relevant potential biomarkers and metabolic pathways, and to explore the similarities and differences between the combined decoction and single decoction, so as to provide reference for the feasibility analysis of replacing traditional decoction with single dispensing granule of this formula. Method:SD rats were randomly divided into normal group, model group, Houpu Wenzhongtang combined decoction group and simgle decoction group. Rats in the normal group were given distilled water by intragastric administration, rats in the other three groups were given cold vinegar at 4 ℃ in the morning and refined lard in the afternoon for 10 days (the dosage of 10 mL·kg-1). After the model was successfully established, rats in the combined decoction group and the single decoction group were given corresponding decoction with dosage of 1.8 g·kg-1 (according to the amount of crude drugs), once a day for 7 days. Ultra-high liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS) technique was used to analyze the small molecular endogenous metabolites in urine. Orthogonal partial least squares-discriminant analysis (OPLS-DA) and principal component analysis (PCA) were used to compare the changes of differential metabolites among the normal group, model group, Houpu Wenzhongtang combined decoction group and single decoction group, and the differential metabolites were introduced into Kyoto Encyclopedia of Genes and Genomes (KEGG) for metabolic pathway analysis. Result:Compared with the model group, the Houpu Wenzhongtang combined decoction group and single decoction group jointly regulated 13 potential biomarkers, including phosphatidylcholine(PC), lysophosphatidic acid(LysoPA) and cholic acid, etc. They played a role in treating deficiency-cold of spleen and stomach by influencing metabolic pathways such as glycerophospholipid metabolism, glycerolipid metabolism, phosphatidylinositol signaling system and so on. The combined decoction and single decoction of Houpu Wenzhongtang could obviously restore the body weight, motilin and gastrin contents of rats with deficiency-cold of spleen and stomach to normal levels. Conclusion:According to biochemical indexes, there is no obvious difference between combined decoction and single decoction of Houpu Wenzhongtang, but according to metabonomics, the combined decoction may be slightly better than the single decoction. The research shows that it is feasible to replace traditional decoction with single dispensing granule of Houpu Wenzhongtang in clinical application.
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OBJECTIVE@#To investigate the effect of different treatment temperatures of a novel cold atmospheric plasma jet treatment on the resin-dentin bonding.@*METHODS@#(1) Fifty-two freshly extracted, non-carious and intact third molars were collected. The occlusal one-third of the crown was removed by means of a water-cooled low-speed Isomet saw. One dentin disc [(900 ±100) μm] was prepared for each tooth. The fifty-two dentin discs were randomly divided into control group and experimental groups, of which four were in control group, and forty-eight were divided into four experimental groups according to the different treatment temperatures (4 °C, 10 °C, 20 °C and 30 °C) of the novel radio-frequency atmospheric-pressure glow discharge (RF-APGD) plasma jet, twelve in each group. Each experimental group was divided into three subgroups according to different treatment time (10 s, 20 s and 30 s), with four in each subgroup. The occlusal one-third of the crown was removed by means of a water-cooled low-speed Isomet saw. The morphology of demineralized dentin surfaces was analyzed using field emission scanning electron microscopy. (2) Twenty unerupted, non-carious and intact third molars were randomly divided into five groups, four in each group: control group, untreated; 4 °C, 10 °C, 20 °C and 30 °C experimental groups, each group was treated with the RF-APGD plasma jet for 20 s. The micro-tensile resin dentin bond strength was tested after 20 s RF-APGD plasma jet treatment with different temperatures, using a universal mechanical machine.@*RESULTS@#(1) The field emission scanning electron microscopy results indicated that when compared with the control group, a 10 s RF-APGD plasma jet treatment with 30 °C and 20 °C collapsed the collagen scaffold. Collagen fibrils maintained an uncollapsed three-dimensional structure after the 4 °C RF-APGD plasma jet treatment for even 30 s treatment. (2) The microtensile resin dentin bond strength results of the 4 °C RF-APGD plasma jet treatment group (57.8±0.7) MPa were significantly higher than that of the control group [(47.4±0.5) MPa] and 10 s, 20 s and 30 s RF-APGD plasma treatment group [(51.9±0.7) MPa,(29.7±1.0) MPa and (22.2±1.5) MPa] with statistically significant difference (P<0.05). Compared with the control group, the micro-tensile bond strength increased about 21.9% and 9.5% after 4 °C and 10 °C RF-APGD plasma jet treatment, respectively.@*CONCLUSION@#Compared with other treatment temperatures, this novel RF-APGD plasma jet treatment with the temperature of 4 °C can preserve the three-dimensional morphology of demineralized dentin better, and can improve the resin-dentin bonding.
