Research advances in primary biliary cholangitis with dyslipidemia / 临床肝胆病杂志

Primary biliary cholangitis （PBC） is an autoimmune liver disease characterized by progressive and non-purulent inflammation of small- and medium-sized bile ducts in the liver. Recent studies have shown that abnormal lipid metabolism is relatively common in patients with PBC， and 76% of PBC patients have dyslipidemia. The effects and harms of dyslipidemia have attracted much attention. Lipid metabolism disorders play an important role in the progression of PBC. This article mainly reviews the research advances in the manifestation， role， diagnosis， and treatment of lipid metabolism disorders in PBC， so as to provide new ideas for the treatment of PBC.

Mechanism of action of macrophage efferocytosis in acute and chronic liver diseases and related targeted therapy / 临床肝胆病杂志

Efferocytosis refers to the process by which apoptotic cells are engulfed and cleared by phagocytes， including professional phagocytes， such as macrophages and dendritic cells， and non-professional phagocytes， such as epithelial cells. Liver macrophages are the main cells with the function of efferocytosis in the liver. In recent years， an increasing number of studies have shown that various acute and chronic liver diseases are associated with the efferocytosis function of liver macrophages， including acute liver injury， alcoholic liver disease， nonalcoholic fatty liver disease， autoimmune liver disease， liver fibrosis， and liver cancer. This article elaborates on the expression of molecules associated with the efferocytosis function of macrophages， the process of efferocytosis， and the role of efferocytosis function in different liver diseases， so as to provide new ideas for the treatment of liver diseases.

The value of neutrophil CD64 index in the diagnosis of patients with sepsis in intensive care unit / 中华危重病急救医学

Objective:To investigate the diagnostic value of neutrophil CD64 index in sepsis patients in intensive care unit (ICU).Methods:A prospective case-control study was conducted, the patients admitted to ICU of Jiangbei People's Hospital Affiliated to Nantong University from December 2016 to June 2020 were enrolled. According to the criteria of Sepsis 3, 107 patients diagnosed with sepsis were classified as the sepsis group, 112 patients without infection were classified as control group. Peripheral venous blood samples were collected within 24 hours after ICU admission, neutrophil CD64 index, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC) were detected. Receiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic value of neutrophil CD64 index, CRP, PCT and WBC for sepsis.Results:The neutrophil CD64 index, CRP and PCT in sepsis group were significantly higher than those in control group [neutrophil CD64 index: 9.03±5.59 vs. 3.18±1.50, CRP (mg/L): 146.9±68.3 vs. 46.5±35.8, PCT (ng/L): 31.82±14.71 vs. 1.87±1.42, all P < 0.05]. ROC curve analysis showed that neutrophil CD64 index, CRP and PCT had certain diagnostic value for sepsis, the area under ROC curve (AUC) were 0.924, 0.915 and 0.879, respectively, the 95% confidence intervals (95% CI) were 0.871-0.978, 0.855-0.975, 0.807-0.951, respectively, P values were 0.016, 0.017 and 0.026, respectively. Among the three indicators, the diagnostic value of neutrophil CD64 index was much higher. When the optimal cut-off value was 4.32, the sensitivity and specificity were 83.6% and 88.7%, respectively, which were higher than the sensitivity (75.1%, 76.3%) and specificity (87.2%, 82.5%) of CRP and PCT. Conclusion:Neutrophil CD64 index is a valuable biomarker for the diagnosis of sepsis in ICU.

Prevalence of vitamin D deficiency in girls with idiopathic central precocious puberty / 医学前沿

The relationship between vitamin D deficiency and idiopathic central precocious puberty (ICPP) has been recently documented. In this study, 280 girls diagnosed with ICPP and 188 normal puberty control girls of similar ages were enrolled and retrospectively studied. The ICPP group had significantly lower serum 25-hydroxyvitamin D (25[OH]D) levels than the control group. Furthermore, a nonlinear relationship was found between serum 25[OH]D and ICPP, and a cut-off point for serum 25[OH]D was found at 31.8 ng/ml for ICPP with and without adjusting the different confounding factors. Girls with serum 25[OH]D ≥ 31.8 ng/ml had a lower odds ratio (unadjusted: OR 0.36, 95% CI 0.15 to 0.83, P < 0.05; height and weight adjusted: OR 0.44, 95% CI 0.18 to 1.08, P = 0.072; BMI adjusted: OR 0.36, 95% CI 0.16 to 0.84, P < 0.05). The ICPP subjects with 25[OH]D deficiency had a higher body mass index (BMI) than the subjects from the two other subgroups. Correlation analysis showed that vitamin D level is correlated with BMI and some metabolic parameters in the ICPP group. Our study suggested that vitamin D status may be associated with ICPP risk and may have a threshold effect on ICPP.

