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ObjectiveTo explore the characteristics of tongue manifestations and traditional Chinese medicine （TCM） syndromes in patients with primary Sjogren's syndrome （pSS） of different time. MethodpSS patients who visited TCM Department of Rheumatism in China-Japan Friendship Hospital from December 2018 to October 2021 were included and grouped according to the disease courses （short<5 years， medium 5-10 years， long > 10 years）. Chi-square test was used for comparison between three groups and Bonferroni method for multiple comparisons. In the pairwise comparison， P<0.017 indicated significant difference. Chi-square test was performed on the syndrome and specific tongue manifestations with inter-group differences to analyze the trend of tongue manifestations and TCM syndromes over time （interval： two years）. ResultA total of 193 pSS patients were enrolled， with 85 （44.0%） of short disease course， 69 （35.8%） of medium disease course， and 39 （20.2%） of long disease course. The common tongue manifestations were crimson tongue， fissured tongue， thin tongue， lack of fluid， and dry coating， which showed no significant difference among the three groups. Higher proportion of patients with light red tongue was observed in the group with short disease course than in group with medium disease course （χ2=6.407， P<0.017）. Higher proportions of patients with thick coating （χ2=6.784， P<0.017） and phlegm-dampness syndrome （χ2=11.545， P<0.017） and lower proportion of patients with Qi deficiency syndrome （χ2=12.706， P<0.017） were found in the group with short disease course than in the group with long disease course. Patients with medium （χ2=6.358， P<0.017） and long （χ2=8.279， P<0.017） disease course tended to have exfoliated coating compared with those with short disease course， and the proportion of patients with exfoliated coating rose and the proportion of patients with thick greasy coating decreased over time （Ptrend<0.05）. In addition， the proportion of patients with phlegm-dampness syndrome decreased and that with Qi deficiency syndrome increased over time （Ptrend<0.05）. ConclusionIn the early stage， patients with pSS often show both dryness and dampness， as manifested by the thick greasy coating and phlegm-dampness syndrome. In the medium and late stage， patients often have Qi-Yin deficiency， as evidenced by exfoliated coating and Qi deficiency. In the clinical practice， medicines should be prescribed based on tongue manifestations and TCM syndrome of patients.
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El diagnóstico y el tratamiento de la artritis reumatoide temprana en el curso de la enfermedad proporcionan alivio de los síntomas y también previene el daño estructural a largo plazo y el deterioro funcional, con una mejora concomitante en la calidad de vida. El propósito de este estudio es exponer algunos enfoques de la artritis reumatoide en cuanto al tratamiento y comportamiento de la actividad de la enfermedad. El reconocimiento de los pacientes de que su enfermedad progresa rápidamente es fundamental para identificar candidatos en los cuales la terapia intensiva puede tener el mayor impacto, en términos de prevenir la progresión de la enfermedad. Los datos acumulados muestran que las estrategias de tratamiento intensivo con agentes biológicos, especialmente los inhibidores del factor de necrosis tumoral, son más eficaces que la monoterapia secuencial o la terapia de combinación progresiva. Estos muestran una eficacia sustancial en combinación con el metotrexato, ya que proporcionan beneficios y mejoras rápidas y sustanciales a los pacientes(AU)
The diagnosis and treatment of rheumatoid arthritis early in the course of the disease provides relief of symptoms and also prevents long-term structural damage and functional deterioration, with a concomitant improvement in quality of life. To expose approaches to rheumatoid arthritis in terms of the treatment and behavior of the activity of said disease. Recognition of patients with rapidly progressing disease is essential to identify candidates in whom intensive therapy can have the greatest impact, in terms of preventing disease progression. The accumulated data shows that intensive treatment strategies with biological agents, especially TNF inhibitors, are more effective than sequential monotherapy or progressive combination therapy. These show substantial efficacy in combination with methotrexate, providing rapid and substantial benefits and improvements in patient outcomes(AU)
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Humans , Male , Female , Arthritis, Rheumatoid/diagnosis , Methotrexate/therapeutic use , Disease Progression , Early Diagnosis , Arthritis, Rheumatoid/drug therapy , Quality of Life , EcuadorABSTRACT