Subject(s)
Composite Resins , Dental Bonding , Dentin , Dentin-Bonding Agents , Materials Testing , Microscopy, Electron, Scanning , Plasma Gases , Resin Cements , Temperature , Tensile StrengthABSTRACT
Objective To observe the effect of out-hospital standardized treatment on the recurrence of the first onset of acute unprovoked pulmonary thromboembolism (PE) after discontinued anticoagulant therapy or during anticoagulation therapy in PE patients after treatment and discharged from hospital.Methods A prospective study of patients with acute PE admitted into emergency ICU for training in out-hospital standardized anticoagulation treatment was carried out from January 2015 to December 2016 (observation group).Another cohort of EP patients without training in out-hospital standardized anticoagulation treatment admitted from January 2010 to December 2014 was enrolled for retrospective analysis(control group).The out-hospital standardized anticoagulation treatment strategy included the guidance of anticoagulation therapy,record all of the patients' symptoms related with recurrent EP both during and discontinuous anticoagulant treatment,V/O scan at 3 months,6 months and 12 months follow-up,respectively.The patients with ceased anticoagulant therapy would be followed up for at least one year.Patients with signs of recurrence would have a definite diagnosis at once.The anticoagulation status and outcome of the patients in control group found in out-patient department were recorded.Results ① There were 129 patients with acute unprovoked PE in observation group and 246 in control grouThere were no significance difference both in mean age and gender between two groups (P ＜0.05).② Recurrence rate was 11.63％ in observation group and 22.36％ in control group (P ＜0.01);③ There was significance difference in mortality rate between observation group (3.1％) and control group (10.85％) (P ＜0.05).There was also significant difference in rate of missing follow-up between observation group (10.85％) and control group (21.54％) (P＜0.001),and.there was significant difference in rate of discontinuous anticoagulation therapy between observation group (1.55％) and control group (8.5％) (P ＜0.01).④ There was no significance difference seen in the rate of patients exposed to multiple risk factors of arteriosclerosis between observation group (82.25％) and control group (77.64％) (P＜0.05).But the target rate of controlling various risk factors of arteriosclerosis was 79.31％ in observation group and 54.97％ in control group respectively (P＜0.05).Conclusions Standardized treatment can effectively reduce the recurrent rate of the venous episodes of the patients with first episode of acute unprovoked pulmonary thromboembolism;Recurrent venous episodes of the PE patients who exposed to the multiple risk factors of arteriosclerosis require more attentions.
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<p><b>OBJECTIVE</b>This review discusses the experimental and clinical studies those show the expression of connexin 36 in the central nervous system and the possible role of connexin 36 in epileptic seizure.</p><p><b>DATA SOURCES</b>All articles used in this review were mainly searched from PubMed published in English from 1996 to 2012.</p><p><b>STUDY SELECTION</b>Original articles and reviews were selected if they were related to the expression of connexin 36 in the central nervous system and its role in epilepsy.</p><p><b>RESULTS</b>The distribution of connexin 36 is developmentally regulated, cell-specific and region-specific. Connexin 36 is involved in some neuronal functions and epileptic synchronization. Changes in the connexin 36 gene and protein were accompanied by seizures. Selective gap junction blockers have exerted anticonvulsant actions in a variety of experiments examined in both humans and experimental animals.</p><p><b>CONCLUSIONS</b>Connexin 36 plays an important role in both physiological and pathological conditions in the central nervous system. A better understanding of the role of connexin 36 in seizure activity may contribute to the development of new therapeutic approaches to treating epilepsy.</p>
Subject(s)
Animals , Humans , Central Nervous System , Metabolism , Connexins , Metabolism , Gap Junctions , Metabolism , Seizures , MetabolismABSTRACT
Objectvies:To investigate the role of vascular endothelial growth factor(VEGF) in the pathogenesis of endometriosis(EMs). Methods:A total of 70 specimens of endometriosis and 30 specimens of the normal controls were evaluated by immunohistologically techique with polyclonal antibody against VEGF. Results:The expression levels of VEGF in endometriotic tissues was higher than that in the normal endometrium( P