Predictive study on recurrence of chronic sinusitis with nasal polyps by tissue eosinophils and sinus CT / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the correlation between postoperative recurrence and clinical parameters in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and to study predicitve value of total scores of eosinophils (EOS) and sinus CT for postoperative recurrence.@*Methods@#A retrospective analysis of 264 patients with CRSwNP who were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2015 was performed. The patient was subjected to a visual analogue scale (VAS) score, a skin prick test, a peripheral blood cell count, a sinus CT score, and a nasal polyp EOS count. All patients underwent endoscopic surgery and were followed up for at least 2 years. The demographic characteristics of the nasal polyps recurrence group and the non-recurrence group were compared with other clinical indicators. Quantitative data were compared by t test or Mann-Whitney U test, qualitative data were compared by chi-square test, and Logistic regression analysis was used for Logistic regression analysis. The risk factors for recurrence were assessed. The best cut-off value was determined by using the receiver operating characteristic (ROC) curve. The predictive value of the parameters was determined by area under curve (AUC). The difference was statistically significant at P<0.05.@*Results@#The recurrence rate of the study patients was 43.56% (115/264). Sex, olfactory VAS score, total sinus CT score, peripheral blood neutrophil ratio, peripheral blood EOS absolute value and proportion, and tissue EOS absolute value and proportion were associated with postoperative recurrence of nasal polyps (χ2=5.241, t=-3.146, t=-7.441, χ2=180.617, t=-5.313, χ2=100.067, t=-7.471, χ2=258.916, all P<0.05), and the tissue EOS ratio and total sinus CT scores have higher predictive value for recurrence of nasal polyps (AUC values were 0.793, 0.767, respectively, all P<0.001). With the EOS ratio of nasal polyps >0.032, the sensitivity of predicting recurrence was 83.48%, the specificity was 56.38%. With the total score of sinus CT>15, the sensitivity of predicting recurrence was 51.30% and the specificity was 87.25%. The combined sensitivity of predictive recurrence was 92.00% and the specificity was 49.20%.@*Conclusion@#The percentage of EOS in nasal polyps and the total score of sinus CT in patients with CRSwNP have better predictive diagnostic value for recurrence of nasal polyps.

Effect of budesonide and salbutamol on serum IL-6 and TNF- levels in bronchopneumonia / 中国生化药物杂志

Objective To explore the therapeutic effect of budesonide combined with salbutamol on serum interleukin (IL-6) and tumor necrosis factorα (TNF-α) in treatment of bronchial pneumonia. Methods A total of 110 cases of bronchial pneumonia patients were randomly divided into the study group and the normal group, with 55 cases in each group, the two groups were given oxygen, anti-inflammatory and symptomatic treatment, the study group received budesonide combined with salbutamol treatment, the curative effect and changes of serum IL-6, TNF-alpha levels were compared between two groups. Results The disappeared time of cough, fever, shortness of breath,rhonchi and moist rales, hospitalization time in study group were significantly shorter than the conventional group, the difference was statistically significant (P<0.05). After 5 days' treatment, the serum IL-6, TNF-α in study group were lower than normal group(P<0.05), the PaO2, SaO2 in study group were higher than normal group (P<0.05). The efficacy in study group was higher than normal group (P<0.05). Conclusion Budesonide combined with salbutamol in treatment of bronchial pneumonia patients could improve clinical symptoms and anti-inflammatory effect, so as to shorten the treatment time and improve the clinical effect.

Evaluation of efficacy of 1 year after completing the 2-year specific sublingual immunotherapy treatment course in allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the efficacy of treatment at 1 year after completing the 2-year specific sublingual immunotherapy in patients with allergic rhinitis (AR).@*Methods@#A retrospective analysis of 124 patients with AR who were allergic to dust mite and treated in the First Affiliated Hospital of Wenzhou Medical University since 2012 was performed. All patients achieved sublingual immunotherapy (SLIT) for 2 years and had a regular follow-up over 1 year. Efficacy evaluation index such as VAS score, total nasal symptom score and total medication score were compared between the time of SLIT for 2 years, and 1 year after termination of SLIT. Paired t test was used for the comparison of scores.@*Results@#Compared with those before treatment, the VAS score, total nasal symptom score and total medication score at the time of SLIT for 2 years were significantly decreased in all patients with AR [(9.40±5.96) vs (24.78±6.36), (4.53±2.06) vs (9.51±2.02), (0.42±0.87) vs (3.02±0.41), t value was 17.627, 24.600, 5.331, respectively, all P<0.01]. Compared with 2 years SLIT treatment, VAS score and total nasal symptom score were significantly increased than 1 year after termination of immunotherapy [(12.52±6.92) vs (9.40±5.96), (5.30±2.36) vs (4.53±2.06), t=5.199, 3.744, respectively, all P<0.01], but the total medication score showed no significant difference [(0.34±0.84) vs (0.42±0.87), t=-1.043, P>0.05].@*Conclusions@#The symptoms after 2 years SLIT in patients with AR have been well controlled. One year after the termination of SLIT, there is a certain rebound in symptoms, 2 years SLIT may not be the ideal treatment cycle for AR.