Objective To explore the effects of diagnostic delay on early disease course of Crohn's disease (CD ), and to analyze the risk factors related with the progress of early disease course. Methods From December 2014 to July 2017,a total of 56 patients in Renmin Hospital of Wuhan University initially diagnosed as CD were selected.The clinical manifestation,previous history,imaging examination, endoscopic examination and pathological results of the patients were collected after initial diagnosis of CD. CD-related surgery,CD-related rehospitalization and use of immunomodulators were followed.According to time interval between initial symptom onset and initial diagnosis,the patients were divided into diagnostic delay group (diagnostic delay time＞two years,14 cases)and non-diagnostic delay group (diagnostic delay time≤two years,42 cases).The clinical characteristics at initial diagnosis and early prognosis were compared between the two groups.The risk factors affecting early prognosis of CD patients were analyzed. Kaplan-Meier was used for prognosis analysis.Log-rank test and Cox proportional hazards model were performed to analyze factors affecting early prognosis.Results The results of imaging examination indicated that the proportion of intestinal injury of diagnostic delay group was significantly higher than that of non- diagnostic delay group (χ2＝ 4.49,P ＝ 0.03 ).During follow-up,the proportion of CD-related rehospitalization of diagnostic delay group was higher than that of non-diagnostic delay group,and the difference was statistically significant (χ2＝7.34,P＝0.01).During follow-up,the nine patients received surgery.The one-year and three-year cumulative incidence of surgery was 10.7% and 22.7%,respectively;one-year cumulative incidence of surgery in diagnostic delay group and non-diagnostic delay group was 38 .6%and 9 .6%,respectively.The results of Cox univariable and multivariable analyses both indicated that intestinal injury in imaging examination at diagnosis was the risk factor of surgery (both hazard ratio (HR)＝2.313,both P＜0.01).A total of 21 patients had CD-related rehospitalization during follow-up.And one-year and 31-month cumulative incidence of hospitalization was 27 .8% and 5 6 .3%,respectively;one-year cumulative incidence of CD-related rehospitalization in diagnostic delay group and non-diagnostic delay group was 43 .7% and 2 1 .6%,respectively;and the difference was statistically significant (χ2＝5 .88 ,P＝0.02).The results of Cox univariable analysis indicated that having systematic manifestation,intestinal inj ury in imaging examination and diagnostic delay were the risk factors of CD-related rehospitalization (HR＝2.972,2.313 and 1.403,all P＜0.05).The results of multivariable analysis indicated that having systematic manifestation and intestinal injury in imaging examination were independent risk factors of CD-related rehospitalization (HR＝3.891 and 2.541, P ＜ 0.01,respectively).Conclusions The proportion of intestinal injury of patients with diagnostic delay is high and the early prognosis is poor. Intestinal injury in imaging examination at initial diagnosis is independently risk factor of CD-related surgery and rehospitalization during follow-up.
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OBJECTIVE@#To investigate the association of the time of initial diagnosis with the severity of chronic obstructive pulmonary disease (COPD).@*METHODS@#A total of 803 patients who were diagnosed to have COPD for the first time in our hospital between May 2015 to February 2018 were enrolled in this study.The diagnoses of COPD and asthma COPD overlap (ACO) were made according GOLD guidelines and european consensus definition.Lung function of the patients was graded according to the GOLD guidelines.@*RESULTS@#The patients with COPD had a mean age of 61.8±9.9 years,including 726 male and 77 female patients.The course of the patients (defined as the time from symptom onset to the establishment of a diagnosis) was 3(0.5,8) years.Among these patients,85.2% had a moderate disease severity (FEV1%<80%),and 48.3% had severe or very severe conditions (FEV1%<50%);47.0% of them were positive for bronchial dilation test.In the overall patients,295(36.7%) were also diagnosed to have ACO,and the mean disease course of ACO[3(1,9) years]was similar to that of COPD[3(0.5,8) years](>0.05).A significant correlation was found between the disease course and the lung function of the patients.Multiple linear regression analysis showed that an older age and a longer disease course were associated with poorer lung functions and a greater disease severity.@*CONCLUSIONS@#The delay of the initial diagnosis is significantly related to the severity of COPD.
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Aged , Female , Humans , Male , Middle Aged , Age Factors , Asthma , Diagnosis , Delayed Diagnosis , Disease Progression , Lung , Pulmonary Disease, Chronic Obstructive , Diagnosis , Severity of Illness Index , Time FactorsABSTRACT
Objective To explore the significance of serum cytokine interferon-gamma (IFN-γ) ,interleukin-4(IL ) ,transforming growth factor-beta 1 (TGF-β1) ,interleukin-9 (IL-9) ,interleukin-17 (IL-17) in detection of youth first-episode depression .Methods Ninety cases of youth first-episode depression as the experimental group were equally divided into 3 groups according to different disease courses(2 years)and other 30 normal persons served as the control group .The levels of serum cytokines were measured by ELISA .The level of each cytokine and Hamilton Depression Scale (HAMD) score were per-formed the Spearman correlation analysis .Results The IL-9 level in the 6 months to 2 years group and > 2 years group was high-er than that in the control group (P2 years group(P<0 .05);the IL-4 level was positively correlated with the depressive mood (P<0 .05) .Conclusion Different cytokines play different roles in youth first-episode depres-sion ,cytokines may involve in the occurrence and development of depression .
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Aim To observe the variation of T-cell subsets in spleen in different courses of disease and tis-sue histopathological changes in rats with adjuvant ar-thritis (AA).Methods The model of rat AA was in-duced by complete Freund’s adjuvant into the right hind metatarsal footpad of 20 male Lewis rats.Arthritis was evaluated by total score,arthritis index and paw swelling number. The percentage of total (CD3 +CD4 +), memory (CD4 + CD44 +), no-sensitizated (CD4 + CD62L +) and Th1 7 (CD4 + IL-1 7 +) on CD4 +T cells in spleen were detected by flow cytometry on days 1 4 and 22 after immuniozation.The his-topathological evaluation of heart,liver,spleen,lung, kidney,ankle joints and mesenteric lymph nodes were examined by hematoxylin and eosin (HE)stain.Re-sults The onset of secondary arthritis appeared on a-bout day 1 0 after immunization,with a peak onset on day 1 9.Systematic arthritis symptoms included front and hind paw swelling and redness (swelling was more apparent in the front rather than hind paws),nodule formation and redness on the ears,connective tissue swelling and redness of the nose and evident nodules and redness on the tail.Total score,arthritis index and the paw swelling numbers were enhanced in AA rats. Pathohistology of ankles joints showed hyperplasia, pannus formation,and inflammatory cells infiltration in AA rats.And pathohistology of heart,liver,spleen, kidney and mesenteric lymph nodes showed inflamma-tory changes.Compared with normal group,there was no change in the percentage of total,memory and no-sensitizated CD4 +T cell in the early stage inflammation but they were significantly enhanced in the peak of in-flammation.Th1 7 cell subsets were significantly en-hanced in both of the early and peak of inflammation. Conclusion These findings suggest that abnormal T cell responses and tissue histopathological changes are important features of AA rats.
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OBJECTIVE: To investigate the effect of berberine in different stages of diabetic nephropathy rat model.
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Introducción: los pacientes con artritis reumatoide pueden tener afectado su bienestar psicológico. Objetivos: evaluar el bienestar psicológico de pacientes con artritis reumatoide y conocer variables asociadas a su deterioro. Métodos: se realizó un estudio observacional descriptivo, de corte transversal, que incluyó 180 pacientes de la consulta de protocolo de artritis reumatoide atendidos desde junio de 2006 hasta mayo de 2008. Se obtuvieron datos demográficos, clínicos y de laboratorio. Se evaluó índice de actividad, capacidad funcional y bienestar psicológico y se determinaron las asociaciones existentes entre ellos. Resultados: el bienestar psicológico estuvo más afectado en pacientes mayores de 60 años, sexo femenino y nivel de escolaridad primario; las variables más afectadas fueron la satisfacción sexual y la laboral. El tiempo de evolución mayor de 10 años mostró diferencias en la satisfacción laboral (p=0,027) y la satisfacción sexual (p=0,043). El grado de actividad de la enfermedad y la positividad del factor reumatoide no se asociaron con el bienestar psicológico. La capacidad funcional se correlacionó de forma negativa con casi todas las variables del bienestar psicológico y se asoció significativamente en varios de los aspectos, tanto por la satisfacción como por el componente afectivo y el índice general del bienestar. Conclusiones: el bienestar psicológico en pacientes con artritis reumatoide se encuentra afectado y se asocia de forma significativa con el grado de discapacidad funcional...