Study on the correlation of eosinophils and sinus CT findings in histology of chronic rhinosinusitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the correlation between eosinophils(Eos) and CT findings in patients with chronic rhinosinusitis(CRS).METHODS The clinical data of 355 CRS patients who were treated at the First Affiliated Hospital of Wenzhou Medical University from January 2013 to June 2015 were studied.Friedman stage and Lund score and pathophysiological Eos count were recorded in all cases.The results were divided into eosinophilic CRS(ECRS) group and non-eosinophilic CRS(non-eosinophilic CRS,NECRS) group.The scores of CT findings of the two groups were compared and analyzed,and the correlation of the results of CT scores and the number of Eos in the tissue were explored.RESULTS There was a significant difference in total CT scores between ECRS and NECRS groups(Z=1.674,P＜0.01),but there was no significant difference in CT scores among T1,T2,T3 and T4 stages(Z=1.011,0.892,0.612,0.80,P＜0.01).And CT scores were positively correlated with Eos counts and percentages in the tissues (correlation coefficients r were 0.216,0.223,P＜0.01).CONCLUSION 1.The difference of Eos in the tissue of the CRS is the cause of different CT manifestations.2.The more Eos count or the percentage,the higher the CT scores of patients with chronic sinusitis,which means the more severe of the CT imaging.

Clinical and prognostic analysis of sepsis caused by Streptococcus agalactiae combined with purulent meningitis in 12 ;neonates / 临床儿科杂志

Objective To investigate the clinical manifestations, treatment and prognosis of sepsis caused by Streptococcus agalactiae combined with purulent meningitis in neonates. Methods Clinical data of 12 neonates with purulent meningitis caused by Streptococcus agalactiae were analyzed retrospectively from January 2012 to May 2015. Results In 12 full term neonates (6 males and 6 females) , there were 4 early onset cases and 8 late onset cases;7 cases of vaginal delivery and 5 cases of cesarean section. All of the mothers had no history of infections, and also no routine screening for group B streptococcus. The serum levels of procalcitonin were elevated in all neonates. Brain magnetic resonance imaging results indicated abnormal meningeal enhancement, subdural effusion in 5 cases and brain parenchyma involvement in 3 cases. One case was treated with penicillin only. One case was treated with meropenem ifrst and then penicillin only with good efifcacy. Most of the neonates need drug combination therapy. During 20?~?29 months of following-up, one case had language development delays, 2 cases had motor retardation, and the other 9 cases had a normal development. Conclusions The neonates with sepsis caused by Streptococcus agalactiae combined with purulent meningitis are critically ill. It is imperative to apply sensitive antibiotics in time or drug combination therapy when necessary. It is proposed to improve the prenatal screening.

Impact of lactose-free hydrolyzed protein formula on feeding intolerance and weight gain in very low birth weight infants / 中国新生儿科杂志

Objective To study whether a lactose-free,hydrolyzed protein formula would ameliorate feeding intolerance and weight gain in very low birth weight infants.Methods The study was conducted on very low birth weight infants ( gestational age ≤34 weeks, birth weight ≤1500 g) in our NICU from August 2010 to August 2013. According to the number of admission, the cases were assigned into lactose-free hydrolyzed protein formula group ( hydrolyzed protein group) and preterm formula group. The data of basic information ( gestational age, birth weight, way of labor, sex, asphyxia ), commencement of feeding time ( days) , enteral caloric intake, parenteral nutrition caloric intake, The time ( days) required to regain birth weight, weight gain index, days of parenteral nutrition, prealbumin level, feeding intolerance, the incidence of necrotizing enterocolitis ( NEC ) and extrauterine growth retardation(EUGR)werecollected.Results A total of 83 infants were recruited in the study. 40 infants were in hydrolyzed protein group and 43 infants were in preterm formula group. There were no differences between groups for basic information ( P>0. 05). The weight gain index of hydrolyzed protein group was higher than that of preterm formula group (13. 5 ± 2. 4 g/d vs. 11. 9 ± 3. 7 g/d, P=0. 036). There were less cases of feeding intolerance in hydrolyzed protein group than in preterm formula group & nbsp;(28/40 vs. 38/43, P=0. 038). The differences of the incidence of NEC (1/40 vs. 2/43) and EUGR (21/40vs.25/43)showed no significance statistically.Conclusions Lactose-free hydrolyzed protein formula can obviously improve feeding intolerance and early weight gain of premature infants.