Introduction: the patients presenting with rheumatoid arthritis may to be involved its psychological wellbeing. Objectives: to assess the psychological wellbeing of patients presenting with rheumatoid arthritis and to know the variables associated with its deterioration. Methods: a cross-sectional, descriptive and observational study was conducted including 180 patients from the protocol consultation of rheumatoid arthritis seen from June, 2006 to May, 2008. The demographic, clinical and of laboratory data were obtained. The activity, functional ability and psychological wellbeing were assessed determining the associations among them. Results: the psychological wellbeing was more involved in patients aged over 60, the female sex and the primary schooling level, the more involved variables were the sexual satisfaction and the working one. The greatest course time above 10 years showed differences in working satisfaction (p=0,027) and the sexual one (p=0,043). The disease activity degree and the positive rheumatoid factor were not associated with the psychological wellbeing. The functional ability was negatively correlated with almost all variables of psychological wellbeing and was significantly associated in some features, as much as the satisfaction as the emotional component and the general rate of wellbeing. Conclusions: the psychological wellbeing in patients presenting with rheumatoid arthritis is involved and it is significantly associated with the functional inability degree...
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Humans , Arthritis, Rheumatoid/psychology , Quality of Life/psychology , Epidemiology, Descriptive , Cross-Sectional Studies/methodsABSTRACT
ObjectiveTo investigate the impact of different origination site of lactation acute mammitis on it' s disease course.MethodsTo retrospectively analyze the clinical data of 63 patients with lactation acute mammitis.All patients were divided into two groups according to the origination site of lactation acute mammitis,inclding the central part of mastitis group (25 cases) and the peripheral mastitis group (38 cases).The healing time of both groups was compared.ResultsThe healing time of the central part of mastitis group was ( 9.0 ± 2.1 ) d on average,and the healing time of the other group was (5.0 ± 1.3 ) d on average ( t =0.387,P ＜ 0.05 ).The difference of healing time of both groups had statistical significance,patients with cerebral hemorrhage seemd to have longer healing time.ConclusionIt seemd like that the disease course of origination site of lactation acute mammitis have some relationship with origination site,patients with cerebral hemorrhage seemd to have longer healing time.
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OBJECTIVE: To assess the disease course and prognostic factors in juvenile idiopathic arthritis (JIA). METHODS: We performed a retrospective study of 136 patients between 1990 and 2000. Patients were classified with respect to the International League of Associations for Rheumatology (ILAR) criteria and prognostic factors were evaluated according to the different subtypes. Poor outcome measures were persistent disease, joint destruction and physical disability. RESULTS: There were 73 males and 63 females and the mean follow up period was 5 years (range 2~25). Predictors of persistent disease in the systemic onset type were polyarticular involvement, symmetric arthritis, and the presence of active systemic disease at 6 months. A poor outcome in the oligoarticular onset type correlated with polyarticular extension, joint erosion, chronic arthritis (duration>6 months), relapse, high antinuclear antibody (ANA) titers (>1:160), persistently high erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Polyarticular extension was associated with chronic arthritis, involvement of small joints at disease onset, and positive HLA-B27. Predictors of persistent disease in the polyarticular type were chronic arthritis, relapse, and the presence of anemia at disease onset. The risk of joint destruction correlated with sex (female>male), polyarticular involvement, polyarticular extension, chronic arthritis, persistently high ESR or CRP, high ANA titers (>1:160), relapse, and positive rheumatoid factor. CONCLUSION: Factors predictive of severity in JIA were identified and prognosis was related more to the disease course than the onset type of JIA. So early diagnosis and more aggressive treatment of patients with poor prognostic features could improve functional outcome.
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Female , Humans , Male , Anemia , Antibodies, Antinuclear , Arthritis , Arthritis, Juvenile , Blood Sedimentation , C-Reactive Protein , Early Diagnosis , Follow-Up Studies , HLA-B27 Antigen , Joint Diseases , Joints , Outcome Assessment, Health Care , Prognosis , Recurrence , Retrospective Studies , Rheumatoid Factor , RheumatologyABSTRACT
Objective In order to investigate the relationship between EB virus superinfection and HBV or HCV persistent .Methods 16 cases of EBV with superinfected HBV or HCV as experimental group and 16 HBV or HCV infected patients without EBV infection with the similar clinical symptoms and blood test results,as control group,both were followed up for one year. Results The disease course of experimental group was longer than the control group(203 19?168 29 days vs 64 63?56 62 days,(P